In MacDonald v. President, New Jersey State Board of Medical Examiners (3d Cir., Aug. 31, 2026), two out-of-state specialists argued they shouldn't need a New Jersey license to consult with New Jersey patients by video. The court disagreed — unanimously, and at length.
Dr. Shannon MacDonald is a radiation oncologist at Massachusetts General Hospital who treats rare pediatric cancers. She is licensed in Massachusetts. One of her former patients, treated as a toddler, is now a teenager living in New Jersey and needs periodic scans. If a scan shows something, his family wants to consult with her by video rather than travel to Boston.
Dr. Paul Gardner is a neurosurgeon at the University of Pittsburgh Medical Center, licensed in Pennsylvania. He wants to discuss treatment options by video with patients located in New Jersey, including a former surgical patient who now needs follow-up.
New Jersey law says a physician who "uses telemedicine or engages in telehealth while providing health care services to a patient" must be licensed in New Jersey (N.J. Stat. Ann. § 45:1-62(b)). Neither doctor holds a New Jersey license. They sued, with three New Jersey patients and a parent, arguing the requirement violates the First Amendment, the dormant Commerce Clause, and the Privileges and Immunities Clause. The district court dismissed the case. On August 31, 2026, the Third Circuit affirmed.
Medical advice is speech, and a licensing requirement regulates it. The court didn't dodge this. Diagnoses and treatment recommendations delivered over video are "the quintessential form of protected speech," and requiring a license before you can deliver them is a content-based restriction. That part of the opinion goes the plaintiffs' way.
But medical licensing has a very long history, so the strictest constitutional test doesn't apply. The court traced physician licensing from a 1518 royal charter in England through colonial New York and New Jersey to every U.S. state by 1898, and concluded that for well over a century "the States have uniformly required a license to practice medicine, including when that practice takes the form of speech." A tradition that old means courts apply a more forgiving test.
Under that test, New Jersey wins easily. The doctors didn't challenge the substance of licensure — board certification, background checks. They argued the process was duplicative for specialists already licensed elsewhere. The court found the burden "slight": roughly $550 and a few months through the standard out-of-state pathway, or about $700 and "weeks" through the Interstate Medical Licensure Compact. Monitoring renewal dates and paying fees is, in the court's words, "de minimis."
The law doesn't discriminate against out-of-state doctors. It applies to anyone who wants to practice on a patient located in New Jersey, wherever the doctor sits. The plaintiffs' real complaint, the court noted, was about being multi-state practitioners — and that burden falls the same on a New Jersey-based specialist with a national practice.
The pandemic waivers don't change the analysis. The plaintiffs pointed out that New Jersey relaxed these rules for two years during COVID-19 and nothing bad happened. The court wasn't moved: a temporary emergency policy doesn't establish that the permanent rule is excessive.
None of this is new law. Every state keys licensure to the patient's location during the encounter, and the compacts exist precisely because of it. What's new is that a federal appeals court has now examined the most sympathetic possible version of the counter-argument — world-class specialists, established patients, follow-up consultations, a streamlined licensing process they simply didn't want to use — and rejected it on every ground.
A few practical takeaways:
The plaintiffs in this case were unusually well-documented: they knew exactly which patients were in New Jersey and said so in their complaint. Most practices don't have that clarity. The patient's address on file says where they live; the visit happens wherever they happen to be. The question a board would ask about any given session — where was the patient? — often has no recorded answer at all.
TeleVerify records the patient's real-time location at the start of each session, checks it against your licenses and compact memberships, and stores a signed record. If the patient in New Jersey turns out to be in Pennsylvania that day, you know before the visit starts — and either way, the record exists.