Do I need a licensing attorney? What one does, and how they fit with your program

A licensing attorney (you will also see "professional license defense" or "board defense" attorney) represents licensed professionals in matters in front of their licensing board or regulator. That is a narrower job than most people picture.

Depending on the attorney and the matter, the work often includes:

• Reading board letters and explaining what is being asked and by when
• Helping prepare written responses to the board
• Attending board interviews, conferences, or hearings with you
• Reviewing proposed agreements or orders from the board before you sign
• Talking through how to answer license, renewal, or credentialing questions about health history or past monitoring
• Coordinating with other people involved, with your permission

A licensing attorney is not your clinician, not your evaluator, and not your monitor. They are also not the same as a malpractice defense attorney, although some professional liability policies include coverage for licensing board matters. If you have a policy, it is worth reading what it covers.

This is the part people most often have blurred together, and it is worth separating.

Your program. A physician health program is built around your health. The Federation of State Physician Health Programs (FSPHP) describes PHPs as confidential resources for licensed professionals with potentially impairing conditions, coordinating evaluation, treatment, and monitoring. Many PHPs are independent nonprofits; some are tied to a state medical association; some are run by the licensing board itself. The relationship between a program and its board varies by state, and many have a written agreement that defines it. (FSPHP FAQs)

Your board. In FSPHP's words, a PHP's primary focus is the health of the physician, and the licensing board's primary duty is to protect the public. Both care about patient safety. They just start from different places.

An attorney. An attorney you hire represents you. Their job is your legal interests in front of the board or other regulators.

Nurses, pharmacists, lawyers, and other professionals often have their own program and their own regulator, and the names vary by state and profession. The basic three-way picture is usually similar.

It does not have to be, and it usually works best when it is not.

Programs are allies in this work. A program is not a courtroom, and treating your first call or your evaluation as an opponent to be managed tends to make things harder, not easier. The gap most people feel is lack of information.

An attorney who regularly works on licensing matters in your state is often familiar with how the local program works. Some attorneys and programs communicate directly when the professional signs a release. Whether that happens, and how, is something to ask both of them.

What an attorney is not: a way around an evaluation, a substitute for honesty, or a replacement for treatment. The process in front of you still runs on getting the real history into the room. If your goal or thought process in hiring an attorney is that you are not going to have to face your real problem, you will likely not be successful and the attorney will likely not be able to deliver on that.

There is no single moment. These are the points where I most often hear professionals start asking the question:

• A letter, complaint notice, or request for information arrives from the licensing board
• The board offers or proposes an agreement, order, or other formal action
• A license application, renewal, or hospital credentialing form asks about health history, treatment, or monitoring, and it is not clear how to answer
• An employer or hospital action affects privileges or employment at the same time as the health process
• There is a legal matter outside of medicine running alongside the health process
• Someone is returning to practice and has questions about reinstatement or restrictions

Some people talk to an attorney early, just to understand the landscape. Some go through a program without ever hiring one. Both happen, and which fits your situation is your decision to make with good information, not mine to make for you.

Twice in my own process, I hired an attorney. Both times, I was trying to get out of or change the course of my evaluation, treatment, or monitoring, and both times it didn't work. Talking directly with the licensing board, and especially with board attorneys, was frightening for me. In my experience, as long as I followed treatment recommendations and stayed in good standing with my monitoring program, I was treated fairly.

Many attorneys offer an initial consultation. Fees and formats vary, so ask up front. Questions people find useful:

• Are you licensed in this state, and can you represent me in person here?
• How much of your practice is licensing board work, and for which professions?
• How often do you work with matters in front of my board in this state?
• How familiar are you with the physician health program (or my profession's program) here?
• How do you usually work alongside the program, if at all? Would you want a release to talk with them?
• How does confidentiality work for what I tell you today?
• Who will actually handle my matter day to day?
• How do you charge (hourly, flat fee, retainer), and what does a typical matter like mine involve?
• What do you need from me, and what deadlines should I be watching?
• Do you see any reason to coordinate with my malpractice carrier or employer?

Write the answers down. Talking to more than one attorney is common.

The program answers a different set of questions, and it is fine to ask them directly:

• How does the program relate to the licensing board in this state?
• Under what circumstances, if any, does the program report to the board?
• If I sign a release, will the program talk with my attorney?
• Is there anything due to the program, or the board, that I should know about now?

It will not tell you whether you need an attorney. It will not interpret your state's rules, your board's letter, or your application questions. It will not recommend a specific attorney or firm.

Those answers live with a licensed attorney in your state, your program, and you.

Whether representation makes sense in your situation. What your board's process looks like where you are. How your program and your board share information. What a specific letter or agreement means for your license.

Those vary. The value of knowing who does what does not.