Many licensees have contacted the Board with a variety of questions regarding COVID-19 as it relates to medical licensure, rules and regulations. Please submit other topics of interest as related to medical licensure during this time of declared emergency: email AHS.VDHMedicalBoard@vermont.gov
The State of Emergency for the COVID-19 pandemic expired at midnight on June 15. Not all the emergency authorities that apply to licensing to practice medicine are tied to the State of Emergency. Thus, if you do not hold a regular Vermont medical license and are practicing here (including practice via telemedicine with patients located in Vermont), you should read this carefully and contact us if you have any questions about whether you are able to continue to practice. Please note that this applies to only the professions licensed by the Board of Medical Practice (MD, PA, DPM, AA, and RA). Members of professions regulated by the Office of Professional Regulation (e.g., DOs, APRNs, and Naturopaths) should contact OPR.
If you had a temporary emergency license with an expiration date of June 15, 2021, it expired at midnight on June 15, 2021. The State of Emergency was not extended. If you have a temporary emergency license and are unsure of the expiration date, you can quickly find out by looking up your license. We recommend entering just your last name to search.
Deemed Licensure for Physicians Licensed in Other States
By virtue of Act 6 of 2021, through March 31, 2022, health care professionals who are licensed in another U.S. jurisdiction and in good standing in all states where licensed, and who are not currently subject to disciplinary proceedings in another state or barred from practice in Vermont, are able to practice in Vermont without obtaining a license, in the following circumstances:
- Practice that is limited to telehealth
- Practice as part of the staff of a licensed facility
- Practice at a Federally Qualified Health Center
Those who are practicing as staff of a licensed facility or FQHC must have the organization submit to the Board their name, contact information, and locations at which they will be practicing. This authority applies until March 31, 2022, so long as the individual remains in good standing in all jurisdictions where licensed to practice.
Deemed Licensure for Vermont Physicians Whose License Became Inactive within the Past Three Years
Health care professionals whose Vermont licenses became inactive within the past three years and who were in good standing also have been, and continue to be, eligible to be “deemed” licensed to practice until March 31, 2022, in the same circumstances as listed above: telehealth, staff of a licensed facility or FQHC. If you began practicing in Vermont under this authority within three years of the date on which you no longer held an active license and have continued to practice, you will remain eligible to practice through March 31, 2022, so long as all other conditions are still satisfied. That is to say that you have not been subjected to discipline or barred from practice in Vermont.
Emergency Licensure for Health Care Professionals Whose Vermont Licenses Became Inactive Between Three and Ten Years Ago
Health care professionals whose Vermont license became inactive more than three years ago are not able to be “deemed” licensed as described above. However, those whose Vermont licenses became inactive between three and ten years ago may apply for a temporary emergency license. They must fill out an abbreviated application, which will be reviewed by the Board. Limitations may be placed on such licenses. These licenses may also be extended through March 31, 2022, as provided by Act 6 of 2021.
Notice to Holders of Emergency Licenses (07/29/2021):
We are receiving many inquiries about the expiration date of the special authorities for medical licensing for the COVID-19 State of Emergency. The Vermont General Assembly very recently passed a bill, S.117, and it has been signed by Governor Scott. That means the law providing for deemed status for certain health care professionals has been extended through March 31, 2022.
For those who have a temporary emergency license the situation is different. Your temporary emergency licenses have been extended through May 15, 2021. At present the State of Emergency has been extended through May 15, 2021; that date is subject to extension by Governor Scott. We will continue to extend the expiration date of temporary emergency licenses through the end of the declared State of Emergency. The reason why the expiration date for temporary emergency licenses is tied to the end of the State of Emergency is that they are covered by a different law. The law authorizing the Board of Medical Practice to issue temporary emergency licenses to individuals licensed in other jurisdictions limits the duration to the end of the state of emergency. The law is 26 V.S.A. § 1353(11).
Special provisions for the COVID-19 public health emergency have been passed to facilitate practice in Vermont by healthcare professionals who are not licensed in Vermont. This sets forth information for physicians (MD), physician assistants, and podiatrists. Other professions (including osteopathic physicians) are under authority of the Office of Professional Regulation. There is special guidance below regarding retirees, physician assistants, and residents or fellows who hold training licenses.
There are two different paths available to be able to practice during the emergency. Both are expedited and free. Deemed licensure is faster, but not available to as many individuals depending on both the individual’s circumstances and the setting in which they will be practicing. Emergency licensure is available to many of those who cannot be “deemed.”
Practice by “Deemed” Licensure
PLEASE NOTE: The guidance here is for ONLY Board of Medical Practice professions (MD, PA, DPM). Other health care professions are licensed by the Vermont Office of Professional Regulation. That includes all types of nurses and osteopaths. Professionals not licensed by this Board need to go to the OPR site.
Physicians, Physician Assistants, and Podiatrists who meet all the criteria below can be deemed to be licensed to practice in Vermont for practice in the following circumstances:
- Providing remote services by telemedicine (note that this refers to “telemedicine” in a generic sense, following the guidance in the emergency law and advisories issued by Vermont agencies and federal authorities). Telemedicine does not require the deemed form.
- As part of the staff of a licensed facility in Vermont. Those practicing as part of the staff of a licensed facility must submit a small amount of information to identify themselves, provide contact information, and note where practicing. That may be done by hospital staff on behalf of the licensee. A form for MDs, PAs and DPMs has been created for your convenience.
NOTE: MD and DPM Residents are also eligible for this status. See note below about residents. Also see special announcement re emergency waiver of PA requirements for documentation of supervision.
Professionals deemed licensed are not required to apply for an emergency license. There is no fee to be deemed licensed. Deemed licenses will be issued for the period while the declared emergency is in effect, but notice may be issued that a deemed license is no longer in effect.
To be deemed licensed to practice in one of the settings specified above, you must:
- Be licensed in at least one US jurisdiction and be in good standing in all jurisdictions where you are licensed.
- Not be subject to professional disciplinary proceedings in any other US jurisdiction (license is not suspended, revoked, or subject to limitations or conditions as a result of a disciplinary action, or formal charges issued. Notice only of an investigation is not disqualifying.
- Not be barred from practice in Vermont for reasons of fraud or abuse, patient care, or public safety.
Deemed License for Vermont Retirees – those who retired from practice within the last 3 years and let their Vermont license lapse are also eligible to practice under the “deemed” framework described above. That is limited to telemedicine or to practice with the staff of a licensed facility in Vermont. Your license must have been in good standing when you retired and not have subsequently been subject to discipline. You need only to submit the notice telling us who you are and providing contact information and where you will be practicing.
Deemed licenses for Residents and Fellows who hold training licenses – residents and fellows who do not have a full license are eligible to be “deemed” to hold a Vermont training license, which we refer to as an LTL license. Those are not unlimited licenses but will allow you to practice as you may be assigned by your residency program. Examples of where this would apply are: Residents at DHMC who are assigned by their program to provide telehealth services are able to do so for patients in Vermont; DHMC residents who are assigned a new practice site in Vermont during the emergency. Some fellows hold full licenses – they fall under the general guidance that applies to holders of full licenses.
Deemed licenses for PAs – PAs may qualify to be deemed licensed in Vermont as described above. The Board is issuing a limited waiver of documentation requirements for PA supervision during the public health emergency. Answers to most questions regarding supervision requirements can be found by reviewing the announcement.
Emergency Licenses for Vermont Retirees
Retirees who held a Vermont license that lapsed more than 3 years ago but less than 10 years ago can apply for an Emergency License. All Vermont retirees who fall into this group must obtain an emergency license in order to practice and are not eligile for deemed licensure. Retired physicians who did not hold a Vermont license within the past 10 years are not eligible under the law.
To apply for an emergency license please click here after you have reviewed all the steps below.
- Create an account by choosing REGISTER. If you have already applied for licensure or have a lapsed Vermont license, please log into your existing account. DO NOT create another account. If you do not know your log in information, please use the password reset option.
- Once you have created an account or have logged in, from the ON-LINE SERVICES menu in the upper right-hand corner of the screen, choose "CREATE/CONTINUE APPLICATION" to start your application. You will choose the application for your profession: MD, PA or DPM. There is not a different application listed as “emergency” and do not fill out the Limited Temporary License Application as that is a training medical license for medical residents who are affiliated with a program.
- Follow these instructions that are specifically for emergency licenses ONLY and supersede any instructions within the online application.
The Board has received questions and expressions of concern about practicing medicine during the public health emergency brought about by COVID-19. Healthcare professionals have been forced to adapt to rapidly changing circumstances and this is only the beginning. The demand for services, constrained resources, the need to modify patient encounters to reduce risk of infection, and peers being unable to practice because of illness have impacted, or will impact, the way you treat patients.
What does all this mean for you in terms of your personal liability, either regarding discipline for unprofessional conduct, or with regard to malpractice liability?
With respect to the Board of Medical Practice and the potential for discipline based on a failure to meet the standard of care, you can be assured that your actions will always be judged based on the circumstances. That does not mean that anything goes in a crisis, but that due consideration will always be given to the circumstances in which you practice.
The law that defines the different forms of unprofessional conduct requires the Board to consider the circumstances whenever deciding if the standard of care was met, as seen in 26 V.S.A. § 1354(a):
22) in the course of practice, gross failure to use and exercise on a particular occasion or the failure to use and exercise on repeated occasions, that degree of care, skill, and proficiency that is commonly exercised by the ordinary skillful, careful, and prudent physician engaged in similar practice under the same or similar conditions, whether or not actual injury to a patient has occurred.
The Board does not play a role in malpractice lawsuits, and cannot give licensees legal advice, but we note that the statutory standard for malpractice liability includes comparable phrasing in the law that establishes what must be proved in a medical malpractice claim in Vermont, as seen in 12 V.S.A. § 1908:
In a malpractice action [ . . . ] the plaintiff shall have the burden of proving:
(1) the degree of knowledge or skill possessed or the degree of care ordinarily exercised by a reasonably skillful, careful, and prudent health care professional engaged in a similar practice under the same or similar circumstances whether or not within the State of Vermont;
(2) that the defendant either lacked this degree of knowledge or skill or failed to exercise this degree of care; and
(3) that as a proximate result of this lack of knowledge or skill or the failure to exercise this degree of care the plaintiff suffered injuries that would not otherwise have been incurred.
Healthcare professionals may also want to consult the State of Vermont guidance on medical services in times of crisis. The Vermont Department of Health has set forth a framework for operating in a public health emergency in a document known as the Crisis Standards of Care Plan. A summary of the plan and the plan itself are available on the Health Department website.
During the State of Emergency for COVID-19, there was a waiver of the requirement for PA supervision documentation for new practice situations arising during the State of Emergency. The waiver was in place from March 30, 2020 to June 15, 2021. Since June 15, 2021, all PAs have been required to have appropriate supervision documentation in place. The Board’s authority to waive the statutory requirement for supervision documentation expired with the end of the State of Emergency on June 15, 2021, and the Board has no authority to grant waivers of the legal requirements.
Questions about prescribing requirements during the declared emergency?
The US Drug Enforcement Agency has an informative webpage that is updated regularly. It addresses topics including whether requirements for in-person contact with patients for controlled substance prescribing are in effect.
Updated March 25th, 2020:
One of the important announcements issued by DEA is a relaxation of the requirement for prescribers of controlled substances to have a separate DEA registration for each state in which they prescribe or dispense controlled substances. Click here to read the announcement or visit the DEA website.