The number one question I have been getting recently is, “What is the scope of a health coach?”
A lot of doctors, chiropractors, NPs, etc. are frustrated by their licensure because they want to move freely around the country and practice medicine, but it is illegal to do so if you are not licensed in the state in which your patient is located.
It can be frustrating to see licensed practitioners who are labeling themselves as “health coaches” in order to give medical advice and treat patients, which is also illegal. Equally frustrating are health coaches who are acting as doctors and prescribing treatment while actual licensed professionals' hands are tied in fear of losing their license by helping someone out-of-state.
The myth that is going around is that you should just call yourself a “health coach” or a “consultant” so that you can do whatever you want wherever you want. While it is frustrating that more states do not allow your licensure to be reciprocal, be very careful that you know the risks and make an informed choice. Practicing medicine in a state in which you are not licensed (and sometimes even suggesting or "holding yourself out" as practicing medicine) is committing a crime, and you could face criminal and civil penalties, up to and including losing your license.
That being said, I do agree that this is a very frustrating regulatory environment. Many doctors have gone to medical school in one state, completed their residencies in another state, and often move to a third location. It’s not like there are a whole lot of different training standards or that medicine is wildly different from one state to the next. (It used to be very different in different parts of the country or urban vs. rural clinics, but not so much anymore.) It doesn’t seem fair that someone can earn their degree in Maryland but it doesn’t count in Virginia. However, this is just the way it is in America as we have fifty different “micro nation-states” that form our larger union. We need to know the laws and abide by them.
The good news is that more states are moving towards opening up telemedicine practice to physicians outside of their own state. We need to be patient and not jump the gun and change our label to “health coach” in the meantime.
Know that your career is based on what you do, not what you call yourself. I went to the U.S. Merchant Marine Academy where our school motto was the Latin phrase, “Acta non verba”— deeds, not words. In the eyes of state medical boards, this is true as well. No matter what you label yourself, it’s what you do that matters. If you are a doctor and you order a test, treat a patient, interpret something, or practice medicine outside of your state of licensure, you are committing a crime (with very limited exceptions). You may have a license in another state, but if you don’t have a license in the state where you are treating a patient (i.e., where the patient is located), you are committing a crime and have civil liability as well.
You may very well know doctors and other licensed professionals who are labeling themselves as “consultants” and are treating patients all around the country. The second most frequent question I hear these days is, "So then how is John Doe doing it? He calls himself a consultant and orders tests and otherwise acts like he normally would around the whole country."
My answer is, "As they exist today, he likely is not acting within the law. He is probably taking a calculated risk that he won't hurt anybody (or he won't get caught), and anyway, the penalty can't be that bad, can it?"
Instead of attempting this illegal activity yourself and wondering if you will ever get caught, why not simply look to the millions of potential patients in your own state? You do not have to commit a crime to grow your functional medicine practice. Twenty-five states have more than 4.5 million people. Florida allows out-of-state providers to register to practice telemedicine in Florida so long as they are licensed in good standing in another state. If your state has 4.5 million people, and Florida has 22 million people, do you think you can legally fill your practice with around 200 patients each year?
Instead of attempting to break the law and potentially losing your license by practicing outside of your state, look to see how you can better reach patients within your state. You may need to examine your marketing or review your patient retention, but there are certainly enough patients to go around. You do not have to put your license at risk by committing a crime in another state. You can also obtain a full license in a particular state if you already have a lot of patients there, or you can register for a telemedicine license in a particular state, or, again, you can refocus your efforts locally within your own state or other states of licensure that you currently hold.
Many functional medicine practitioners have decided to offer an educational product to build awareness of their practice and grow their business. You can offer an online educational course. For example, you could offer a “14-Day Reset Your Gut” course, a “30-Day Detox” course, an “Elimination Diet” course, etc. While you may be able to gain course clients outside of your state through your course, you still need to be careful to not to treat your consumers as patients. You have to be very careful in your language and course content to be sure that you are still doing things legally. Your words are protected by the First Amendment. You just need to be careful to not turn a teacher-student relationship into a physician-patient relationship. This can certainly be a slippery slope as many practitioners will want to make specific recommendations (treatment plans) to individuals (patients) they desire to help (heal). Again, this is illegal. The alternative and less risky option would be to make something like a video series that people can purchase and consume on their own time. This could be more like a book that comes to life on video, and people can absorb the information as they choose rather than an interactive experience where your feedback could be considered the unauthorized practice of medicine (i.e., a crime).
Hopefully, you can see that there are many alternatives to choosing to illegally practice without a license. You don’t need to break the law. Be patient as more states are opening up. Double your efforts locally. Offer a video series. Apply for a telemedicine license in another state.
This is a sticky issue. There is a lot more to delve into on this topic. So this blog post is the first of more to come, where we will explore this subject in greater depth.
Remember: You are in this profession because you want to help people. I am here for the same reasons: to help you help people.
If you have any questions about this topic, please reach out to us at Functional Lawyer for more clarity. And stay safe out there.