How COVID-19 Emergency Practitioner Licensure Impacted Access to Care: Perceptions of Local and National Stakeholders

Ann M. Nguyen, PhD, MPH; Jennifer J. Farnham, MS; Jeanne M. Ferrante, MD, MPH

Publication Date: 02/01/2023

The COVID-19 public health emergency required US states to respond rapidly on regulatory issues, including the process for licensing healthcare practitioners. At least 45 states enacted some form of a licensure waiver, enabling practitioners to temporarily work across state lines. We conducted 22 interviews with national and local (New Jersey) licensure stakeholders in September and October 2021 to capture perceptions of how emergency licensure impacted access to care. Five themes emerged: (1) Emergency licensing helped shift the nation’s healthcare workforce supply into regions and specialties of high need; (2) Expanded telehealth capacities complemented emergency licensure programs; (3) Concerns about care quality were mitigated by the urgency of the pandemic, credentialing processes, and investigative authorities; (4) Relocation packages and the need to replace staff could lead to higher costs of care; and (5) Views on licensure reciprocity and interstate compacts were favorable, but smaller provider organizations need to be protected. Overall, stakeholders perceived emergency licensure as successful in expanding access to care during the pandemic. Findings suggest that stakeholders view interstate licensure compacts more favorably now than pre-COVID. While stakeholders may be in favor of licensure reciprocity, they raised concerns about its feasibility, cost, and quality.

The COVID-19 public health emergency required US states to respond rapidly on multiple regulatory issues, including the process for licensing healthcare practitioners to address health personnel shortages during the crisis. The temporary suspension of licensing requirements has long been a strategy for responding to public health emergencies.1  During the COVID-19 pandemic, at least 45 states activated emergency-response licensure laws—some using existing statutes and others passing new laws2 —which enabled healthcare practitioners to temporarily work across state lines.3,4 

In general, healthcare practitioner licensing is important, as it ensures that a practitioner has the required training, knowledge, and experience to perform as a professional in their field. Licensing, which is the formal recognition by a regulatory agency or body that an individual has met designated requirements,5  is rooted in the tenth amendment of the Constitution (ie, reserving rights to states),6  meaning that licensing is conducted at the state level. Licensure serves as revenue for state governments and professional licensing boards and, in some instances, may also be used to mitigate professional competition across state lines.

Currently, most states only allow practitioners to treat patients within the state in which the practitioner holds their license.5 Obtaining a license is a lengthy process, however, as licensure requirements and processes vary vastly by state and practitioner type. For example, to become a licensed professional counselor, an individual typically needs to complete a 2-year master’s program with direct, supervised clinical hours ranging from 1500 to 4500.7 They may then apply for licensure by taking exams, submitting documentation of coursework and supervised hours, and paying application and licensure fees (initial and renewals)—all of which have different specifications by state. Given the variability in state requirements, becoming licensed in more than one state can be difficult and time consuming. While there are some mechanisms to address professional licensure portability issues,8 they vary in scope, adoption, and implementation across states,9 posing challenges for the provision of health care not only during the pandemic but also non-pandemic times.

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