After malpractic insurance, rent, salaries, a lot don't make the 400k a year. It's very frustrating to not to able to talk to someone in one language or have you ever tried?

State-by-state licensure exams are cumbersome and won't work well in medicine. Imagine having to take a new exam every time you move to a new state in order to work. Could you afford to sit idle while waiting to sit for an exam, then waiting for the results to arrive? Then, there's the "good ole boy" network to contend with. Local doctors and surgeons will form the governing body, and they will be motivated to keep nonlocals out to decrease competition.

All this would encourage doctors and surgeons to stay in a state where licensure is easy to obtain. A doctor from Georgia would be unlikely to travel to a high-need area like Alaska first to take a licensure exam, then to jump through whatever hoops the government of Alaska might decide are necessary to licensure.

Reciprocity (licensure in one state = licensure in any state) is much easier and gives providers the flexibility to practice wherever they want and are needed once they are licensed. Better yet would be national licensure.

Dentistry has state-by-state or regional licensure exams, and they are a barrier to access to care. The exams cost a lot of money to take, and may not be offered in the area where the candidate resides, so travel expenses are an issue, as well. The state of North Carolina had its own licensure exam, and the state legislature had to force the dental board to start accepting candidates with comparable credentials to license enough dentists to serve the population.