Skip to main content
Oregon is desperate for more health care workers. Researchers call parts of rural Oregon a “medical desert.” People are dying in short-staffed nursing homes and jails.
So, wonders Rep. Ed Diehl (R-East Salem), why is the state making it so hard for doctors, nurses and other health care professionals to work here?
The source of his frustration: lawmakers’ refusal to join what are known as “interstate licensing compacts.” The details of these arrangements vary, but their shared goal is to make it easier for medical professionals to cross state lines for work.
The idea has gained momentum thanks to the pandemic, which brought telemedicine into the mainstream. Now at least 40 states are members of these physicians and nurses compacts. But not Oregon.
Diehl worries the state is being left behind. “We want to make it easy for good quality people to come to our state and start serving patients and clients on Day 1,” he says. “And that’s what the compacts allow us to do.”
Diehl, who serves on Santiam Hospital’s board of directors, has introduced legislation in recent years for Oregon to join compacts for nurses, social workers and therapists. This year he’s trying again with psychologists, physician associates and dentists. So far, however, he’s made little progress.
Rep. Rob Nosse (D-Portland), who chairs the health care committee in the House, says there are a variety of reasons prior efforts haven’t moved forward.
“The compacts are not set up for real in some cases,” he wrote in a text message to WW. “Or in the case of physicians and nurses, their unions or professional associations hate them.” (That much is certainly true: “Despite 25 years of trying, the compact has failed in its goal to increase access to care,” says Oregon Nurses Association spokesperson Kevin Mealy.)
But Diehl says there’s another opposing lobby: the state’s licensing boards, which he believes fear losing their authority.
Last Monday, Nosse called in the leaders of state’s major health care licensing boards to explain what they thought of the compacts. Here’s a list of the major compacts and what officials had to say about them:
Compact: Interstate Medical Licensure Compact
Member states: 40
Is Oregon one of them? No.
Why not? An Oregon Medical Board spokesperson did not directly answer the question. But leadership has been largely critical. “We have been actively engaged in discussions about the compact, and remain concerned for patient safety,” said the board’s executive director, Nicole Krishnaswami. “When a person is licensed through the compact, we are not able to review their criminal history.”
Compact: Nurse Licensure Compact
Member states: 42
Is Oregon one of them? No.
Why not? The Oregon State Board of Nursing has not taken a position on the issue, its spokesperson tells WW. Still, its director, Rachel Prusak, didn’t have much positive to say about the idea. “While it allows for ease in mobility, it does not increase the workforce,” she told legislators. Plus, joining the compact has a cost. “If we join the compact, we would lose approximately $700,000 in revenues from licensing fees,” she added.
Compact: The Psychology Interjurisdictional Compact and the Counseling Compact
Member states: 42 and 37, respectively
Is Oregon one of them? No.
Why not? Both the Oregon Board of Psychology, which licenses psychologists, and the Oregon Board of Licensed Professional Counselors and Therapists have voted to send the question to legislators. Still, they have reservations. “While interjurisdictional practice compacts are often promoted as a way to increase the number of practitioners in Oregon, it’s important to remember that [the compact] will also allow Oregon [psychologists and counselors] to practice in other states, leaving the overall impact on Oregonians uncertain,” both say on their websites.
Compact: Dentist and Dental Hygienist Compact
Member states: 10
Is Oregon one of them? No.
Why not? “We’re neutral on all these compact issues,” said Stephen Prisby, executive director of the Oregon Board of Dentistry. Still, he provided a seven-page memo outlining a list of potential pitfalls of joining the relatively new compact. One: money. “The OBD relies on licensing fees as the main source of revenue and may experience a reduction of revenue if professionals are allowed to practice across state lines without obtaining separate licenses,” Prisby wrote.
Compact: Social Work Licensure Compact
Member states: 22
Is Oregon one of them? No.
Why not? The most recent proposal had “some constitutional conflicts regarding liability and delegation of authority,” said Raymond Miller, executive director of the Board of Licensed Social Workers. Also, there are safety issues. “The compact reduces competency standards,” he added.
Compact: EMS Compact
Member states: 24
Is Oregon one of them? No.
Why not? The most recent effort to pass legislation adding Oregon to this compact died last year. Karl Koenig, president of the Oregon State Fire Fighters Council, came out against it. “Oregon is a collective bargaining state and has been since 1973, we are not about to have a regulatory body from another state inform us what we are earning,” he testified.
Compact: Physical Therapy Licensure Compact
Member states: 38
Is Oregon one of them? Yes. Oregon was the first state to join in 2016.
Why? The Oregon Board of Physical Therapy trumpets the compact’s benefits on its website: “[It] is intended to increase public access to physical therapy services, to enhance the exchange of licensure, investigatory, and disciplinary information between member states, and to support spouses of relocating military members.” The Oregon chapter of the American Physical Therapy Association also supports it. “We believe it’s been a success,” said manager Geoff Horning.