You can give out general health-related advice online even without a health degree. As long as you aren’t stepping into clinical medicine or offering nutritional advice, you are in the clear. What about the physician who wants to distance themselves from clinical practice?
A physician will have a more challenging time stepping into the physician health coach role, whether with or without an active medical license. Whenever you are talking about a particular disease or referring to any treatments, you’re throwing yourself under the jurisdiction of the medical boards.
If you interact with a patient online, one-on-one, any advice you give them could be considered medical care. Specifically, it might be regarded as telemedicine care. You’d be held to the same standards as any US telemedicine physician.
In this post, I want to talk about how physicians can protect themselves as they take on a more educational role and safely take on a physician health coaching role.
The Physician Health Coach
The issue of licensure and telemedicine, explicitly relating to practicing across state lines, was brought up to Congress as early as 1997. Since then, telemedicine has grown and captured everything from interpreting an X-ray to reading your heart monitor.
Soon, everything you do online as a health professional will fall under telehealth or telemedicine rules. As of 2019, the rules are still somewhat vague, and it’s up to everyone but you to decide whether you have broken the law. Legal advice is available, but very few lawyers are experts in such topics; it’s easy to get the runaround and waste your money on lawyers who don’t know this field adequately.
Physician Assistant Health Coaching
To touch on the topic of a physician assistant health coach briefly, the advice isn’t too different. You can offer general medical advice, and you won’t need to be under the supervision of a physician.
Because you are acting independently and not claiming to use your PA license, you can give general health-related advice–advice that is available in public channels such as the CDC.
Disease-Specific Health Coach
You’re an expert in diabetes and want to help patients come off of their insulin. You have a proven method where lifestyle, diet, and medications can be managed right, and the patient can achieve better control without insulin.
When referenced to diabetes (a medical diagnosis), all of these actions would fall under the practice of medicine. You will always be held to the clinical standard because you have a medical education, whether you still identify with or maintain an active license.
Recommending fasting or herbal remedies, or over-the-counter supplements are all clinical interventions.
If a disease-specific model doesn’t interest you, you can be a primary care physician health coach. There are so many habits and mindset themes you can work on with your client – the list is endless.
Existing Medical Degree
Denying your medical expertise or omitting your credentials won’t protect you. The content of your advice and your professional history can still be used against you by regulating bodies.
And what’s the point of being a Physician Health Coach if you can’t use your medical background and expertise to build your practice? There are legal ways around this, but don’t expect your medical board to support you in this endeavor.
You can mention that you are a physician, but you must make it quite clear that in this case, you are in no way acting as someone’s physician. You require your client to have their physician.
General Health Advice
By maintaining anonymity and offering general health advice, it is possible to circumvent some legal issues with being a Physician Health Coach.
This way, you don’t have to deny being a physician, and you don’t have to deny having an MD or DO or another clinician title. But you must notify your audience that you aren’t acting in the role of a physician.
According to Cohen Healthcare Law Group, it’s essential to emphasize your role as someone offering general education and information—focusing on servicing a group of individuals as opposed to an individual patient.
The Cohen Law Group recommends:
- avoid referencing specific diseases (‘managing blood sugar readings’ might be okay, treating diabetes is not okay)
- reaffirming to your clients that despite your MD/DO credential, you aren’t acting in a clinical role as a licensed physician
- adding a disclaimer on your website and letting clients know that they must consult their physician
- don’t mix standardized medical terms with vague clinical issues (don’t say “avoiding hypoglycemia”)
- don’t recommend or interpret lab studies or remote data
- offer webinars, courses, and tutorials that are informational and generalized
I will add that you shouldn’t refer to your clients as patients. You shouldn’t manage disease or make health statements that cannot be substantiated. If you want to act as a non-clinician, your advice must be very carefully worded.
To me, this seems silly. If you’re a physician and you want to be a Physician Health Coach, you want to offer general medical advice in the role of a physician. Let’s talk about that next.
A Licensed Physician Health Coach
Alternatively, you could be a full-fledged physician health coach and flaunt your license to those patients who are from your state.
The Group Model
Your clients can still be part of a group practice model for webinars and other group online sessions. You would need to get informed consent from each participant and may have to create a medical chart for each.
Your advice can still be generalized and individualized, but as long as you’re not making absurd claims or aren’t treating each patient individually, you aren’t placing yourself at high risk. There has to be a distinction between your group model and your patients.
Patients are routinely referred to group sessions in traditional medicine. People with diabetes will gather for their insulin-start classes. Or obese patients will be sent to group weight loss classes. As long as nothing individualized is addressed during these group sessions, you can still act in a physician role safely as a physician health coach.
As an upsell, you can offer individualized services for 1:1 patient care. Perhaps you want to help a patient better handle their blood sugars. Maybe they have peripheral neuropathy, which you want to address with them.
I would recommend having a lawyer help you tease out the lines between your group practice, where you offer general medical advice, and your individualized practice, where you see patients individually, whether online or in-person.
A brief word about practicing across state lines: this is a big no-no and considered a violation of FSMB’s telemedicine rules. If you’re going to be a licensed Physician Health Coach, then it’s on you to verify the location of your patient before starting a health coaching session.
As of this writing in 2019, asking the patient where they are located is adequate. You don’t need to capture their IP address and cross-reference that. I expect that this will change in the future.
Branding Yourself as an Educator
If the FDA or FTC or a medical board wants to come after you, they will genuinely look to see if you are genuinely in a role of an educator or if you’re dishing out quasi-medical advice.
It’s essential to pass the sniff test and be genuine about this, at least if you intend to transition into a non-licensed or non-clinical Physician Health Coach.
Steps to take:
- turn off your comment section on your website
- interact with a client only in a group setting
- don’t make claims about a particular disease
- don’t have clients report individual results to you
- don’t interpret lab results for clients
- discuss an illness but not the clinical management of it
- use consumer-directed sites such as CDC or WHO or FDA as references
The Nutrition Professional
When you browse IG or YT, there are a lot of non-licensed individuals who give out nutrition advice. They also often do one-on-one coaching or answer individual client questions.
Most states don’t allow this, but it’s a matter of oversight. The medical boards and nutrition boards cannot go after everyone who is sidestepping the already vague state laws.
If you choose to act in a non-clinical role, remember that you cannot give nutritional advice. Only nutritionist professionals can provide such advice. That includes MDs, DOs, DCs, DDSs, and NDs.
To touch upon this once again, you only need malpractice insurance if you are engaging in the practice of medicine.
If not, no insurance company would even offer you malpractice coverage. There is other professional liability insurance you can consider depending on your state. That’s best to discuss with your attorney.
10 replies on “Physician Health Coach Legal Issues”
Really nice information 🙂 i wish i could get the same information somewhere about the german medical sector concerning this topic.
As far as i understand the physician are the screwed ones while noone cares about the Instagram amateurs who offer a similar services.
It’s tough because the landscape in the US is shifting quickly. With the passing of many telemedicine laws – right now there are over 25 new ones pending – many health related interactions will be limited to those with proper credentials.
I actually think that the amateur IG and FB advice groups are a good thing for physicians who are expert in a field such as athletics and exercise, like yourself. There is no black without white and no noise without silence. And there is no expert opinion without information pollution.
The majority of those who are poor at gathering information will still be drawn to terrible websites like WebMD and IG accounts. But the discerning few who have the intelligence and money will pay handsomely for the right opinion. But branding yourself as such an expert is important and takes some time from what I’ve learned.
I’ve often thought about this route as an MD. You highlight the barriers quite well. One thing that I’m thinking about is building health coaching educational programs for other providers/health coaches. If you were a “physician health coach” perhaps you could host an advanced health coaching course for other non-physician health coaches, maybe even giving them CME, or some kind of credential. People love fancy pieces of paper!
That’s pretty brilliant idea actually. My friend N. did something like that for dentists and getting a license to dispense CME’s is really easy and costs less than $150. Lemme look into a little and see what the market is like for it. Should be an open-wide space. I have another post here somewhere about teaching advanced courses to medical practices. One was a medical emergency course for outpatient practices where they don’t know how to deal with emergencies – huge demand for that and it pays really well.
Hi- great detailed post.
I am not an MD or DO- I am a licensed as a mental health counselor and certified as a health coach. I also teach health and wellness courses for coaches and therapists. It is my understanding that a health coach cannot give disease-specific information one-to-one and you made reference to the same, stating that giving generalized disease specific information in a group is fine. But more and more I am seeing the emergence of health coaches within the medical model who are indeed giving one-to-one disease specific information and education and this is even being promoted as part of the health coach’s role- see this article: https://www.aafp.org/fpm/2010/0900/p24.html
We know that patients benefit a lot from health coaching, especially when it’s done routinely and as part of their overall healthcare plan. The article referenced talks about how medical groups can involve someone to take on the health coaching role. In such cases they are trained to do so. In fact, with adequate supervision and training can do that.
But what I’m seeing a lot and others comment on is that someone gets a health coaching certificate online or even without one will start telling people how to eat, what to eat, how much exercise to get, etc. Each state has their own rules and regulations but generally, most will not allow just anyone to give such specific advice.
The best way to uncover this is to look at the nutritionist/dietitian guidelines for each state. They will mention what kind of licensing and training is required.
For sure, nobody but a doctor or a health coach who is under the direct supervision of a physician can give disease specific advice.
One way to get around this is to talk in general terms. For example, you can say that “studies show that increasing your protein consumption and decreasing your simple carb intake could help you decrease your insulin”… that’s general advice, especially if you can cite some studies to back it. But if you say “it would best to lower your carb intake so that you can take less insulin”, that’s specific advice and not acceptable.
I’m quite careful in the kind of advice I give because I fall into the same category. If I give specific advice then I become the patient’s doctor which I don’t want to do as a health coach. You can read what I talk about at http://www.medicalhealthcoach.com
THANK-YOU for this posting. Some of the clearest I’ve found as I am trying to create clear agreements with my “patients.” As an integrative physician who invested lot of time and money to obtain coaching certification, my practice is evolving to offer 6 and 12 month packages to help people obtain specific health care goals.
Sadly it’s the only valid information out there. I’ve been looking for this stuff forever and even the lawyers don’t have anything concrete. Why? Because the state medical boards and other professional boards benefit from keeping the rules vague, this allows them to go after damn near anyone and leave it up to the courts to figure out who’s right.
But, in such cases don’t be afraid to go toe to toe with any professional body who is investigating you. Usually you’ll win, they don’t want such a long and drawn out fight. Especially when they know that if this goes to a administrative law judge you’ll easily demonstrate that you’re out there helping patients.
Great post. Thank you. I know many licensed medical professional who choose not to become health coaches due to these restrictions. What I don’t know is anyone who has ever been to court for being accused of practicing medicine while being a health coach. I just can’t find this information. Do you know of any licensed medical professionals, MD, DO, NP, PA etc, who have? Where do find this sort of information?
You can search court cases because they are all public. The best way would be to contact your state medical board and request a full case list or ask about any such particular cases because they would have to be handled by the licensing body, as in, the medical board.