Starting Private Practice For International Patients - Trying Not To Lose License!

[Xepa777]

Hey everyone!

Shout-out to everyone here who has given some AMAZING advice in the past around private practice software tools definitely using a lot of that right now! My wife is contemplating starting up a private practice with some of her asian friends in psychiatry and psychology around the asian population and I'm just here to set up all the backend infrastructure.

Sorry if this is a dumb question...but what are the legal things to watch out for when providing practice to someone in countries like China, India, etc.? I'm building this private practice to be fully HIPAA (and aspiring to also be GDPR) compliant. But in terms of either technical or regulatory requirements (let's keep it simple, just China and India), is there anything to watch out for? I don't want to inadvertently jeopardize her license with patient populations. Not sure what restrictions the US has on providing care (like psychotherepay) to patients in specific countries?

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[trophyhusband]

Not sure I understand. The license they'd need to worry about in these instances are their licenses in China/India/Etc. I don't know if anyone on SDN is really going to be able to tell you the licensing requirements for those countries. Each country has their own licensing requirements and they'll likely need at least one license in each country they want to see patients in... though I don't know if all countries consider psychotherapy the practice of medicine or not.

Practical issues I can think of are they going to need to carry some sort of malpractice insurance (it could be called something else or not exist at all) in each country? If so I wouldn't think you'd be able to find one company to cover all countries. Are you going to be able to find a prescription software to all countries (if doing any medication management)? Can you legally prescribe in those countries from outside the country? How will you be getting paid for services? If planning self pay is that legal in the countries they'll be seeing patients?

 

[Bartelby]

Good questions. I doubt many, if any, of us are familiar with healthcare regulations in India or China. I spoke with one psychiatrist who worked with patients based in China (more as a pro-bono collaboration), but he did not mention whether he cared about or addressed any of the legalities involved. My sense is that he did not.

I recommend:

-talk with an attorney with relevant experience as step one
-clarify what your malpractice carrier's stance on this would be before starting anything
-figure out how you will handle issues "on the ground" such as contacting emergency services, people who can do physical exams when needed, commitment laws and procedures, etc.
-do your best to research what the process for licensure is in relevant countries, and try to figure out what happens if someone initiates a lawsuit against you there (are you safe to just ignore it as long as you never visit the country?)

If you do learn anything I'm sure others would be interested in an update! Consider contacting something like Doctors without Borders or Operation Smile to see if they have any tips. Few US-based doctors are doing this outside of the context of a charitable mission.

 

[splik]

The US does NOT have restrictions on providing care to other countries. The issue is what restrictions other countries might have. I think this is a complex evolving area and really depends on what you are doing. You also will need to have malpractice coverage that allows for this and assume that if there is a lawsuit, it will be filed in the US.

I can tell you that many academic medical centers provide telemedicine 2nd opinion consultations to wealthy overseas patients (including patients from China and India). The idea is that this is the starting point for the pt potentially coming to the US for treatment (usually non-psychiatric though we have had pts coming from overseas for psychiatric consultation as well and leaving several hundred thousand dollars "tip".) However this is an overseas consultation, not treatment, and with clear explanation that no doctor-patient relationship is formed. Presumably you would need to have prescriptive privileges in the countries, as well as knowing what medications are available and what local resources are available. Also academic centers usually self-insure and thus must have decided it's worth the risk to offer such services. Solo practitioners or small practices cannot do that, they are beholden to their malpractice carriers. It is probably ill advised to be routinely providing treatment to patients overseas even if it is allowed, unless you really know what resources are available locally, are connected with local practitioners, are familiar with what medications are available, and are able to prescribe.

You probably need to consult with a large law firm specializing in health law that has offices in the US and in the countries which you wish to provide services.

 

[Celexa]

I'm confused why you need the international component and all the complexities it introduces as per the posts above. I'm sure they can make a thriving practice focusing on Asian patients who are currently residing in the United States.

 

[whopper]

Telemedicine in general is going to eventually force the argument should we not provide care to one outside our state license? How the heck will you prescribe a med if they are outside the US? Are you in violation with practice requirements in that other country? If so how the heck will this be enforced?

I wouldn't touch it with a ten foot pole.

 

[deleted1100659]

im assuming you would need a medical license in those countries, and who knows what the requirement is there to obtain that. There may be required board exams or may require residency training, who knows. Then how would staffing work? You would have to have schedulers and office staff that know multiple languages im assuming. Then I dont even know how billing would work that part seems highly convoluted.

 

[whopper]

It seems what's really being asked here is, is it okay to practice in another country without license for that country?

This is more a matter of international law than it is for us psychiatrists, even forensic psychiatrists like me.