Enigma variations

We hear it all the time: one of the benefits of EHR will be to get a handle on physician practice variation. Between states, and even within departments, we diagnose and treat the same things very differently. By switching from paper to electronic charting, analysis of practice variation becomes a lot easier (it also becomes easier to steer physicians into following guidelines).

With all this focus on how doctors do things differently, I'd like to turn the focus, however briefly, on the practice variability of government.

Specifically, why is the physician's license fee so variable, from state to state? Little Rhode Island and big Texas both charge over $1000 to issue or renew a license, while Wisconsin is just $125. Are the medical boards in high-fee states doing so much more work than the low-fee states, to justify the expense? Can I expect faster licensure and more courteous phone staff in New York ($725 every 3 years) than Illinois ($300)?

Sadly, despite these systems moving to the web and facilitating electronic applications and payments, the pricing remains as impenetrable to me as ever. I hope we physicians can set a better example than our state licensing boards do.