"What about Dr Jones. She's a doctor, she calls herself a health coach, and she practices all over the country?" My answer to that is: Dr. Jones is probably not doing it correctly, and unless she's licensed in all of the states in which her patients are located, she is rolling the dice by committing crimes in each of those states.
Here at Functional Lawyer, these sort of questions pass by my desk weekly. I admit that I am a little bit exasperated because I answer these questions several times a week with new clients and even with some existing clients. Hopefully this blog will fully answer this common inquiry, even though I am certain people will have further questions.
There are several things to address here, but the main topic of this question is regarding the health coach or consultant's role. There's a huge myth out there that's being propagated either by people who want to sell you a course on how to do what they're doing (which may be illegal, by the way), or people who are trying to sell get-rich-quick schemes. You may have already come across these new entrepreneurs who are starting their Functional Medicine clinics, saying that you can just call yourself a health coach or a consultant so that you would be free to practice around the whole country. Sure, that sounds great, but it is a lie. They're giving you misinformation.
You must know that for telemedicine purposes, wherever the patient is located is where you're deemed to be practicing medicine. You must be licensed in that state. If you're calling yourself a health coach but you're still practicing medicine, that is can be considered diagnosing, treating, preventing, or curing disease, illness, symptom, or condition. Whether or not you are using prescriptions, whether or not you take insurance, it doesn't matter so long as you're in the art of practicing medicine. Whatever title you give yourself, if you are practicing medicine in any way, then you are considered to be practicing medicine. It is your actions that control, not the label you put on it.
If you are licensed in New York and you see a patient or a client in California and decide to do the things you would normally do with clients in your own state or at your practice, then you are practicing medicine without a license in California. And this goes for every state; it's a criminal offense. There are civil penalties as well as financial penalties that are potential consequences. Even so, whenever I tell people this, they say, "Well, what about Dr. Jones? She's doing this." It's true that some who may even be considered a type of quasi-celebrity are saying that they are a consultant and practicing around the country. My answer to that is that they're really rolling the dice and practicing illegally unless they're licensed in all of the states they are serving. They're committing crimes and hoping they don't get caught. I know that I've talked about this in the past, perhaps ad nauseam, but it's extremely important. I'll link to my prior content on this subject at the end of this blog.
The next question I always get is "...then what are they doing and how are they doing it?" The better question to ask is, "How can I reach people in my own state?" You have literally millions of people where you are licensed who want and need your services. I suggest focusing on those people that you can help, legally, and not worrying about having to look over your shoulder.
This brings to mind a quote that I first saw at the US Merchant Marine Academy, where I went to school. We had quotes about honor and other virtues painted all over the walls in the dorms, and one of them was about character: "Character is doing the right thing even when nobody's looking," mostly attributed to J.C. Watts. Service Academies often take a deeper and more serious focus on honor than most universities do. Adhering to such virtues is a huge part of life at a Service Academy, and in fact I'm trying to raise my two boys to live up such a creed-- that a Rattigan will never lie, cheat, or steal.
In light of this, we can conclude that Dr. Jones is probably a low character person, and while I'm not here to pass judgment, breaking the law in this way is lying, cheating, and stealing. I'm not perfect by any means; raising my two boys certainly holds up a mirror to all of my character flaws and defects, but I do want to shed light on the point of doing what's right even though you may not get caught. J.C. Watts goes on to say, "There are too many people who think that the only thing that's right is to get by, and the only thing that's wrong is to get caught." I hate to see fellow colleagues in the Functional Medicine business live by this rather than with honor and character.
I give this advice to everybody-- to focus on states in which you are licensed and see patients in those states. If you really are a person of high character, you will decline to see patients that call you from out of state, and that will have a two-fold benefit for you. One, you won't have to worry about breaking the law; two, assuming that there are other high-character doctors out there, I imagine that all of you will also decline patients from out of state and refer them to each other. Say, for example, you live in North Carolina and a patient calls you from Texas. You reply, "Sorry, I can't see you. I recommend you see a practitioner with a Texas license." That's fantastic. A Texas practitioner may get a call from a North Carolina patient, and if that Texas practitioner is a person of high character, they will say, "I'm sorry I can't see you. I'm not licensed in North Carolina; but I do know a provider in your own state." That would be you in this scenario, and so it would have the benefit of one, you're not having to worry about getting caught, and two, you may be able to capture more of the people in your area of licensure. This is a win-win!
The bottom line is that you can't call yourself a coach, and then get rid of all the regulatory systems we have around the country. You can't call yourself a consultant and do the same thing. Doing so puts you in criminal jeopardy of being caught, convicted, and prosecuted with a crime, as well as civil penalties. While others may put their license at risk, I highly advise against this. You would be breaking the law.
Where do you go from here? What are your options to expand your reach?
You've got plenty of options, and the last thing I'll leave you with is this: if you're a provider, do the math. Most Functional Medicine providers who have appointments of 45 minutes or so can honestly see five, maybe six, patients a day. As far as the emotional investment that goes into it and the amount of notes you have to take, seeing six patients can be a bit much. So, we will just go with five to keep the math easy. Five patients a day on average, over the course of a year, is 12,050 patient slots (250 days x 5 patients). Some of those patients will be repeat customers, so if everybody comes twice, that is 625 patients that you need. Imagine if they all come three or four times...you get the idea. What I am saying is that if you just reach 100-200 people, your practice is full, and you're even on a waitlist.
You don't need to access 350 million Americans to fill up your practice with 200 people a year. You just don't. If you live in a state of a smaller population, you might consider getting a full license or a telemedicine license in a state with a higher population. For example, Florida allows anybody with a medical license, and others lots of mid-levels and below, to apply for and receive a telemedicine registration license in the state of Florida, with which you can see patients in Florida. This would mean adding 22 million to your legal pool of prospective patients. With 22 million, plus however many are in your state, you can certainly fill your practice up with 100-200 patients per provider. You can see that those who are planning on calling themselves a consultant in order to have free rein to practice around the country are doing something this is not only illegal, but also unnecessary.
Don't concern yourself with what others are doing. It's likely that they are not in compliance with the law. I know it can be frustrating to be in a tightly regulated industry, such as medicine, but that's the world we live in. You can fight against the wind, or adjust the sails in your sailboat. I imagine that adjusting your sales is going to be a lot easier than getting mad when the wind is not coming in the right direction. Youare smarter than this. Be smart. Be safe. Be a person of high character, and you will have less to worry about. You can sleep well at night, knowing you're doing the right thing even when no one is looking.
Here are two helpful links to expand on this topic.
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