I recently read that physicians have come together to pursue pathways for multi-state licensure. The Interstate Medical Licensure Compact will allow physicians to more easily practice across state lines, and while legislation has not been enacted in every state yet legislation has passed in 29 states, the District of Columbia, and Guam.
While reading this, I immediately asked myself - where are we?
I did a quick Google search for 'multi state pharmacist licensure' and only pulled up results about the usual licensure transfer, MPJE, etc. In other words, no mention of interstate pharmacist licenses. I think it's time this changed.
The fact is, it is still a major hassle to keep licenses in multiple states. I've only had up to two state licenses at one time (I've had a total of three but gave one up because I didn't plan on practicing in that state anymore), but I feel for those of you that have many more (the most I've heard of is 5 - can you beat that? Let me know!).
We not only have to keep up with multiple date ranges for the continuing education, but also with individual state mandates about the composition of that CE. Out of the states I'm licensed in, for example, Hawaii is easy - 30 hours of any accredited CE and renew every other December - but Florida also requires 10 hours of live CE, a med errors course, an HIV course with the first licensure, an opioid course, etc.
Multiply a complicated state like that by 2 or 3 and you're in for a real nightmare just keeping up with deadlines and state requirements.
It is also time consuming to to even obtain multiple states licenses, especially for pharmacists also needing to keep up with board certifications or multiple state-specific licenses and registrations.
Florida, for example, also has a consultant pharmacist license with separate requirements and additional CE, and you can't manage an inpatient or LTC pharmacy unless you have it. So it is common here for pharmacists to have a pharmacist license, a consultant pharmacist license (with separate CE requirements), and board certification.
Honestly, how is that much administrative burden even helping to protect the public safety?
In contrast, here are some benefits creating a multi-state licensing program:
Improving healthcare near state lines
A large part of the country lives on a state line (or even multiple state lines - anyone work in the Four Corners area?), and if you do then you will probably need a license in those states to be able to help other stores (or hospitals within the health system), get that new dream job, etc.
From an employer's standpoint, if they are located on a state line (let's say Vancouver, WA, for example) and they need a pharmacist, many of the potential candidates within commuting distance (i.e. Portland, OR) would not even be able to apply because they do not have a license in that state.
I realize that the market is becoming more flooded, but the fact is it is still hard for healthcare systems to recruit and hire experienced pharmacists in certain specialties. I live in a major city and I've heard of a hospital in this area that wants to hire more pharmacists experienced in oncology but cannot find them.
Also, by pharmacists having a barrier to practicing on both sides of the state line, it reduces the exchange of information and ideas, especially for local initiatives to improve the healthcare of the area.
Mail Order, Specialty, and Compounding Pharmacy
I often see job ads from compounding pharmacies that are looking for pharmacists that have licenses in specific states so they can get or keep their pharmacy license in that state and continue doing business. They are basically having to prioritize hiring staff to collect licenses instead of hiring staff based on their expertise.
Why does that improve patient care? I have a Hawaii pharmacist license (I lived there for five years) but I have very little post-graduation experience in non-sterile compounding; should I be the one compounding medications for Hawaii residents?
By needing so many licenses, it not only makes it harder for pharmacists to get into those areas of pharmacy (how many of you have a license in WA, MN, AK, and SC?), it ultimately hurts patient care by artificially deflating the talent pool.
Improving rural health and expanding telemedicine
Telemedicine has taken off recently and shows no signs of stopping. In community pharmacy it takes the form of MTM and in inpatient pharmacy it takes the form of remote order verification (I know, probably among a long list of other things).
Just like with mail order, specialty, and compounding pharmacies, the best pharmacist to practice in that area is not necessarily the pharmacist that can manage to keep 6 or 7 state licenses. Yet there is a high need for more healthcare in rural America, and we can help fill that need now with telemedicine.
In many states, like Wyoming, there aren't any major metropolitan areas, so naturally it is going to be harder to find pharmacists with experience in specific practice areas (any Wyoming-licensed transplant pharmacists out there?).
[By the way, a note to you Wyoming residents - I'm not saying 'no major metropolitan area' as a bad thing, just a fact. I actually prefer it that way....for everyone's viewing pleasure, below is a picture of your state.]
Creating jobs
What else would happen if pharmacists in other states could practice in Wyoming (or any other number of more rural states) with a multi-state license? The unmet demand for healthcare could be easier to meet, and in the process create jobs to take care of people who live in areas with shortages of healthcare providers.
Those jobs might be fully remote, using telemedicine, or remote with some amount of travel. I wonder if, for example, some companies, like PipelineRx, might more easily be able to employ pharmacists to not only use telemedicine to help the daily workload in multiple states but also use those pharmacists as on-site consultants to help with medication safety, informatics, P and T, etc.
Just like practicing across state lines, the ability for pharmacists to practice across multiple states would also promote the exchange of ideas, and I can guarantee some innovative projects would come out of that exchange.
Residency
Most pharmacy students are not accepting, or even applying exclusively to, residency programs because it is located in a state they want to live in permanently. Rather, most people look at the residency program first, including the future potential job opportunities, interest, the quality of the program, the fit, etc., and the state is below those considerations.
Streamlining the process could allow many pharmacists to get their license for both residency and the state(s) they want a job in at the same time, saving them from the headache of taking yet another MPJE when they are nearing the end of residency.
Challenges
There definitely would be challenges, like renewal deadlines, CE requirements, and primarily the challenge of having individual state laws, especially about controls, etc.
However, as a profession we have certainly tackled more challenging problems before, so I feel confident we could address the challenges ahead of us if we pursued this path.
Keywords: Licensing, mail order, specialty, compounding
