In the early days of the COVID-19 pandemic, when overwhelmed New Jersey hospitals struggled to find staff to care for desperately ill patients, Gov. Phil Murphy put out a call for medical professionals across the country to help one of the nation’s first COVID hotspots.
More than 31,000 answered the call.
They came from every state. They provided care — in person and via telehealth — to 1.4 million residents of New Jersey. And these medical professionals were as diverse as the state that needed them, able to converse with patients in 36 different languages.
The help from out-of-state doctors, nurses, respiratory therapists and mental health professionals was made possible through a temporary licensure program that waived the usual criminal background checks and licensing fees for licensees in good standing in other states.
A new study by researchers at Rutgers and the New Jersey Division of Consumer Affairs, which licenses professionals, evaluated how it worked.
The “unplanned experiment” offers lessons for public health emergencies to come, said Humayun J. Chaudhry, president and CEO of the Federation of State Medical Boards, in a commentary on the study, which was published this month in the journal Health Affairs.
As the pandemic spread, 45 states ultimately tried similar strategies to expand their pool of health care providers, but this is the first to be analyzed.
“The numbers were remarkable,” said Ann M. Nguyen, the study’s lead author and an assistant research professor at the Rutgers University Center for State Health Policy. “When we saw a person coming from every single state in the entire country because they heard our call for help … it was heart-warming.”
The out-of-state health professionals provided crucial aid during a time of crisis at New Jersey hospitals and helped to meet the growing need for counseling and behavioral health care during the pandemic’s first year, the authors found. The United States lacks a national licensure system for health professions, so each state issues licenses. New Jersey’s experiment showed the importance of states’ “regulatory flexibility” during a public health emergency.
Two main groups used the temporary licenses — the hands-on nurses and respiratory therapists who came to help with hospital care, and the physicians and mental health providers who provided care remotely — on the telephone or via FaceTime or Zoom — for both COVID and non-COVID patients.
Many who answered the call, in fact, never left their home states. They were temporarily licensed in New Jersey but worked from elsewhere to care for New Jersey patients. This was especially true of mental health care providers. And although the program was intended to address the need for COVID care, it also expanded access to non-COVID care.
Here’s who got the temporary licenses:
- Thirty-five percent were nurses and nurse practitioners, 27% were physicians, 26% mental health providers and 2% respiratory therapists.
- They were from every state, but the largest numbers came from New York, Pennsylvania and Delaware, along with Florida and California.
- They conversed with patients in 36 languages.
- They were mostly non-Hispanic white women ages 40 to 59.
- They cared for Medicare and Medicaid patients as well as those who were privately insured.
- About 30% of those who got the licenses didn’t use them.
The use of telehealth was vital to make the program work, especially as the demand for mental health services escalated. Before the pandemic, doctors and other providers needed to have seen a patient at least once in the office before they could bill for telehealth visits.
Pandemic-inspired changes in federal law, however, allowed practitioners to take on new patients through telehealth. As a result, telehealth’s use skyrocketed. From June to October 2020, a national study found, 46% of behavioral health visits were virtual, compared with 0.4% the previous year; 22% of medical visits were virtual in the same period, compared with 0.3% the year before.
The temporary licensure for out-of-state professionals was the largest of several emergency measures adopted in New Jersey to boost the workforce. Retirees who’d left their professional health care employment within the previous five years were enabled to return to work, and nursing students and others within a few months of graduation were placed in non-front-line jobs. Doctors from other countries also had an easier time applying to practice in New Jersey.
Plus, the U.S. military and the National Guard sent staff to the state’s nursing homes and a few hospitals, while other hospitals and health systems paid millions of dollars to travel nurse agencies to fill the gaps.
New Jersey’s program for out-of-state medical providers offers lessons for what to do in future pandemics, the authors said. But there are two caveats.
First, Murphy asked for help when COVID-19 cases were concentrated in New York, New Jersey and Washington state. In a more widespread emergency, medical workers would be needed at home and might not be so able to help elsewhere.
Second, the study didn’t look into the quality of care delivered by the temporary licensees. No information currently is available about whether any were disciplined by regulatory boards for their work in New Jersey. The Division of Consumer Affairs did not respond to a question about whether such actions had been taken.
The out-of-state doctors, nurses and counselors who rode to the rescue were a short-term fix. The program aimed “to help address workforce needs during a dire time,” Nguyen said. “And yes, it did help.”
Now New Jersey and most states face a more intractable long-term shortage of health care professionals, as their ranks have been depleted by resignations and early retirements after the stress of the pandemic.
And as of Aug. 1, only respiratory therapists from other states can get a temporary license. Everyone else has to apply through the normal process.