My partner is a therapist in Romania. She has the master's degree and required endorsements (called "attestations" in Romania) to practice, and she sees several Romanian clients.
She also speaks English, and is potentially interested in seeing American clients online. We understand that if she were to move to America and wanted to practice here, there is a process she would have to go through to demonstrate that her education and supervised clinical work are sufficient, and then she could get licensed like any American therapist.
But we are trying to understand if all of that is necessary if she wants to see American clients from Romania.
I can think of two analogues, and they lead to opposite conclusions.
It could be considered to be a form of medical tourism, which is legal. The difference of course is that the patient hasn't really traveled to the foreign country (except they have done so virtually). But in all other respects it's the same, in particular that the practitioner is qualified to practice in the foreign country, but would not be qualified to practice in the U.S. without going through some proving process.
We could consider it to be like an offshore gambling operation, which is illegal when accessed from the U.S. If you want to travel to the foreign country to gamble, you can. But if you are accessing the service from the U.S., even if all of the servers and transactions are handled offshore, it is not allowed.
Can you help me understand which of these two analogies is applicable or if there are some other angles I'm not considering?