I Got Dumped

Well, it happens to all of us sometime or other - I got dumped. (Don’t worry, mom - the wedding is still on next summer!) My psychiatrist, however, dumped me.  I have been seeing my psychiatrist since high school, though we had the classic on-again-off-again while I was in undergrad during which I tried seeing some other people, none of whom understood me the way that he does. He’s been one of my healthiest, longest standing relationships. He’s there when I call and is always willing to listen to my thoughts, no matter how crazy I feel they are (though he hates the word crazy). And, maybe most importantly, he refills my prescriptions when needed. But after 10+ years, he said it’s not me - and it’s not him. It’s state medical licensing laws. 

I grew up in New York and went to college in Illinois, during which I continued to claim NY as my permanent residence since I returned to my parents’ house for holidays, summers, and trips home every few months through the year. I managed to coordinate my visits with an appointment. During the lower periods of my mental health journey, these in-person visits were supplemented with frequent phone calls and video sessions to check in on how I was adjusting to medication changes. I don’t think it’s hyperbole to say I could not have gotten through this period of my life without him. 

I worked in Illinois for a few years after college and managed to make my schedule of returning to NY for treatment work, knowing that I intended to move back to NY permanently. Towards the end of 2019, I made the move and got myself situated in Manhattan. A few months later, the world was upended with the COVID-19 pandemic. Selfishly, COVID-19 worked out pretty well for me. While I never managed to put roots down in NYC, I was introduced to my fiancé and ended up moving back to Chicago for him in March 2022. Also as a result of COVID-19, emergency orders were issued in various states, including Illinois, relaxing licensing measures to facilitate healthcare services during the pandemic. In other words, I’ve had no trouble receiving care from my psychiatrist over the last two years through phone and video calls. But as of May 2023, the public health emergency has been declared officially over, and despite extensions through July, my psychiatrist is no longer able to provide me with out-of-state care since he does not hold a license to practice in Illinois. 

Medical licensing laws originated to protect patients during a time when medicine in the US was largely unregulated. In the late 19th and early 20th centuries, the Progressive Era ushered in a period of widespread reform in the US, addressing various social and political issues. Medicine during this era was characterized by a lack of standardized education, variable training quality, and a multitude of unregulated practices. The Flexner Report in 1910 prompted a reevaluation of the entire medical system in the pursuit of standardized, science-driven medical education. Consequently, licensing laws saw a significant overhaul including the creation of medical licensing boards that implemented standardized examinations, set minimum competency standards, and ensured that physicians were equipped with the necessary knowledge and skills to practice medicine effectively. 

However, it's evident that state licensing laws are struggling to keep pace with the evolving landscape of healthcare. In an era where technology has made remote healthcare both possible and increasingly normal, these laws are proving to be outdated and counterproductive. The licensing process for healthcare professionals is a tangle of state-specific requirements. Obtaining licenses in multiple states is not only time-consuming but often financially burdensome. Health professionals find themselves mired in a system that impedes their ability to provide seamless, cross-border care to patients who rely on their expertise.

For me, who has formed a relationship over years with my mental health professional, the toll of such bureaucratic hurdles is paralyzing. The thought of having to start “dating” again to find someone with whom I feel comfortable sharing my innermost thoughts is just the first step. After finding “the one”, I’ll have to recount my history, reliving the lows that my current psychiatrist helped me through. Truthfully, this breakup has already affected my mental wellbeing as I navigate several new life transitions (engagement, new puppy, Master’s degree, career change). 

The impact of these outdated laws isn't confined to my brain or my psychiatrist’s office; it reverberates across the entire telehealth landscape. As the demand for remote healthcare grows, the limitations imposed by state licensing laws hinder the full realization of telehealth's potential. Patients and providers alike are left frustrated, caught in a web of regulations that fail to recognize the borderless nature of modern healthcare needs.