Breaking into Telemedicine: A General Licensing Guide for NPs, PAs, and MDs
Covid-19 ushered in an explosion of growth in the telehealth space. Over 1,500 patient facing telehealth companies have been established since 2020. It is no surprise then that telemedicine is quickly becoming one of the most exciting and flexible ways for healthcare providers to expand their practice. Whether you’re an experienced NP (Nurse Practitioner), PA (Physician Assistant), or MD (Medical Doctor) looking for a change, the telemedicine industry offers the opportunity to reach more patients, create a more adaptable schedule, and improve work-life balance.
However, for clinicians entering the telemedicine space, one of the most significant hurdles is understanding and managing the licensing process. Unlike traditional in-person practice, telemedicine opens up opportunities across multiple states—but it also requires you to navigate a complex regulatory landscape to remain compliant. This guide offers a general overview of the licensing process for NPs, PAs, and MDs interested in transitioning to telemedicine, and highlights the differences between roles and how to navigate the nuances of each.
We will be following up with more detailed guides specific to each type of clinician, so stay tuned for more in-depth resources!
Why Licensing is Critical in Telemedicine
Licensing is more than just a formality in telemedicine—it’s a fundamental aspect of practicing legally and safely across state lines. In traditional settings, a single license may be enough, but telemedicine allows you to treat patients in multiple states. This brings about a unique set of challenges, as each state has its own set of regulations governing healthcare providers.
Here are a few key reasons why licensing is so critical in telemedicine:
Legal Compliance: States have strict and varying rules about who can practice medicine within their borders, and telemedicine is no exception. Practicing without proper licensure can lead to fines, penalties, or even the loss of your medical license.
Patient Safety: Licensing ensures that providers meet the necessary qualifications and standards, protecting patients by ensuring they receive care from competent, credentialed professionals.
Professional Liability: Practicing without the proper license can lead to legal ramifications, malpractice claims, and other professional risks. Proper licensing helps mitigate these risks.
Understanding the importance of licensing is just the first step. The complexity lies in navigating the regulatory differences between states and clinician types. Below, we’ll outline some of the key aspects of the licensing process for NPs, PAs, and MDs in the telemedicine field.
Licensing for Nurse Practitioners (NPs) in Telemedicine
Nurse Practitioners are increasingly in demand in the telemedicine space due to their advanced clinical skills and ability to provide high-quality, comprehensive care. However, the licensing process for NPs varies widely across states, particularly in terms of scope of practice.
Key Considerations for NP Licensing:
Full, Reduced, and Restricted Practice:
States are divided into three categories when it comes to NP scope of practice: full practice, reduced practice, and restricted practice.
In full practice states, NPs can operate independently without physician oversight. In reduced practice states, NPs may need some physician collaboration, and in restricted practice states, physician supervision is mandatory.
For telemedicine NPs, understanding the state’s scope of practice is crucial for determining the level of autonomy you can exercise when treating patients remotely.
State-Specific Requirements:
Some states require NPs to complete additional steps beyond standard licensure. For example, certain states may require specific telemedicine-related continuing education credits or impose additional telemedicine-specific regulations.
Additionally, state regulatory boards may have unique requirements related to prescribing medications, especially controlled substances, which must be adhered to when practicing across state lines.
Compact Licensure:
NPs can benefit from the Nurse Licensure Compact (NLC), a multistate licensing agreement that allows RNs (Registered Nurses) and some NPs to practice in participating states with one license.
While not all states are part of the compact, the NLC can streamline the licensing process for those looking to practice in multiple states via telemedicine.
We have licensed hundreds of clinicians across dozens of states using the NLC. We will be publishing a complete guide on the NLC, but we are always happy to answer your questions - reach out to us to chat!
Licensing for Physician Assistants (PAs) in Telemedicine
Physician Assistants (PAs) play a pivotal role in telemedicine, especially in providing acute care, specialty care, and chronic disease management. Like NPs, PAs face state-specific regulations that determine how they can practice remotely. The major distinction for PAs is the physician supervision requirement, which varies significantly by state.
Key Considerations for PA Licensing:
Supervision Requirements:
Unlike NPs, PAs are generally required to work under the supervision of a physician. However, the nature of this supervision can vary from state to state. In some states, telemedicine allows for more flexible supervisory relationships, such as remote supervision where physicians don’t need to be physically present.
It’s crucial for PAs entering telemedicine to understand whether their state requires direct supervision (in the same room or building), indirect supervision (available by phone), or allows for remote supervision. This can impact the type of telemedicine services a PA can offer.
State-Specific Regulations:
Each state regulates PAs differently, and some may impose stricter licensing requirements for telemedicine. For instance, certain states may require PAs to register separately to practice telemedicine or may impose additional supervision requirements for remote care.
Some states also limit the number of PAs that one supervising physician can oversee, which can be a crucial factor in scaling a telemedicine practice.
Physician Assistant Licensure Compact (PA Compact):
The PA profession is working towards establishing the Physician Assistant Licensure Compact to streamline the licensing process across states, similar to the NLC for nurses. While still in the works, this initiative could drastically reduce the complexity of multistate licensing for PAs in telemedicine once implemented.
Licensing for Physicians (MDs/DOs) in Telemedicine
For physicians (MDs and DOs), telemedicine opens up a world of opportunities, but it also comes with a host of regulatory challenges. Licensing requirements for physicians are perhaps the most stringent, and ensuring compliance with multistate practice laws is essential for avoiding legal pitfalls.
Key Considerations for Physician Licensing:
State Medical Board Requirements:
Every state has its own medical board, and each has its own set of requirements for licensing. Physicians practicing telemedicine must be licensed in the state where the patient is located, not just where the physician is based. This means that physicians often need to hold multiple state licenses if they wish to see patients in various states.
Some states have telemedicine-specific rules, such as requirements for establishing a physician-patient relationship through an initial in-person visit before telemedicine consultations can occur.
The Interstate Medical Licensure Compact (IMLC):
One of the best options for physicians looking to expand their telemedicine practice across multiple states is the Interstate Medical Licensure Compact (IMLC). This compact allows eligible physicians to obtain expedited licensure in participating states, drastically reducing the time and effort required to gain multistate licensure.
While the IMLC is a huge benefit to telemedicine physicians, it’s important to note that not all states participate. Additionally, eligibility requirements, such as having a clean disciplinary record, must be met to qualify for the compact.
Controlled Substance Prescribing:
Telemedicine physicians who prescribe controlled substances must comply with the Ryan Haight Act, a federal law that imposes strict rules on how and when controlled substances can be prescribed via telemedicine. Ensuring compliance with both federal and state laws regarding controlled substance prescribing is essential to avoid legal risks.
Some states may require additional certification or training for telemedicine physicians who prescribe controlled substances.
The Cost and Time Involved in Licensing
One common question clinicians ask when entering telemedicine is, “How long does the licensing process take?” The answer, unfortunately, varies widely depending on the clinician type and the state in question. Here are a few factors that influence the cost and time involved in obtaining telemedicine licenses:
State Variability: Some states have fast-tracked processes for telemedicine licenses, while others can take months to process applications. On average, you should expect the licensing process to take anywhere from 6 weeks to 6 months.
Application Fees: The cost of applying for a new license can range from a few hundred dollars to over $1000 per state, depending on the clinician type and the state in question. Multiply this by the number of states you plan to practice in, and licensing costs can quickly add up.
Credentialing: Beyond the license itself, credentialing with telemedicine platforms or insurance providers can add another layer of complexity and time. Many telemedicine companies handle this for you, but it’s essential to understand the full scope of the process.
Why Outsource Licensing?
Given the complexity, time, and cost involved in the licensing process for telemedicine providers, many clinicians and telemedicine companies choose to outsource this process to experts. Licensing experts can navigate state regulations, expedite the process, and ensure that your licenses are in compliance, saving you time and avoiding costly delays.
Outsourcing your licensing process allows you to focus on what you do best—caring for patients. For more information on how outsourcing licensing can benefit your telemedicine career, read our post on Why Outsourcing Licensing is Key to Scaling Your Telemedicine Business.
Conclusion: Licensing as the Gateway to Telemedicine Success
Breaking into telemedicine as an NP, PA, or MD offers exciting opportunities for expanding your practice and reaching more patients. However, the key to a successful transition lies in understanding the nuances of licensing across states. Whether you’re an NP navigating scope-of-practice laws, a PA managing physician supervision requirements, or a physician juggling multistate licenses, mastering the licensing process is essential for ensuring your telemedicine practice is both compliant and profitable.
