By Gabriela Nostro, Esq.
Guest Blogger
This article is my fifth in a series on the obstacles facing military spouses with professional licenses. This time, I’m focusing on medical professionals, specifically doctors and nurses. While it’s impossible to cover all the details for every specialty within those professions, I’ll provide general thoughts and plenty of external resources so you may continue your own research.
I had a much more difficult time finding doctors and nurses than I have other professions thus far in this series. I quickly realized that difficulty was actually at the heart of this piece. Doctors and nurses who are military spouses do not have the same professional networking groups and active communities that I have seen in the other professions I’ve covered. They are significantly more alone in their journey than other professionals. So while this piece will include the same licensing discussion and resource references as some of the others, perhaps the theme of this piece was fated all along… a rallying cry.
General Licensing
With both physicians and nurses, transferring a state license can take anywhere from 3-6 months and requirements like fingerprinting can make it difficult to clear those burdensome hurdles if you’re overseas. Even domestically, the COVID-19 pandemic highlighted the incredibly detrimental effect stringent licensing restrictions can have when capable and available medical professionals are unable to fill hospital staffing shortages due to licensure wait times.
Military spouse nurses should make sure to familiarize themselves with the Nurse Licensure Compact (NLC) and the specific conditions and allowances attached to it. Although I learned it can be of great help, one military spouse ER nurse I spoke with explained: “Virginia wouldn’t grant me a compact (multi-state) license because I am not truly a resident of Virginia, which was a requirement. So it seems that I can get a single-state license down there, but can’t hold both! Maybe there are circumstances in which the compact license does help but in my situation I’m struggling to see how it is beneficial. The one time I thought I understood and used it correctly I nearly, unknowingly, exceeded my grace period to transfer states.” For nurses specifically, these complexities in the rules make it worthwhile to learn whether the state you are applying in participates in Nursys, a nurse license verification system. This could quickly expedite the process for transfer to eligible states.
One thing that really struck me as unique to both physicians and nurses is that this isn’t just a one-shot licensing obstacle. Registration with the Drug Enforcement Administration (DEA) is necessary, state to state, for any physician administering, prescribing or dispensing any controlled substance. To learn more, check out this comprehensive list of DEA offices by state or find a registration specialist in your area. If you are a medical professional trying to keep your DEA registrations straight, make sure you understand exactly when those licenses expire and which other states require or accept it.
There is an important point to make here for physician assistants and nurse practitioners, which is that nurses may be eligible to administer certain controlled substances in one state but not in another. As one military spouse nurse I spoke with reiterated, this can be very stressful in both directions — either you are stripped from prescribing something you are capable and used to prescribing simply for being in another state or you are suddenly able to prescribe something for which you’ve never had the authority. This inconsistency must be not only frustrating and overwhelming but it demonstrates the very real and continuous responsibility to stay current on a tremendous amount of regulations and state rules.
All these requirements seem confusing and unstructured from the outside looking in, so I can only imagine the added stress for medical professionals who are handling these, plus the other challenges of military life. In addition to transferring state licenses, physicians have recertification exams, continuing medical education requirements and, depending on your specialty in medicine, other requirements such as quality improvement projects, MOCA questions, state-specific controlled substance exams or other specialty-specific requirements and, of course, annual fees. (While it is always worth exploring reimbursement, most medical health professionals I spoke with were not able to do so successfully for various reasons, the most common being a lack of knowledge by the personnel office.)
Credentialing Companies
An interesting solution I learned to ease the mountainous amount of paperwork necessary to transfer a license was to use a credentialing company. Several MilSpouses I spoke with said their employer paid for a credentialing company, such as Catalyst Consultants. You still need to do the grunt work of pulling the components together but once you submit it all to them, they store it, and can carry the credentialing process out for you through various states. In addition, they can work with providers to assess which insurance carriers and networks you want to/can participate with. It seems like a worthy proposal to make to an employer.
If you are a medical professional working for a company that is not willing to pay for it, look at paying your own way with the Federation State Medical Board (FSMB). I was advised that while not free, as a military spouse physician likely to acquire multiple licenses it is worth the cost since you only have to submit your documentations one time. FSMB stores all of it — degrees, transcripts, internship information, work records, identifying information, and licensing paperwork, and then they send it out to each state for which you seek licensure.
While it seems that most state licensing boards do have a military spouse preference to expedite your application, it is not always obvious when first submitting it, so reach out to your medical licensing state board to ensure you are participating. The catch here is that you may need orders before using this option, which may delay your licensing and job search.
Working on a Military Installation
The obvious thought I carried into this piece was the impact of COVID-19. I have personally struggled with unacceptable impediments to get my children into basic medical care at the base hospital where we are currently stationed. I cannot get appointments for wellness visits, I can’t get them seen for normal illnesses, and I know this stems from coverage protocols and a shortage of staff. So, on a personal level, I could barely contain my first question in my first interview with a military spouse physician. I asked, “What opportunities do you have to work on base as a civilian doctor?” While that would seem like an ideal scenario given that any license would be accepted to work on base, the unfortunate reality, succinctly stated by this doctor, was, “None. It is super frustrating.”
If you are a military spouse, you are likely similarly frustrated with the way the pandemic has affected our ability to get care on base, but that brings me to a bigger question. Leaving base and going out into the civilian world. We are currently in what should be an optimal time to be hiring medical professionals and yet this untapped market of over-qualified and under-employed military spouse professionals hasn’t been identified as a viable way to fill those gaps.
One of the overarching frustrations expressed by both nurses and doctors was the lack of a centralized place for information. Listings on USAJobs, or I should say the lack of listings, don’t accurately reflect what the on-base clinics need, as discussed above. Jobs in local hospitals or clinics aren’t clearly advertised, and the bureaucratic process of opening positions, even when needed, is a significant hurdle. This group of highly skilled spouses needs to come together and petition the different branches to create hiring programs like the Air Force and Army have for military spouse attorneys. Although likely a small start, a program like this would be of incredible service to military spouse medical professionals and, quite frankly, to irritated military family members like myself who would strongly benefit from medical hospitals and clinics being properly staffed. Even creating part-time, temporary, or on-call positions would be of an immeasurable benefit to all parties involved.
It is worthwhile to mention reaching out to the Red Cross and seeking a volunteer position. While it is not a guarantee that a job will follow, it does at least offer the possibility of experience that will keep you active, despite the very real frustration that can come with not getting paid for work for which you are qualified.
Along those lines, any license is also accepted to work as a nurse at a DODEA school, although those positions seem to go to people who can fill them long term, rather than military spouses. While it may feel less than ideal for a variety of reasons, subbing is one way to at least get your foot in the door and be at the front of the line should a position become available.
Telehealth
Disjointed attempts to work or volunteer among different states can make any professional feel like they are treading water versus progressing, which is why I was thrilled for my fellow military spouse professionals to learn that, as with attorneys, telework opportunities have recently exploded, due in large part to the COVID-19 pandemic.
Dr. Zarana Bayona, a military spouse and pediatrician told me, “You have to start thinking outside of the box if you want to keep practicing and you want to see patients. The military isn’t going to help you get a job. You have to advocate for yourself and seek opportunities elsewhere.”
I was impressed to see spouses like Dr. Amy Brandon, a former active-duty physician, who acted on this sentiment and creatively pursued additional licensing in order to make herself more diverse. She became certified by the International Board of Lactation Examiners and was then able to work overseas in a related field that just added to her physician resume for later on. She explained:
“The reality of our lifestyle inspired me to make some career choices I might not have made otherwise (pursuing credentials in a secondary, less lucrative but potentially more portable specialty; practicing on a digital platform) — which ultimately have been supremely rewarding as I learned more about myself and my passions and found myself in something like a niche. The great irony is that I now, at this very moment, find myself looking my dream job in the face — I can almost taste it. It’s exactly what I love doing, with the flexibility I need for my life/family, with competitive compensation, and the opportunity to be part of something amazing that’s growing! But when I was frank about the potential of moving overseas on orders, they pulled back, and I fear it might all get snatched away.”
Instead of getting licensed in every state you move to, medical professionals, through telehealth companies, can now work out of one state as long as their patient is in the state in which they are licensed. Although there are some nuances, this provides some opportunities even for those stationed overseas. Interestingly, I heard from medical professionals who successfully worked in telehealth while overseas and from those who faced roadblocks and shared cautionary messages, like Dr. Brandon. If you’re looking to work overseas, review the laws in the state where you are licensed and carefully explore the financial/insurance stipulations of the work. Consider, for example, that Medicare does not reimburse or cover services that are provided by a practitioner that is abroad. Additionally, ensure that you have malpractice coverage and, importantly, review the stipulations attached to working in your local economy and under your status in the foreign country.
A site recommended by a military spouse physician for medical professionals seeking to work overseas is Hippocratic Adventures Abroad. Though not specific to telemedicine or the military, it does offer interesting conversation and a place to ask questions.
As I discussed at length in my first article, when we talk about military spouses and families, we are also talking about the larger military community as well. These issues directly affect retention for servicemembers. To miss that connection is to ignore not only the current reality, but a reality that will only become more difficult to avoid as people get married later in life and military spouses are more likely to have their own professions. Dr. Rebecca Kay, an emergency room doctor and military spouse, explains this perfectly: “If the Navy had even offered me a part-time job we would have accepted an overseas assignment. Spousal preference has never worked. Non-spouse civilians have always been given GS or contract positions over me. So we are resigning next year. It tears a marriage apart to ask a spouse to give up their career for the other.”
These thoughts led me to a question Dr. Bayona posed that resonated deeply with me. She said, “We signed up to make sacrifices, but which sacrifices are necessary?” That question is the motivation behind these articles. Yes, we support our spouses and the military by extension. No one understands what that means more than us, but does it have to be all or nothing? What is necessary? What can be different? While this article has listed some resources, the most pivotal way to ease the pain of these sacrifices for now is simply to find and support each other.
The National Military Family Association facilitates a Facebook group as part of their effort to “ease military spouses’ transitions from school through licensure to jobs in nursing”. I also spoke with several people when researching this story before I learned of a private Facebook group called “The Mrs.” It describes itself as “A place for women military physicians or women physicians with military spouses to share their experiences or challenges of everyday life.” You can’t search it yourself, you have to be added by an existing member, so find someone, anyone, who can connect you to that community. If you are able to connect to these groups, you will certainly find that at over 5,000 members for nurses and over 800 members for doctors, you are not actually alone.
About Gabriela
Gabriela Nostro, Esq. is an attorney licensed to practice in NY, DC, and NC and has served as Adjunct Faculty with the University of Maryland Global Campus since August 2017, both in person and online. Prior to teaching, Gabriela worked as an Assistant District Attorney for the Fourth Prosecutorial District in Jacksonville, NC. From 2009-2012 she was an attorney with the National District Attorneys Association’s National Center for Prosecution of Child Abuse in Alexandria, VA. Gabriela also served as Director of MSJDN’s non-profit organization, Justice for Military Families, serving Gold Star families from 2015-2017. Gabriela is a 2009 graduate of the American University Washington College of Law. She currently lives with her husband and three beautiful children in Twentynine Palms, California.
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