Viola, T. Carlson, C, Trojian, T, Anderson, J.  Br
J Sports Med doi:10.1136/bjsports-2012-091460
https://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