This is the first article in a series written to help medical providers interested in engaging in medical support work. This series will help you wade through often-overlooked legal issues. As medical support work performed domestically falls under the purview of laws you are most likely familiar with, this article covers international legal considerations.
Before we dive in, there are a couple of general issues I would like to address. First, this series covers medical support work in remote environments defined as areas requiring over one hour to transport patients to definitive medical care. It does not address urban areas. Second, this series assumes that you are considering working for an organization, for-profit or not-for-profit, and not as a sole practitioner. Third, these articles are summaries and do not constitute legal advice. Each medical support job is different and presents unique circumstances. Before accepting a medical support contract, I encourage you to do your own diligent research and to speak to an attorney.
Laws covering the practice of medicine vary widely by country and application, and these laws are in a constant state of flux. It would be impractical, if not impossible, to cover them all. However, regardless of the country, there are several questions that you should always ask your sponsoring organization prior to accepting a medical support contract. These questions are included below and can be utilized as a baseline checklist:
Will the organization procure your work visa and other required documents for you to work in the foreign country, or are you required to do so yourself?
Doing this yourself can incur significant costs and may not even be possible. As addressed below, licenses to practice medicine are generally not transferrable from country to country. However, many aid organizations are able to work with host countries to make possible what individuals cannot.
Are you allowed to practice medicine in the foreign country where you will be working?
Generally, United States licenses on any level do not transfer to any other country since the U.S. does not offer the same reciprocity. At the least, a United States medical provider has to apply for a license to practice in that country. International treaties and organizations often times allow international providers to practice medicine in certain cases. This permission/exception should be documented and shown to you upon your request.
If you are allowed to practice medicine in the foreign country, are you allowed to do so only while you are working, or are you also allowed to provide medical care in accordance with your level of training when you are not working?
This is a very important question to ask considering that, often times, a foreign country’s permission allowing you to practice medicine is limited to your official working capacity.
Are you covered under the organization’s medical malpractice insurance? If so, does the policy specifically cover you, the geographic area you will be working, and the scope of practice you will be engaging in? What are the policy limits?
Standard medical malpractice insurance is limited in geographic coverage and scope such as the venue and activities to be carried out. Have your organization provide you with documentation showing your insurance coverage.
Does the organization have a medical director and medical protocols?
If the organization does have a medical director, you will want to find out if she/he is allowed to practice medicine in the foreign country. This is important because you may be working under an extension of the medical director’s license and the scope of their protocols.
Will you be compensated if you are injured at work?
In the United States, you are compensated by individual states’ workers’ compensation insurance, regardless of fault, if you are injured at work. Typically, employees working internationally are not covered under these plans. Instead, international organizations protect their employees through similar insurance such as Defense Base Act insurance for those working on U.S. military bases and insurance through private carriers. Be sure that the organization provides you with documentation showing you are covered if you are injured at work.
The questions listed above are the baseline questions you should ask if you are considering engaging in medical support work internationally. Failing to do so may expose you to legal liability. In addition to the questions outlined here, it is important for you to engage in your own research specific to where you will be working, the organization you are considering working for, the work to be performed, and any other questions advised by counsel.
Phong Duong is General Counsel for Remote Medical International®. He joined the company in 2005 to escape the suit and tie lifestyle of the law firm and corporate world. Prior to joining Remote Medical International, Phong worked as a W-EMT, kayak guide in the San Juan Islands, ski and mountain bike patroller in Park City, Utah, and corporate attorney. He is also an instructor for our WFA, WFR, WEMT, and custom course trainings.