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considered for the last 15 years that I’m aware of.” But with recent advances in tele- medicine, there has been a renewed interest in licensing doctors in other states, he says. The practice is espe- cially common among radiologists, who can provide excellent ser- vices from remote lo- cations, including oth- er countries, he notes. “Most radiologists

don’t go to the hospi- tal as much anymore,” he said. According to SB 190,

ally taking place? He agrees a physi- cian should adhere to the standards of medical care in the state in which the patient resides. For example, if an out-of-state phy-

The Texas Medical Board

receives 50 to 60 applications for out-of-state telemedicine

the compact would adopt the prevail- ing standard that the practice of medicine occurs where the patient is located at the time of treatment. Dr. Thomas says a common question that arises from telemedi- cine is: Where is the treatment actu-

licenses each year. Source: Texas Medical Board

sician provides telemedicine care that results in a negative outcome for a patient in Texas, that physi- cian is not likely to face repercussions in his or her state of resi- dence; the physician should be licensed in Texas and held to Tex- as’ standards, he says. In April 2014,

FSMB declared that the location of the pa- tient — not that of the

physician — defines the location of treatment. Still, there is no universal policy for telemedicine in the United States; that makes it difficult to pro- vide care to patients across state lines,

says the American Telemedicine As- sociation (ATA). According to ATA’s “State Tele- medicine Gaps Analysis,” published in September 2014, “State-by-state ap- proaches prevent people from receiv- ing critical, often life-saving medical services that may be available to their neighbors living just across the state line. They also create economic trade barriers, restricting access to medi- cal services and artificially protecting markets from competition.” According to the gaps analysis,

available at, only Washington, D.C., Maryland, New York, and Virginia allow licen- sure reciprocity from bordering states. Texas scored a “B” on ATA’s scale

of licensure portability and was one of only 10 states, along with Alabama, Louisiana, Minnesota, Montana, Ne- vada, New Mexico, Ohio, Oregon, and Tennessee, extending a conditional or telemedicine license to out-of-state physicians. No state scored an “A” on the scale. In 2011, ATA adopted policy not-


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ing that all states have similar re- quirements for physician candidates, including taking the U.S. Medical Li- censing Examination, to qualify for licensure, and arguing that individual state requirements are outdated and harmful to the public. State licenses differ only on what

ATA calls “procedural and tangen- tial issues.” To read the policy, visit n

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Kara Nuzback is a reporter for Texas Medicine. You can reach her by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370- 1629; or by email at Amy Lynn Sorrel, associate editor of Texas Medi- cine, contributed to this story.

Legal articles in Texas Medicine are intended to help physicians understand the law by providing legal information on selected topics. These articles are published with the understanding that TMA is not engaged in providing legal advice. This is not a substitute for the advice of an attorney. When dealing with specific legal matters, readers should seek assistance from their attorneys.

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