States regulate professions. If you are a licensed professional, chances are your license came from a state body acting under state law and regulation. Federal laws, which are uniform nationwide, generally have only limited, if any, effect on professional regulation. Professional regulation can therefore differ from state to state. If you face a license proceeding, then you should know your state's specific differences. General information can be helpful, but it can also mislead you as to state-specific issues. Recognize where and how states can differ on professional regulation. Know what you're up against.
Differences Generally From State to State
The differences from state to state can take several forms. Substantive rules for what constitutes misconduct may be similar from state to state, especially when state professional codes follow standards developed by national bodies. But state codes may also differ in details and specifics in that a violation in one state is not a violation in another state. Read more below about substantive differences in state codes, from state to state. The details can be important.
The agencies, committees, offices, or other bodies that regulate each profession may also differ from state to state. A professional facing a license proceeding should take any regulatory authority seriously, no matter its state-specific form. But the different agencies, committees, offices, or other regulatory bodies can have different authorities, procedures, customs, and conventions, affecting case outcomes. Know the specifics of your regulatory body, about which you can read more below.
States may also offer different diversion programs for professionals facing license issues. As a professional licensed in one state, you may find a favorable program to assist with a substance abuse issue or other issues, thereby preserving your license that would not be available in another profession or another state. Know available programs, about which you can read more below. And license proceeding outcomes can also certainly be different in different states. If you face a license proceeding, retain national professional license defense attorney Joseph D. Lento to help you evaluate the probable outcome and advise you on your state's other specific licensing issues. Consider the following summary of state-specific issues, for which this website's breakout pages provide more detail.
Substantive Differences in State Codes
The state agencies and bodies that regulate professions do not do so in a vacuum. They look to one another's professional conduct rules, codes, and regulations. They also look to rules, codes, and regulations developed and recommended by national professional associations. The American Medical Association's Code of Medical Ethics, the American Nurses Association's Code of Ethics for Nurses, and the American Bar Association's Model Rules of Professional Conduct for lawyers are all examples of national recommended codes. Those codes can be influential. You may find that the professional rule that your license proceeding implicates is similar to the rule in other states.
Yet states agencies and other bodies regulating the professions do not always adopt those national recommended codes wholesale. They may instead adopt those codes piecemeal or not at all. They may write their own codes meeting their own state's profession's history, traditions, culture, and commitment. The result can be a patchwork of differing state-to-state regulations. What one state permits, another state may reject as a professional rule violation. You can get into license trouble in one state for conduct that would be innocent or even customary in another state. Retain national professional license defense attorney Joseph Lento to advise you on your state's specific licensing distinctions. Those differences can include:
- Physicians facing different requirements regarding when they must report suspected misconduct by colleagues, whether and how they may practice medicine remotely, the terms on which they may involve medical students or others in the clinical care of patients, and when they may accept a gift from a patient
- Nurses facing differing interpretations as to when they may or must speak out on staffing shortages affecting clinical care, how to allocate limited resources, and when they must participate in beginning of life and end of life issues against their conscience
- Lawyers facing distinctions on whether a lawyer may accept referral fees, practice in a firm owned by non-lawyers, share fees with non-lawyers, offer non-lawyer services with lawyer services, participate in a lawyer referral service, retain or pay over interest on trust accounts, and advertise specialties
- Accountants facing differing interpretations on when an accountant may have a financial stake in the client's business, have a personal relationship with a client, perform with a conflict of interest, and report client fraud or other misbehavior
Differences in Professional Regulatory Bodies
States organize and regulate professions differently. Some states regulate professions primarily through state agencies. Other states delegate regulatory authority over some professions to professional bodies or associations led by appointed or elected members. Some states regulate professions through a combination of public agencies and professional bodies. In contrast, other states regulate one profession through a public body and another profession through a professional body or association. While some states have a single powerful office regulating many professions, other states delegate regulation to multiple boards, committees, and offices, while having a single office or a small number of offices act as complaint clearinghouses.
Differing professional regulatory structures means that you must know your state's specific structure for your profession. You may find yourself responding to a complaint served by one office, investigated by another, and heard and determined by a third office. Depending on the state and profession, having multiple agencies, boards, committees, or other bodies involved in your license proceeding would not be highly unusual. Retain national professional license defense attorney Joseph Lento to advise you on which agencies or bodies have what regulatory authority over you, under which professional codes. Examples include:
- New Jersey regulates physicians through a State Board of Medical Examiners governed by twenty-one professionals whom the governor appoints, nurses through a similar State Board of Nursing, accountants through a similar State Board of Accountancy, but lawyers through the Supreme Court of New Jersey's Office of Attorney Ethics;
- Pennsylvania regulates physicians through a State Board of Medicine, nurses through a State Board of Nursing of the Commonwealth, accountants through a State Board of Accountancy, but lawyers through the Disciplinary Board of the Supreme Court of Pennsylvania; and
- New York regulates physicians and physician assistants, nurses, accountants, engineers, and land surveyors through the state Office of the Professions, but lawyers through the Appellate Division of the New York State Supreme Court.
Differences in Professional Assistance Programs
Professionals who face license issues because of alcohol and drug addictions, or mental or physical disorders, may qualify for voluntary recovery programs, also known as professional assistance programs. Though differing from state to state, these programs generally delay or defer any license proceeding while the professional completes treatment for a diagnosed mental or physical disorder, including substance abuse disorders. Disciplinary authorities may not have compassion for professionals with mental or physical illness contributing to license issues. Yet professional assistance programs can provide compassionate, restorative treatment for professionals with license issues.
If you face a license issue related to a mental or physical condition or other explainable and forgivable cause, then seek reliable information and candid advice on available voluntary recovery programs. Assistance programs can be wise in some cases but unduly onerous and unwise in other cases. Some recovery programs require the participating professional to surrender the license, participate in unnecessary tests and services, and remain in the program for an unreasonable duration. Other programs are more flexible and thus more suitable for more professionals. You may be better off pursuing a recovery program to delay or avoid license sanction, or you may be better off fighting the misconduct charges. Call professional license defense attorney Joseph D. Lento now at 888.535.3686 or go online. State-specific assistance programs include:
- in New Jersey, the Professional Assistance Program providing substance abuse help for healthcare professionals, including physicians, nurses, dentists, and pharmacists. The program's services can include diagnosis and education and evaluation, treatment, monitoring, counseling, and medical advocacy. The State's Board of Nursing also has a Recovery and Monitoring Program (RAMP) assisting nurses in recovery from substance abuse issues;
- in Pennsylvania, the Voluntary Recovery Program for health professionals with diagnosed mental or physical disorders, including substance abuse disorder. Participating professionals enter into a consent agreement with the licensing body requiring program participation for at least three years;
- in New York, the Professional Assistance Program for professionals with substance abuse issues. Participating professionals surrender their licenses temporarily to avoid license proceedings, with the consent of a state committee, one member of which is from the profession's licensing board. The program refers professionals for treatment and monitoring. New York also offers a specific Statewide Peer Assistance for Nurses (SPAN) program and a similar Committee for Physician Health program.
Differences in License Proceeding Outcomes
The outcomes of license proceedings can also differ from state to state. Outcomes can vary whether the licensing bodies from state to state are similar or different or the state rules are similar or different. The reasons for outcome differences can be the state's specific norms, customs, traditions, and regulatory precedent. Professional culture and state politics can also influence outcomes in particular cases or types of cases. State and local events, constituencies, and interests differ. One outrageous, public example of professional misconduct may cause a state's disciplinary authority to overreact to other similar but less serious cases. A state disciplinary authority dominated by academics may treat misconduct differently than another state disciplinary authority dominated by practicing professionals. What one state treats as a serious offense, another state may treat as a minor offense, and vice versa.
Predicting outcomes can be important to how you proceed with your license defense. Discipline cases can resolve short of a final hearing. Not all cases go to a hearing. Cases often resolve by consent of the professional and agreement of the disciplinary authority. That's where predicting the probable outcome of your case at a final hearing can be critically important. Depending on the most likely outcome, you may be wise to accept or wiser to reject a proposed settlement arrangement. National professional license defense attorney Joseph Lento has the knowledge, skill, and experience to project probable outcomes. The Lento Law Firm can also research state databases on the sanctions in specific types of cases against professionals in specific professions. Those databases include, for example:
- the New Jersey Division of Consumer Affair's databases for physician, nursing, and physical therapist disciplinary case results;
- the Pennsylvania Department of State's listing of disciplinary actions taken by boards of twenty-nine different professions; and
- the New York State Department of Health's database for physician and physician assistant disciplinary case results.
Professional License Defense Attorney Representation
No matter your state-specific issue, you should recognize the value of retaining the best available attorney representation. Administrative license proceedings are special proceedings. Few lawyers know professional regulation, experience in administrative proceedings, and trial and negotiation skills necessary to a successful discipline defense. You need a lawyer with the unique expertise and experience of regularly defending professionals in license proceedings.
National professional license defense attorney Joseph D. Lento has that unique expertise and unusual experience. Attorney Lento has represented many professionals in many states before various agencies, bodies, boards, and committees. He has both the litigation-like skills and the administrative experience to act aggressively while counseling wisely. Attorney Lento also earned his way into his own profession. He knows the investment that a professional makes in education and their career and cares deeply about helping professionals preserve their reputation, career, and legacy. Attorney Lento has represented physicians, nurses, other medical professionals, lawyers, accountants, engineers, and hardworking professionals in the trades and other occupations and disciplines.