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 issues and renews licenses to practice within the state. The Division of Licensing requires renewal every two years. Plan on allowing two to four months to have your initial application processed. For information on licensure, visit the site or call (916) 263-2382.

If you’re 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, visit the site or call (916) 263-3100.

REGISTER WITH THE DEA
To legally prescribe controlled substances, you must register with the Drug Enforcement Agency, (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.

• 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. Go to the California State Board of Pharmacy Web site. 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.

DEA phone numbers in California:

Northern California: (888) 304-3251
Southern California: (888) 415-9822

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’re calling about a specific case, have your patient’s claim number handy.

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

NHIC phone numbers:

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 here and click on Universal Credentialing Datasource.

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 important. For more information about reporting births and deaths, contact the Statistical Resources Section of the State of California Department of Health Services at (916) 552-8095. The California Department of Health Services, Prevention Services has made available a list of reportable diseases and conditions that can be accessed here. Because your local area my 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 here.

OBTAIN HOSPITAL PRIVILEGES
Before making any final decisions 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. CAFP has resources available should you have privileging questions or encounter difficulties obtaining desired privileges. Visit our Practice Resources section, or contact Sandra Newman at (415) 345-8669 ext. 226 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. Other resources are available here.

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 here.

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:

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. To order, call the CMA at (800) 882-1262. The cost is $399 plus sales tax for the CD-ROM. This handbook comes highly recommended -- every practice should have a copy. For more information, visit their Web site.

For California codes relating to the practice of medicine and the Medical Practice Act, click here, or send a self addressed envelope with a written request for “Guidebook to the Laws Governing the Practice of Medicine by Physicians and Surgeons” and a $5 check made payable to the Medical Board of California to 1426 Howe Avenue, Suite 54, Sacramento, CA 95825. Medical practice regulations governed by the Medical Board of California can also be found by visiting the State of California Office of Administration and Law 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.

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 $450, 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.

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 Practice, hospital staffs and other societies; and responding to Medical Board of California audits for you. Fifty continuing medical education credits (25 prescribed and 25 elective credits) are required to be reported to AAFP each year to maintain Board recertification. Start a record keeping system and stay current! If you have questions call the AAFP CME line at (800) 274-8043 or the CAFP office at (415) 345-8667. You can report your CME directly to AAFP here.

MAINTAIN YOUR MEMBERSHIP WITH CAFP
If you have just completed residency and are currently a member of the CAFP/AAFP, your membership will be automatically upgraded to Active membership. To maintain this status you will need to report your license and contact information to the AAFP. AAFP will send you a reporting form, and you will be billed automatically for your Active membership dues. A tiered dues scale is offered to physicians in their first three years of practice following residency. In recognition that those first three years can be financially challenging, the AAFP provides a 75% reduction of national dues in your first year in practice, a 50% reduction in the second year and a 25% reduction in the third year. Full dues will be billed thereafter.

If you are already an Active member and are moving to a state other than California, you will need to fill out the “Relocation Application for Continuing Membership” form. You can obtain this form from AAFP, CAFP, or your previous Academy state chapter.

ABOUT CAFP
The California Academy of Family Physicians’ mission is to advance the personal and professional development of California’s family physicians. With nearly 7,000 members, including active practicing family physicians, residents in family medicine, and medical students interested in the specialty, CAFP is the largest primary care medical society in California, and the largest chapter of the American Academy of Family Physicians.

For more information about the benefits of membership or details on how to obtain an application, go to Membership.