Sports Medicine Research: In the Lab & In the Field: Traveling Team Doctor? You could be “Practicing without a License!” (Sports Med Res)
Friday, November 9, 2012

Traveling Team Doctor? You could be “Practicing without a License!”

A survey of state medical licensing boards: can the travelling team physician practice in your state.

Viola, T. Carlson, C, Trojian, T, Anderson, J.  Br J Sports Med doi:10.1136/bjsports-2012-091460
http://bjsm.bmj.com/content/early/2012/10/03/bjsports-2012-091460.abstract

At the professional and NCAA Division I competition level, it is not uncommon for an out–of-state physician to travel with his or her team.  However, an important medico-legal question has been raised with regard to this scenario: Is this traveling physician practicing medicine in a state without a license? To answer this question, Viola, et al. performed a simple yet well designed survey study with the goal of investigating if state medical licensing boards have legislation in place that exempts traveling team physicians from state licensure requirements when traveling to a non-licensed state provided that they hold an active home-state license.  Fifty four of the 58 medical licensure boards (doctor of medicine [MD] and doctor of osteopathic medicine [DO]) in the United States responded to the survey.  Thirty percent (16 states: AK, CA, CO, CT, DE, IN, IA, KS, MN, MS, NH, NC, UT, VA, WA) have legislative exemptions that allow traveling team physicians to practice medicine with only their home-state license.  State medical boards in Montana and Wyoming reported they would not require licensure and do not have specific legislation for exemption.  Twenty seven states (50% of states surveyed) specifically have laws in place that require an in-state license for the practice of medicine and have no exemptions for the scenario of the traveling team physician. Arizona, Georgia, and Oklahoma responded that despite not having a law exempting traveling team physician from licensure, they do not allow traveling team physicians to practice in their states, but they recognize that it happens without their involvement.  For the second part of the study, a survey was sent to 20 medical malpractice carriers asking if they include coverage for physicians traveling with a team and practicing in a state without holding a license in that state. Eleven (11) companies responded and only 2 provide policies that cover the entire United States, hence covering team physicians traveling to provide care for their team(s). One company offers a policy that will cover a team physician traveling anywhere in the world as long as written approval was provided by the appropriate government agencies. The remaining 5 companies that responded would only provide coverage if the team physician had a license in the state to which he or she was traveling.

This article highlights a particularly important medico-legal aspect of sports medicine that often is overlooked.  With new and proposed legislation in states across the country involving issues like mandatory reporting of sports-associated sudden cardiac death, concussion management, and monitoring of athlete drug use, it is important for the sports medicine community to be aware of potential legal issues that could arise while providing care for athletes.  With only 30% of states providing protective legislation for a traveling physician, the potential for a major liability suit involving an out-of-state physician is an issue that could change the scope of practice for many sports medicine physicians.  Additionally, the fact that many malpractice insurance carriers will not provide coverage for a traveling team physician, even if that physician is traveling to one of 18 states that have legislative exemptions in place, is certainly noteworthy. The Policy and Practice Committee of the American Medical Society for Sports Medicine is currently working on a federal legislative resolution to this problem.  Do you travel with your team as a covering physician to other states in which you do not hold a license? Do the results of this article make you think twice about traveling with your team? Do you think athletic trainers are also at risk for licensure issues by traveling with their teams?

Written By: Stephen Stache, MD and Marc I. Harwood, MD
Reviewed by:  Stephen Thomas


Viola T, Carlson C, Trojian TH, & Anderson J (2012). A survey of state medical licensing boards: can the travelling team physician practice in your state? British Journal of Sports Medicine PMID: 23038784

2 comments:

Brian Sabb said...

Hi,

This article raises serious implications for team doctors traveling in the US. International travel is addressed in regards to malpractice insurance but I did not see the legality of international medicine addressed. I imagine the legality of practicing abroad could be also be an issue.

Thanks,

Brian Sabb
www.linkedin.com/in/briansabb

Stephen Stache said...

Brian,

Thank you for your comment, which brings up another appropriate concern. In the international setting, for major sporting events, international governing bodies, such as the IOC for the recently Olympic Games in London, generally mediate a registration process so traveling team physicians can temporarily practice (see page 8: http://cmedica.coe.es/WEB/EVENTOSHOME.nsf/b8c1dabf8b650783c1256d560051ba4f/43e0200dfab4631bc12571410039ed90/$FILE/London%202012%20Olympic%20Games%20Healthcare%20Guide%20-%20December%202011.pdf) in the country to which they are traveling. Most often however, the average scenario of the traveling physician is not a major international sporting event such as the Olympics.
A similar survey study could certainly be done on an international level to help understand the legislation in other countries. However, based on the results within the states of the U.S., I feel it would be in the best interest of physician who are asked to provide coverage in another country without an overseeing governing body such as the IOC to do their research and think twice before committing.

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