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're 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. Plan on allowing two to four months to have your initial application processed. For more information on licensure, call (800) 633-2322 or go to http://www.medbd.ca.gov/.
• If you're a DO-You must be licensed by the Osteopathic Medical Board of California, and renewal is required every two years. For information on osteopathic licensing, call (916) 263-3100 or go to http://www.ombc.ca.gov/.

Register with the DEA
In order to legally prescribe controlled substances, you must register with the Drug Enforcement Agency.  For more information, go to http://www.deadiversion.usdoj.gov/ or call (800) 882-9539.  You must obtain a DEA number, issued by the Department of Justice in Washington, DC.  It must appear on all prescriptions.  If you move, a new number is required.

Physicians may prescribe drugs only in the regular practice of their profession and may furnish controlled substances only to persons under their care.

To reach your local DEA office, please call:
Northern California: (916) 480-7250
Southern California: (213) 621-6942
San Diego and Imperial Counties: (858) 616-4100

Contact Medi-Cal and MediCare
California's Medicaid program is known as Medi-Cal (http://www.medi-cal.ca.gov/).  For provider numbers and billing problems or concerns, call the Medi-Cal office at (800) 541-5555.  If you're calling about a specific case, make sure to have your patient's claim number ready.

Medicare, the primary source of insurance for elderly Americans, is administered by the National Heritage Insurance Company (NHIC), http://www.medicarenhic.com/.  Contact NHIC for all claims, participation information, guidelines, and general information.

NHIC phone numbers:
Northern California: (877) 591-1587
Southern California: (866) 502-9054

Know Disease Reporting Requirements
Physicians are required to report a wide variety of diseases and conditions, including births and deaths, in California.  Protecting the public health, advancing scientific knowledge, and guarding the safety of individuals at risk of violence are some of the reasons reporting is imperative.  For more information about reporting births and deaths, contact the statistical resources section of the Statistical Resources Section of the State of California Department of Health Services at (916) 445-4171 or visit http://www.dhcs.ca.gov/.  The California Department of Health Services, Prevention Services, has made available a list of reportable diseases and conditions that can be accessed at ww2.cdph.ca.gov/HealthInfo/discond/Documents/SSS_Reportable_Diseases.pdf.  Because your local area may also have additional reporting requirements, you can contact your local department of public health for any further information.  Links to your city or county department of public health can be found at ww2.cdph.ca.gov/programs/immunize/Pages/CaliforniaLocalHealthDepartments.aspx.

Obtain Hospital Privileges
Before making any final decision about where you might practice you should have a realistic sense of the typical family physician scope of practice in communities of interest, especially if you want to practice obstetrics.  Once you've 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 http://www.familydocs.org/ or contact Sandra Newman at (415) 345-8668 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.

Learn to Manage Your Practice

Read Practice Management News
Published on a monthly basis, this e-newsletter focuses on quality improvement and best practices advice on how to succeed as a family physician in the evolving health care system.

Browse CAFP's Practice Resources
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.

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. More information about MICRA can be found here. Another by-product of the ‘70s malpractice struggle was the emergence of physician-owned malpractice insurance companies, including:

The Doctors Company
(800) 421-2368

Southern California Physicians Insurance Exchange
(310) 551-5900

NORCAL Mutual Insurance
(415) 397-9700

Medical Insurance Exchange of California
(800) 227-4527

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's Legal 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. For more information, visit their Web site.

Attorneys
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 to our consultant list, or visit the AAFP Web site.

Employment Opportunities and Career Planning

• FP Jobs Online-www.fpjobsonline.com
• AAFP Physician Placement Services and Career Opportunities-www.aafp.org/careers
• American College of Physicians/American Society of Internal Medicine Career Opportunities-www.acponline.org/jobs

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 healthcare law and medical practice issues. CAFP can help! For a modest fee of $525, we will lead you through the process, from basic education to legal review with a qualified health care attorney. For more information, contact Sandra Newman at (415) 345-8667.

Continuing Medical Education
Continuing Medical Education (CME) requirements must be for licensure renewal and re-certification.  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.  Contact the AAFP at (800) 274-2237 if you have questions or would like to report your CMEs.