Porting Professional Privileges Across State Lines

Most professionals are licensed on a state-by-state basis. A license issued in a professional’s home state usually doesn’t entitle her to practice in any other state. Exceptions, though, are starting to emerge. Whether professional licenses should be portable, and the terms of any portability, are significant policy choices for states.

States that make licenses portable usually follow one of two approaches. The first approach, universal licensing, involves a state’s individual decision to recognize a license issued by another state. The second approach, reciprocity, often involves a multistate agreement on licensure.

Universal Licensing

Universal licensing is a relatively new form of license portability. Under this approach, a state individually decides to recognize professional licenses issued by other states. This approach currently applies in nine states: Pennsylvania, New Jersey, Arizona, Montana, Utah, Colorado, Missouri, Iowa and Idaho.

Arizona was the first state to implement universal licensing. Under Arizona’s system, a person who has held an out-of-state professional license in good standing for at least a year can receive a comparable Arizona license. The person still needs to submit an application and pay fees to an Arizona licensing board. In addition, depending on the profession, the person might also need to take an Arizona-specific exam or pass a background check. However, the person can often avoid other requirements, like minimum training hours.

Proponents of universal licensing emphasize its twin aims: reducing burdens on new licensees and crediting licensees’ work experience as evidence of professional competence. Proponents also argue that universal licensing is compatible with protecting the public health and safety. Arizona’s law, for example, continues to require background checks for certain professionals like nurses and behavioral-health counselors. It requires new licensees to have good standing in all states where they are licensed. It also limits licensees to the practice areas in which they were trained and certified in other states.

Critics of universal licensing take a different view of the cost-benefit analysis. They focus on how universal licensing defers to licensing requirements from other states. Under this line of criticism, a licensee who moves to (for example) Pennsylvania from a state with less-stringent licensing requirements poses a greater harm to the public than does a professional who has completed Pennsylvania’s usual licensing requirements.

Although only nine states have adopted broad forms of universal licensing, other states have implemented more limited forms of it:

• Multistate professional exams are, in essence, a limited form of universal licensing. Consider, for example, the relatively new Uniform Bar Examination. The UBE is developed by a national organization, but it is administered by individual states. States grade parts of the exam separately and set their own passing scores. Although the UBE generates a portable test score, each state retains ultimate authority over each licensing decision. Thirty-four states, plus the District of Columbia and the Virgin Islands, now use the UBE.
• Many states, including North Carolina and South Carolina, allow military spouses to practice with an out-of-state license under varying conditions. These policies acknowledge the frequent relocations required of service members and their families.
• Other states recognize out-of-state licenses in emergencies. Most recently, the COVID-19 pandemic has prompted some states, including North Carolina and South Carolina, to adopt temporary waivers of licensing requirements that would normally govern health professionals who move into those states.

Reciprocity Agreements

Reciprocity agreements are a narrower form of license portability. In reciprocity agreements, the licensing boards of certain states make a compact to recognize licenses issued by any other state in the compact.

These compacts take two varying forms. In the first form, the compact itself authorizes the issuance of a license that can be used across the signatory states. In the second form, the compact itself does not authorize licensure; instead, it helps the signatory states exchange information about licensees.

Compacts in the medical profession illustrate these two forms.

First, the Enhanced Nursing Licensure Compact (eNLC) allows certain types of nurses to earn a single license that allows them to practice in every state that belongs to the compact. The requirements for an eNLC license are uniform across the signatory states. Twenty-nine states, including North Carolina and South Carolina, have joined the eNLC.

States that have signed onto the eNLC stress that a multistate license can benefit health care systems that stretch across states, offering those systems a mobile workforce. Proponents also argue that the eNLC promotes higher-quality patient care, improved continuity of care, less bureaucracy, faster disaster response and, thanks to a national database, more-thorough background checks.

In contrast to the eNLC’s “compact as licensor” approach, other compacts function only as information conduits. The Interstate Medical Licensure Compact is one example. The IMLC authorizes signatory states to share information about physicians who apply for licensure in a compact state. Physicians still seek a separate license from each state where they practice, not a multistate license. Even so, the IMLC has the potential to help states issue licenses more quickly because they can gather information on applicants more easily.

Although state-by-state licensing of professionals remains the norm, important exceptions are starting to develop. The Regulated Professions Practice Group at Robinson Bradshaw will keep an eye on these developments. In the meantime, feel free to contact any of us with your questions on regulated professions.