March 17, 2014

Lessons from Health Care

I’ve written about some parallels between education and health care in the past, focusing in particular on the similarities between the shortcomings of research into outcomes in both fields. Other parallels exist as well, particularly in the ways in which licensing of doctors and teachers occurs at a state level.

Remote Medicine Tests Physician Licensing Rules explores these licensing issues and demonstrates the ways that state-based rules and roles, while well-meaning, are outdated and holding back medicine for some patients—including those who, in disruptive technology terms, would be called “non-consumers.”

Excerpts from the article point out some of the similarities:

About 10 million people already rely on telemedicine, often from doctors who live in another state. As a result, more physicians are applying for medical licenses in multiple states – a costly and time-consuming proposition for some.

We are not aware of any published numbers showing how many teachers are teaching (or hoping to teach) across state lines. We have heard repeatedly, however, from national providers in the private, public, and nonprofit sectors that the need to have teachers licensed in multiple states is a challenge. Similar to the situation with doctors, the situation is time-consuming and costly.

The push-and-pull of state policy in medicine also mimics education policy in the ways that some states are embracing some aspects of online and blended learning policy, but leaving in place some other regulations that hinder more rapid adoption. Those states are driving with a foot pushing on the gas and another on the brake at the same time.

Many states are embracing telemedicine by encouraging it in their Medicaid programs and requiring private insurers to pay for it. But they have made little progress in removing medical licensing barriers that proponents of the technology say have kept doctors and hospitals from expanding even more.

Why does state-based licensing persist? The arguments appear to have some merit at first glance:

States have argued that easing licensing requirements could jeopardize patient safety. If doctors practice in a state without obtaining a license there, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. Also, these doctors would not benefit from any legal protections the state may have against malpractice lawsuits.

The response from those trying to expand patients’ access to doctors, however, addresses those concerns and mirrors some of the debates that we see in education.

Proponents of telemedicine argue that since doctors take standardized national exams and most requirements are set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. They say state medical boards are simply trying to shield doctors from out-of-state competition and preserve state revenues from licensing fees.

This is similar to state requirements around not only teacher licensing but content standards as well, and is among the reasons that the adoption of the Common Core State Standards is so important.

Even the ways in which national for-profit companies are involved in health care and the national licensing issue echoes online learning:

Now, under pressure from major telecommunications and health care firms that want to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. Patients would have greater protection than exists now, because states that join the compact would share data on any ongoing investigations of licensed doctors.

Finally, there is a similarity to online learning and blended learning in that at times telemedicine supplements the work of onsite doctors, but in other cases telemedicine is patients’ main option.

Telemedicine was once the purview of small town doctors who needed to consult with specialists available only in larger urban areas. Today…For some consumers, it is the primary way they receive medical care.

The article is worth a review by anyone focused on education policy, as education can certainly learn from other fields that are grappling with some related issues.

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