New to Practice Checklist
The California Academy of Family Physicians has developed this checklist of action items and issues to consider as you enter practice in California, whether you have just completed residency or have moved here from another state.
Obtain your license
If you are an MD: The Medical Board of California's Division of Licensing develops and administers the physicians’ and surgeons’ examinations and also renews licenses to practice, which is required every two years. Allow at least four to six months to have your initial application processed; the Medical Board recommends starting the processing six to nine months before you need your license. For information on licensure, call (800) 633-2322 or go to www.mbc.ca.gov.
If you are a DO: Osteopathic physicians must be licensed by the Osteopathic Medical Board of California; renewal is required every two years. For information on osteopathic licensing, call (916) 928-8390 or go to www.ombc.ca.gov.
Register with the DEA
To legally prescribe controlled substances, you must register with the Drug Enforcement Agency (DEA). For more information, go to www.deadiversion.usdoj.gov or call (800) 882-9539.
- You must obtain a DEA number, issued by the US Department of Justice. It must appear on all prescriptions. If you move, a new number is required.
- Drug thefts or patients seeking restricted drugs under false pretenses must be reported to the DEA.
- Prescription pads for controlled substances may be ordered from any one of many approved printers.
- As of January 1, 2005, written prescriptions for controlled substances must be on tamper-resistant security prescription forms that have been preprinted by a Board-approved printer and must contain specific elements. For a list of approved security prescription vendors, go to the California State Board of Pharmacy website. You must first have your DEA number. It can take several months to obtain a provider number.
- Physicians may prescribe drugs only in the regular practice of their profession and may not furnish controlled substances to persons not under their care.
To reach your local DEA office, please call:
Northern California: (888) 304-3251
Southern California: (888) 415-9822
San Diego/Imperial: (800) 284-1152
Contact Medi-Cal and Medicare
California’s Medicaid program is known as Medi-Cal. For provider numbers and billing problems or concerns, call the Medi-Cal office at (800) 541-5555. If you are calling about a specific case, make sure to have your patient's claim number ready.
Medicare, the primary source of insurance for older Americans, is administered by Palmetto GBA. Contact Palmetto GBA at (866) 931-3901 for all claims, participation information, guidelines, and general information.
Enroll in HMOs, IPAs, and PPOs
For information regarding HMO, IPA, and PPO listings in California, contact the California Department of Managed Health Care at (877) 525-1295. Your local CAFP chapter or local medical society can also serve as a resource. The Council for Affordable Quality Healthcare has a new credentialing system recommended by the AAFP. For more information, go to www.caqh.org and click on Universal Provider Datasource.
Know Disease Reporting Requirements
Physicians are required to report a wide variety of diseases and conditions, including births and deaths, in California. Protecting public health, advancing scientific knowledge and guarding the safety of individuals at risk of violence are some of the reasons reporting is imperative.
Reporting births and deaths is done through county departments of public health. Reporting information is not available online; to request a booklet outlining reporting instructions, contact your county department of public health (use the link at the end of this section). The California Department of Public Health has made available a list of reportable diseases and conditions that can be accessed at cdph.ca.gov. Information on California's cancer reporting guidelines is available at the California Cancer Registry.
Because your local area may also have additional reporting requirements, you should contact your local department of public health for further information.
Obtain Hospital Privileges
Before making any final decisions about where you might practice, you should have a realistic sense of the typical scope of practice for family physicians in communities of interest, especially if you want to practice obstetrics or do procedures. Once you have settled on a practice location, you will need to apply to the medical staff office at the local hospital or hospitals before you will be allowed to admit or treat patients. Remember to keep all written documentation from your residency training regarding any and all procedures you have performed, especially gastrointestinal and obstetrical procedures. Resources are available from CAFP to help with privileging questions or difficulties encountered when trying to obtain desired privileges. Visit the Practice Resources section of CAFP's website or contact CAFP at (415) 345-8667 for more information.
Set Up Your Practice
If you are thinking about starting a new practice in California, start planning early. This process should begin with a careful evaluation of potential practice locations and managed care or other health insurance income streams. Allow ample lead time to become credentialed with Medicare, Medi-Cal, and commercial health plans.
Starting a new practice, or buying an existing practice, is a significant undertaking. For a step-by-step guide, CAFP recommends AAFP’s On Your Own: Starting a Medical Practice From the Ground Up, available online or from the AAFP’s Orders Department (800) 944-0000 (item #749). Go to www.familydocs.org for more resources.
Learn to Manage Your Practice
Read Family Practice Management. Published by the AAFP on a monthly basis, this magazine offers peer-reviewed advice on how to succeed as a family physician in the evolving health care system. It offers practical how-to articles and analyses of current issues. Full text copies of FPM are available online.
Visit CAFP’s website www.familydocs.org. The Practice Resources section has numerous resources to help you in your practice including information on coding and billing, working with consultants and attorneys, a forms directory, and the latest in practice management news. Check it out today!
Protect Yourself Legally
A malpractice crisis in the mid-1970s led to the passage of the Medical Injury Compensation Reform Act (MICRA), which placed a cap on non-economic damages (pain and suffering) in malpractice settlements. MICRA has been instrumental in maintaining affordable malpractice insurance in California. More information about MICRA can be found online.
Another by-product of the 1970s malpractice struggle was the emergence of physician-owned malpractice insurance companies, including:
The Doctors Company (800) 421-2368 www.thedoctors.com
NORCAL Mutual Insurance (800) 652-1051 www.norcalmutual.com
Medical Insurance Exchange of California (800) 227-4527 www.miec.com
Published Legal Resources
An ounce of prevention is worth a pound of cure, or so the saying goes. The single best resource for the ins and outs of the many aspects of California health law is the California Physician’sLegal Handbook, published by the California Medical Association. This CD-ROM series is a comprehensive reference for practicing physicians and covers both state and federal laws. To order, call the CMA at (800) 882-1262 or visit: www.cmanet.org. The cost is $480 for non-members and $398 for members, plus sales tax. This handbook comes highly recommended; every practice should have it.
For California codes relating to the practice of medicine and the Medical Practice Act, go to www.leginfo.ca.gov. Medical practice regulations governed by the Medical Board of California may also be found by visiting the State of California Office of Administration and Law Web site at www.oal.ca.gov.
You should have an attorney you know and trust to help with legal issues that may arise in the course of practice. Establish a relationship with an attorney before you need one in an emergency situation. For references, go toCAFP’s directoryof trusted attorneys.
CAFP’s Physician Employment Contract Review Service
Family physicians these days commonly begin life in practice as employees. Sometimes this is a trial period prior to being invited to become a partner in a practice. To make sure your rights are protected, you should seriously consider having your contract reviewed by a knowledgeable attorney familiar with health care law and medical practice issues. CAFP can help! For a modest fee of $525 for members and $700 for non-members, we will lead you through the process, from basic education to legal review for one contract with an experienced health care attorney. Contact CAFP at (415) 345-8667.
Set Up Your CME Record Keeping
CAFP works with AAFP to maintain your CME records, automatically re-electing you to membership in both organizations if you have sufficient CME, verifying your CME hours to the American Board of Family Medicine, hospital staffs and other societies, and responding to Medical Board of California audits for you. You need to earn and report 150 (75 must be AAFP Prescribed credits; 75 may be elective credits) CME credits each three-year election cycle. Start a record keeping system and stay current! If you have questions, call the AAFP CME line at (800) 274-2237 or CAFP at (415) 345-8667. You may report your CME directly to AAFP online at www.aafp.org/mycme.
Maintain Your Membership with CAFP/AAFP
If you have just completed residency and are currently a member of the CAFP/AAFP, your membership will be automatically upgraded from resident membership to Active membership. To maintain this status, you must report your license and contact information to the AAFP. AAFP will send you a reporting form, and you will be billed automatically for your dues. If you are already an Active member and are moving to another state, you should complete the “Relocation Application for Continuing Membership” form at www.aafp.org/relocation. You may also obtain this form from AAFP, CAFP, or your previous Academy state chapter.
Online Resources for the New FP
New family physicians have said they are most concerned about practice management, staying current with medicine, medico-legal issues, technology management, reimbursement and coding, career management and connecting with fellow family physicians. CAFP has compiled a list of websites on each of these topics to help you better manage your practice and career.
Family Practice Management
National Guideline Clearinghouse
Medical Professional Management and Marketing
CAFP’s Practice Resources
CMA On-Call Legal Resource Center
AMA’s Legal Issues for Physicians
Cooperative of American Physicians
Harvard University Risk Management Foundation
Payment and Compensation Information
Medical Group Management Association
Family Practice Management
Coding & Billing Monograph (updated annually)
Staying Current with Medicine
American Family Physician
Journal of Family Practice
ACP Journal Club
Essential Evidence PLUS
AAFP’s Center for Health Information Technology
AAFP Partners for Patients E.H.R. Program
Family Practice Management
Employment Opportunities and Career Planning
FP Jobs Online
AAFP Physician Placement Services and Career Opportunities Online
American College of Physicians Career Opportunities
Family Medicine Specialty Resources
California Academy of Family Physicians
American Academy of Family Physicians
American Board of Family Medicine
AAFP CME Courses
AAFP Discounts for New FPs
Loan Repayment and Debt Management
Many changes to loan repayment programs have been made in recent years. For more information on options available, go to the financial management for residents webpage.
Healthcare Workforce Development
Division National Health Service Corps (NHSC)/State Loan Repayment Program
AAMC Educational Debt Management Services for Residents
Health Professions Education Foundation
Steven M. Thompson Physician Corps Loan Repayment Program