Last year, the Missouri Legislature passed a watershed law that established one of the first true interstate license reciprocity reforms in the country. Missouri's law recognizes out-of-state licenses for a host of jobs to make it easier not only for trained professionals to offer services in the state, but to ensure Missourians have a robust supply of workers to meet their needs. Now for most licensed professions, Missouri consumers have practical access to workers who could be licensed (and in good standing) in any of the 50 states, not just Missouri.

It's why I don't quite understand the logic of a handful of proposals being floated in the legislature this year that would adopt "compact" licensing legislation for doctors. A compact is an agreement between and among states that facilitates cooperation on a given issue and is often overseen by a third-party regulatory group. For instance, the Interstate Medical Licensure Compact (IMLC)—launched by the Federation of State Medical Boards to oversee interstate physician licensing—has been adopted in about half the states in the union.

If a state has no license reciprocity statute at all, it might make sense to join a compact. After all, access to two states' resources is greater than access to one, and in the case of the IMLC, about half of the states is certainly greater than one state alone.

But if you've already opened the door to your residents accessing doctors from all FIFTY states, what incentive is there exactly for a state like Missouri to delegate any authority to an association of other states' medical boards?

We touched on the idea of medical compacts in our 2016 paper on health care licensure reform "Demand Supply: Why Licensing Reform Matters to Improving American Health Care," and we noted our concern about reinforcing a licensing system that is overly fixated on protecting the prerogatives of state-based medical boards. As Cato Institute adjunct scholar Shirley Svorny wrote about a similar proposal in Mississippi in 2016:

The [IMLC] compact may seem like a positive step to those who don't have the time to look at it very closely. Surely, respected representatives of physician groups and the Federation of State Medical Boards will encourage Mississippi legislators to adopt the model legislation and join the compact. These groups are overselling the contribution the compact can make to improving access to telemedicine because they do not want federal licensing. (At the same time, the Mississippi State Board of Medical Licensure is seeking to squash private telemedicine providers, thus diminishing health care access even further.) [Emphasis mine]

Therein lies the issue. Compacts like the IMLC market that it makes it easier for doctors to go through the arduous process of licensing in multiple states, but the point of interstate license reciprocity is that it shouldn't be an arduous process to begin with, and barely a "process" at all for doctors already licensed and in good standing in their home states. Throw in the self-interest of the Federation of State Medical Boards of establishing its own national umbrella organization to protect its turf from federal regulation, and you have all the reason in the world to question why Missouri would adopt the IMLC at all.

The future of licensure is fewer licenses, and to the extent a proposal works in the opposite direction and supports the status quo, policymakers and the public should be highly skeptical of whether such proposals are more useful to the public—or whether they're more useful to the interest groups that would control the proposed system.