Lansing gridlock jeopardizes licenses for 8K Michigan doctors

The Interstate Medical Licensure Compact allows 8,000 Michigan doctors to practice across state lines
It’s set to expire March 28. Legislation to renew it has stalled
Without the compact, patients may lose their doctors — at least temporarily, if not permanently. Patients throughout the state can expect longer wait times, doctors warn

Dr. Dorothy Nelder’s ability to see her 440 patients in northwest Michigan after this month depends largely on what happens in the coming days — 200 miles away at the state’s capitol.

She and other doctors are on edge as the deadline approaches for the state to renew its participation in the Interstate Medical Licensure Compact — an agreement that allows doctors to practice medicine across state lines.

If Michigan allows its membership to lapse March 28, Nelder is one of an estimated 8,000 Michigan doctors whose licenses will lapse.

If Nelder or other doctors practice with a lapsed license — meaning it’s technically no longer active, they could be subject to disciplinary action, Marschall Smith, executive director of the Denver-based Interstate Medical Licensure Compact Commission, told Bridge Michigan.

“Through no fault of my own, in three weeks I may not have a license to practice medicine,” said Nelder, who holds a Georgia license but practices family medicine at East Jordan Family Health Center that serves Antrim and Charlevoix counties.

Meanwhile, members of both political parties are blaming the other for the impasse.

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Indeed, there seems little, if any, opposition tothe compact, nor the doctors it covers, nor Michigan’s membership in it.

Two Republican-sponsored bills — one in each legislative chamber — would renew the compact, and both passed from their chambers with overwhelming bipartisan support.

Last year, Republican Sen. Roger Hauck, of Mount Pleasant, introduced Senate Bill 303, and Senate members approved it 36-1, sending it to the House within a week. It has been in the House Rules committee, chaired by Republican Rep. Bill Schuette of Midland, since June.

This year, Republican Rylee Linting of Wyandotte introduced a similar bill, House Bill 5455, in January, and House members voted 102-2, sending it to the Senate within a month. It was moved to the Government Operations committee, chaired by Democrat Senator Winnie Brinks, where it awaits a hearing.

Through their staff, both Linting and Schuette blamed Democrats for stalling legislation. A spokesperson for Democrat Brinks, Rosie Jones, said the legislation is “very important,” but countered that it’s Republicans that have “sat on it for so long.”

If Michigan fails to renew the agreement, it would be the first state to do so, said Smith, in Colorado.

The uncertainty is “not a small bureaucratic inconvenience,” Dr. Emily Hurst, an critical care medicine physician, at Henry Ford Health. Hurst, the past president of the Michigan Osteopathic Association, and others last week called on state leaders to move the legislation.

Hurst’s own licenses to practice in Michigan and elsewhere pre-date the compact, she said. But for thousands of her colleagues, “if they don’t have a license, they cannot practice,” she said.

And on March 29, “those appointments don’t happen” unless the compact is renewed, she said.

Of the 8,000 doctors whose licenses are approved by the compact, 5,000 are out-of-state doctors who see Michigan patients, either in-person or by telehealth. The remaining 3,000 are Michigan doctors who see patients in other states, said Smith, the executive director.

In Nelder’s case, she returned to Michigan, her home state, last year to be closer to family. A long-time doctor in Georgia, she was able to quickly begin practicing in rural East Jordan because of the compact.

The compact covers primary care and specialists, and doctors in both rural and urban areas.

The compact gives hospitals, for example, access to “high-demand specialties such as emergency medicine, psychiatry, obstetrics and primary care,” according to the Michigan Health & Hospital Association.

“Specifically, psychiatry is going to be significantly impacted here, and we’re gonna have a critical loss of coverage in mental health here in the Detroit Medical Center,” Dr. John Haapaniemi, a Detroit-area pulmonologist, said during the press call Thursday.

Before Nelder arrived in East Jordan, the clinic at times contracted with a doctor in Florida, who would fly into Kinross in the Upper Peninsula, then travel more than 90 minutes to the clinic to practice for a week or so at a time, said Chris Wilhelm, chief operating officer.

Dr. Dorothy Nelder has 440 patients, with oversight into the care of 1,000 more. But her ability to practice medicine in Michigan ends March 29 without legislation to continue an interstate compact that allows the former Georgia doctor — and thousands of other Michigan doctors — to practice here. (Courtesy of East Jordan Family Health Center)

These days, Nelder sees 440 active patients. Additionally, she oversees the care by a physician assistant and nurse practitioner who together see another 1,000 patients, according to the clinic.

Nelder said realized the compact hadn’t been renewed when she was on the compact’s webpage last month. She began the process of applying for a Michigan license through traditional routes “the very same day,” she said.

But the traditional process of applying for a Michigan medical license can take months.

The first step is fingerprinting — something she’d expect to take just a few days, Nelder said.

Two weeks after she was fingerprinted, she said, she still doesn’t have confirmation that they’ve been processed so that she can move to the next step.

“I’ve been checking and … nothing,” she said.

That the compact has stalled is as frustrating as it is baffling, she and others told Bridge.

Earlier in the day, Nelder had seen patients from 2 to 79 years old. Her weekly slate is full of patients trying to manage diabetes, high cholesterol, heart disease, respiratory sickness, and mental health challenges.

“There’s a physician shortage, and having more doctors is a good thing,” Nelder said. “I guess I am not sure why they can’t agree on it” in Lansing.

Hurst echoed the frustration: “It’s insane that it’s gotten to this point.”

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