Telehealth was supposed to make geography irrelevant to care. For the patient, it largely has — a specialist three states away is now a video call. For the physician, geography came roaring back through a different door: licensure.
A physician can deliver care across the country technologically and still be barred from doing so legally, because most licensure is tied to the patient's state, not the physician's competence. The technology erased distance. The regulatory framework rebuilt it.
This is the central unfinished business of telehealth policy. Temporary cross-state flexibilities expanded access during the public health emergency, and much of that ground has since been ceded back. The compact helps, but compact membership and telehealth-specific licensure are not the same thing, and the patchwork that remains is genuinely confusing for physicians trying to do the right thing.
PLG's position: telehealth licensure should be resolved as a workforce-and-access question, not a turf question. We track the state-by-state rules, advise physicians on where they can lawfully practice, and push for frameworks that let the technology do what it was built to do.