Viewpoint: How to Get More Physicians Practicing in Montana

"It is possible to remove the licensing barriers preventing more physicians from practicing in Montana while maintaining high quality health care."

I bet most people are certain that physicians should be licensed, if they think about it at all. For me, a physician in the U.S., I must have a medical license in order to work. For years, I never questioned it. I view occupational licensing as a trade-off and not always a good one. Some people think we shouldn’t have occupational licensing at all and I understand that view. At least licensing shouldn’t make it harder to recruit enough good physicians. 

I got interested in licensing after reading Milton Friedman’s classic “Capitalism and Freedom,”around 2010. Chapter VIII is on monopoly and limitations of free trade. An example was memorable: an expensive medallion was required to operate an independent taxicab and this was sold by local governments. These kinds of restrictions and fees are “arbitrary limitations on the ability of individuals to enter into voluntary exchanges with one another,” raising costs and decreasing access. Chapter IX is on occupational licensure. Economics is a broad and deep field, but when we read the works of a clear-thinking economist and writer such as Milton Friedman, we can then look around us, and observe things with new insights and questions. Our policy ‘solutions,’ such as medical licensing are actually trade-offs and this idea comes from another great economist, Thomas Sowell in “A Conflict of Visions: Ideological Origins of Political Struggles.” 

Montana is a wonderful state in which to practice medicine. WalletHub just ranked it number four out of 51, including Washington D.C. However, Montana is also a very underserved state, with 52 out of 56 counties classified as health professional shortage areas. It is at further risk for a severe physician shortage due to having an older physician workforce. Licensing of qualified physicians should not be an obstacle to expanding the physician workforce, but it is, especially for physicians who may wish to live and practice in Montana part-time.

Medical licensing is done at the state level. I oppose federalizing issues, instead favoring decentralization of power in many areas, with medicine being no exception. Currently, a physician must go through a process with each state to get a medical license, which is expensive and time-consuming. I believe there are more physicians who would like to practice in Montana than currently do, some of whom live elsewhere and visit here. Some have never visited here but would travel to underserved communities, if the obstacles can be made minimal. If Montana could honor the medical licenses from their home states, these physicians could more easily participate in efforts to provide medical care in underserved areas. There are a number of ways to do it, and it does not need to be complicated. We already do this with driver’s licenses, for example.

During the height of the COVID-19 pandemic, medical licensing rules in many states were waived temporarily to facilitate telemedicine. This helped bring medical care to underserved areas. If it was OK to do this during COVID-19, shouldn’t we consider making these waivers permanent? This would be another way to enlarge the effective physician workforce in Montana.

Licensing is promoted to ensure a certain level of competence, although I think it does it poorly. It is also a way of limiting entry to a high-earning occupation. Many other people besides physicians already legally practice medicine under other types of licenses, and their licensing requirements are different. The policy goal should be to decrease obstacles that discourage competent physicians and other medical professionals from practicing in Montana. It is possible to remove the licensing barriers preventing more physicians from practicing in Montana while maintaining high quality health care – we may just find this is a better tradeoff. 

Healthcare Viewpoints is a monthly series featuring original columns from Montana healthcare leaders focused on addressing the challenges presented by our broken healthcare system. The opinions of guest authors do not necessarily represent the policy positions of the Frontier Institute.