Telehealth Licensing Requirements: Where Do I Have to Be Licensed?

As a health care provider, I’m  concerned that so many large and small websites are now offering “ask-a-doctor” type services, and claiming that their practitioners are “licensed.” I’m writing this blog to pose these questions:

Does their licensure signify that they are indeed competent and operating legally/ethically as many consumers would believe? Or does it simply mean that they are simply running ahead of the law, taking advantage of an overburdened legal system that cannot keep up with the rapid pace of technological advancement? Are they taking their chances because they know that licensing boards are severely overworked, sometimes employed by states that are financially strapped, and that consumers often need to file a significant number of complaints before even an informed licensing board can take action? Are they just trying to make a fast and much easier buck than in their face-to-face practices? Or is this just all one big misunderstanding? If it is a misunderstanding, whose job is it to know and disseminate the facts?

licensingBefore I offend too many of my loyal readers, let me say that ask the questions I am asked by my readers at SelfhelpMagazine, and I hope to assist rather than point to any specific professional or business online. I also will speak only to mental health websites in particular, because this is  my area of specialty.

In reviewing a large number of websites for mental health practitioners offering “online counseling” or “online therapy,” it’s obvious that there’s a fair amount of confusion or misinformation (or what else?) about licensure,  and even among licensed professionals.

This is an interesting phenomenon, especially because licensure means that some point in time, those licensed professionals understood the law clearly enough that they passed the test designed to document their understanding of state law, particularly state law related to where it is legal to practice.

As we detailed in our last text book, The Mental Health Professional and the New Technologies: A Handbook for Practice Today, licensed mental health professionals need to be licensed in the state of residence of the client or patient.

In other words, professionals selling their services to Internet sites by claiming they are “licensed” may very well be misleading consumers, who may trust that they are more protected when seeing  a licensed practitioner.

While indeed, licensure signifies that the professional has demonstrated to an objective third party that they have at least a minimal level of competence, the fact that these particular professionals are announcing to the world (and their local licensing boards) that they are open for business to treat anyone who calls them from their Internet site, lets us all know that they are not as competent (or perhaps just not as informed?) as most consumers would like to believe.

After all, just how informed are they if they don’t realize that they’re in effect advertising that they are either licensed in all 50 states (and anywhere else in the world where local licensure is required), or that they are practicing over state lines without a license?

Now there might be some online counselors or online therapists who only make themselves available online to consumers from the particular state(s) from where the professional is licensed, but they are the vast minority. Never have I met a mental health practitioner who is licensed in all 50 states.

That’s not to say that no single practitioner is licensed in all 50 states, but after training literally thousands of therapists who want to learn about online practice, I can honestly tell you, I’ve never met any. Most of the time, what I see on these websites is a practitioner whose license in 1-3 states in making themselves available to anyone who’d like to call, chat or email.

Making this sort of public mistake about one’s licensure is noteworthy. Caution is in order. It literally is a crime to practice without a license in all 50 states. If any of you have different information, please let me know below.

If any of you are offering services online without having fully considered the boundaries of your licensure, you may want to simply go to your website now,  and make it clear to your readers as well as clients and patients that you can only legally serve them online if they currently reside in a state where you are licensed. If you have any doubt as to the veracity of my statements above or my suggestion herein, call your licensing board and ask them. I would be interested in hearing your feedback.

Those are my views. Might you provide additional information that could help me see it differently? Please comment below.

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