James K. Rone, MD, FACP, FACE

The Millennial Medical License

August 21, 2016

Tags: Medicine as a profession

I am president of a large multispecialty group, and a “Boomer.” By that I mean, Baby Boomer. Recently the chief executive officer of our group and I and one of our office managers got an email from a young physician who had left us on good terms four months earlier. As far as we are aware, the only motivation behind his departure was his spouse, a surgical specialist, accepting an attractive job offer out of state. In the email, the physician—let’s call him, “Dr. M” for “Millennial”—described receiving a forwarded piece of mail from his old address. It was a bill for $400 from our state tax agency, stating his Professional Privilege Tax was overdue. Dr. M protested that he had expected us to deactivate his license, and requested we pay the tax bill resulting from this “lapse.”

Now, as I’m sure is common in bigger practices, our office managers and other administrative support personnel do routinely handle the physicians’ licensing issues, along with all the other myriad credentialing matters necessary to modern health care. When I arrived fresh from more than a decade in the Air Force 18 years ago, except for providing a few documents and signatures, all the hoop-jumping required to obtain my shiny new state license was indeed accomplished by my new office manager. And ever since, all those annual taxes and every-other-year renewals have been dealt with, virtually without my knowledge, by her, or her successor. Dr. M’s experience was no doubt similar in his 3 years with us. Accordingly, I can understand the nuts and bolts of state licensing—of maintenance as well as divestment—slipping through the cracks of a busy mind, preparing for a big move of both family and career.

I was however struck by the callousness of Dr. M’s thinking about his license once the matter came to the fore. When advised, in so many words, to take the issue up with the state, he replied he had never intended to maintain the license, and again emphasized his expectation that we would have “retired” it upon his departure.

It is Dr. M’s prerogative—no argument—to surrender or inactivate, or whatever, the relevant license assuming he no longer plans to practice medicine here. Be that as it may, it is neither our responsibility, nor within our power, to surrender any physician’s license. This confusion seems stranger still, since Dr. M came to us out of a fellowship program not far away—in other words, already possessing the license in question. Do large academic institutions, with bureaucracies far bigger than ours, apply for and maintain licenses for their trainees? I don’t know. But for whatever reason, it seems Dr. M never took ownership of his state medical license. Perhaps the fault of “helicopter office-managering.”

I took from this exchange, however, deeper concerns, and proposed a hypothetical. What if he loved some picturesque corner of our state and wanted to spend a month there annually doing locum tenens work? Even if the furthest thing from his mind today, what about in a year, or 5 or 10 years in the future? Not a likely scenario, I’ll grant you. My point being, it would be inappropriate for any soon-too-be ex-employer to assume Dr. M did not wish to avail himself of that freedom.

At that point he probably thinks I went a little “survivalistic” on him. What was really nagging me was the disrespect being shown the ethos, the essential nature, of medical licensure. To me, a “license to practice medicine and surgery” framed and mounted on my wall represents my right to ply my skills as a physician unfettered (relatively so) within the stated jurisdiction. It represents, at the basest level, my ability to earn my living in my chosen profession. It is a valuable personal and professional asset. And it is intrinsic to the physician. It represents his or her covenant with the state, with one of the fundamental governing instruments of our social order. It does not belong to an employer, to a hospital, to a clinic: it belongs to the doctor. In my reply to Dr. M I counseled he ought not want any third party having enough power and privilege over him to intervene between him and the agency granting him his right to practice. He believes we erred not unilaterally inactivating his license? Careful what you ask for… I shudder over the ramifications of the opposite error—curtailing a physician’s license without his/her knowledge or consent.

Most assuredly, differing fee schedules from state to state render it more or less practical for licenses to be maintained that are not required in a current practice setting. I don’t know what Dr. M’s financial options were here, and again, keeping or not keeping that license was entirely his affair. Speaking for myself—I have maintained a license in my home state since 1989, even though I haven’t cared for a patient there since medical school. I worked off that license in the military but I haven’t have that need for it in 18 years. To me—the “readiness is all” survivalist in me—it represents insurance. The peace of mind and security of knowing I can move to that other state anytime I need or want to and establish a medical practice without asking anybody’s permission, or waiting for the gears of bureaucracy to slowly mesh before I can start earning a living.

I don’t know if Dr. M’s emailed concern was idiosyncratic or generational or what it was. Perhaps I’m overreacting. Or perhaps this is yet another symptom of our profession devaluing itself—more “cookbooking” and “corporatizing” and “out-sourcing” and “shift-working” of medicine. My clarion call to Dr. M and to all of us: grant the medical license the respect it deserves, consider it a professional asset, a source of personal pride, alongside one’s diplomas and board-certification documents. In other words—more than just a piece of red tape you expect somebody else to cast aside for you.

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