US-Licensed Doctors Practicing Telemedicine from Other Countries
US-licensed physicians generally cannot practice telemedicine for US patients while physically located in another country without additional licensure and regulatory compliance in the patient's state, as medical practice is legally considered to occur where the patient is physically located at the time of the encounter. 1
Legal and Regulatory Framework
- Medical practice is legally considered to occur where the patient is physically located during the physician-patient encounter, requiring the physician to be under the jurisdiction of the state medical board where the patient is located 1, 2
- There have been no opinions issued by state boards that electronic diagnosis and treatment is not a form of medical practice, meaning medical licensure in the patient's state is a prerequisite to providing telemedicine services 2
- States have taken actions against out-of-state physicians for practicing medicine without a license in the patient's state, including for internet prescribing violations 1
- The Interstate Medical Licensure Compact streamlines the medical licensure process across participating states within the US, but this does not extend to international practice 2, 1
Prescribing Considerations
- The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 places restrictions on prescribing controlled substances via telemedicine, requiring at least one in-person evaluation before prescribing controlled substances 2
- While the DEA has indicated it does not intend to interfere with legitimate prescribing of controlled substances during telemedicine practice, physicians practicing from abroad face additional scrutiny and regulatory barriers 2
- Several states have enacted specific legislation regarding prescribing controlled substances via telemedicine, but these regulations vary by state and generally do not address international practice 2
Patient Safety and Quality Concerns
- Without proper licensing and regulatory oversight, patients have limited legal recourse in cases of malpractice when using providers from other countries 1
- International telemedicine faces additional barriers including:
Potential Limited Exceptions
- Medical consultation (as opposed to diagnosis and treatment) may have somewhat less clear requirements, but still generally requires appropriate licensure 1
- Some states allow for emergency telepsychiatry services without a license, but with strict regulations on the extent and frequency of implementation 2
- During the COVID-19 pandemic, there was temporary relaxation of some regulations allowing telemedicine across state lines within the US, but these provisions did not extend to international practice 3, 4
Common Pitfalls and How to Avoid Them
- Practicing telemedicine across international borders without proper licensure can result in legal actions against the physician 1, 2
- Unclear legal frameworks regarding liability and practice across borders create unnecessary risk 5
- To avoid these pitfalls:
- Consult state laws and medical board guidelines before initiating telemedicine services 2
- Ensure proper licensure in the state where the patient is located 1, 2
- Consider collaboration with locally licensed physicians when providing specialized expertise from abroad 1
- Verify coverage with professional liability and malpractice carriers for international telemedicine services 2
Future Developments
- The TELE-MED Act proposals would allow providers licensed in one state to provide telemedicine to Medicare patients in different states, but this legislation has not been enacted and would not address international practice 2, 3
- Some have advocated for regional or national approaches to licensure in response to the growth of telemedicine, but these efforts have not yet extended to international practice 1, 6