Information Pertaining to the Practice of Medicine
The Medical Board of California provides licensee’s guidance in closing a medical practice to ensure a smooth transition, surrendering a physician’s and surgeon’s license, and with general inquiries and prohibition in regard to corporate practice of medicine to ensure compliance while avoiding complaints.
The following provides guidance to physicians regarding the closure of, or departure from, a medical practice office.
It is the Medical Board of California’s position that due care must be exercised when closing or departing from a medical practice. Not only does this ensure a smooth transition from the current physician to the new treating physician, but it also reduces the liability of "patient abandonment." Therefore, to ensure minimal disruption in continuity of care, the physician terminating the physician-patient relationship should notify patients sufficiently in advance.
Ultimately, it is the patient's decision from whom to receive medical care. However, it is the responsibility of all physicians and other parties who may be involved in the transition to ensure that:
- Patients are notified of changes in the medical practice. This is best done by mailing a letter to patients from the physician explaining the change and the final date of practice. The California Medical Association (CMA) recommends, if possible, that letters be sent by certified mail, return receipt requested, and that a copy of the letter with the return receipt be kept. CMA also recommends placing an advertisement in a local newspaper or posting notice of closure in the reception area for inactive patients.
- Patients are advised as to where their medical records will be stored including how they may access them. To facilitate the transfer of medical records to the new treating physician, upon written authorization, an authorization form should be included in the letter addressed to the patient notifying him or her of the change.
Assist the patient in obtaining care from another physician. If the physician is moving practices, provide an opportunity for patients to move practices and remain under their care. For information on retirement, the CMA offers a publication that addresses physician retirement issues. For more information, please visit the CMA website.
A physician may submit an application to voluntarily surrender their California physician's and surgeon's license. A surrendered license may not be renewed, reissued, reinstated, or restored. To regain licensure, the physician must reapply for a physicians and surgeons license. The physician is subject to current licensing requirements, including examination requirements.
In addition to completing an application to voluntarily surrender the license, the wall certificate and the last wallet (pocket) license issued must be returned to the Medical Board of California (Board). If the wall certificate and/or wallet (pocket) license is not in the possession of the physician, a written explanation must be submitted with the application.
Voluntarily surrender of a license may not be available if the physician is currently under investigation by the Board or if the Board has initiated disciplinary action against the physician.
The following is to provide guidance to physicians on the prohibition against the corporate practice of medicine. Corporate law can be complicated and it is encouraged that licensee’s discuss their medical practices and business enterprises with knowledgeable legal counsel that specializes in this area of practice.
Listed below are the most frequently inquired topics in regards to corporate practice of medicine.
Business and Professions Code (BPC), section 2052, states: "Any person who practices or attempts to practice, or who holds himself or herself out as practicing...[medicine] without having at the time of so doing a valid, unrevoked, or unsuspended certificate...is guilty of a public offense."
BPC, section 2400, states, in part: "Corporations and other artificial entities shall have no professional rights, privileges, or powers." This section of the law is intended to prevent unlicensed persons from interfering with, or influencing, the physician’s professional judgment.
The decisions described below are examples of some of the types of behaviors and subtle controls that the corporate practice doctrine is intended to prevent. From the Medical Board of California’s perspective, the following health care decisions should be made by a physician licensed in the State of California and would constitute the unlicensed practice of medicine if performed by an unlicensed person:
- Determining what diagnostic tests are appropriate for a particular condition;
- Determining the need for referrals to, or consultation with, another physician/specialist;
- Responsibility for the ultimate overall care of the patient, including treatment options available to the patient; and
- Determining how many patients a physician must see in a given period of time or how many hours a physician must work.
In addition, the following "business" or "management" decisions and activities, resulting in control over the physician's practice of medicine, should be made by a licensed California physician and not by an unlicensed person or entity:
- Ownership is an indicator of control of a patient's medical records, including determining the contents thereof, and should be retained by a California-licensed physician;
- Selection, hiring/firing (as it relates to clinical competency or proficiency) of physicians, allied health staff and medical assistants;
- Setting the parameters under which the physician will enter into contractual relationships with third-party payers;
- Decisions regarding coding and billing procedures for patient care services; and
- Approving of the selection of medical equipment and medical supplies for the medical practice.
The types of decisions and activities described above cannot be delegated to an unlicensed person, including (for example) management service organizations. While a physician may consult with unlicensed persons in making the "business" or "management" decisions described above, the physician must retain the ultimate responsibility for, or approval of, those decisions.
The following types of medical practice ownership and operating structures also are prohibited:
- Non-physicians owning or operating a business that offers patient evaluation, diagnosis, care and/or treatment;
- Physician(s) operating a medical practice as a limited liability company, a limited liability partnership, or a general corporation;
- Management service organizations arranging for, advertising, or providing medical services rather than only providing administrative staff and services for a physician's medical practice (non-physician exercising controls over a physician's medical practice, even where physicians own and operate the business); and
- A physician acting as "medical director" when the physician does not own the practice. For example, a business offering spa treatments that include medical procedures such as Botox injections, laser hair removal, and medical microdermabrasion, that contracts with or hires a physician as its "medical director."
In the examples above, non-physicians would be engaged in the unlicensed practice of medicine, and the physician may be aiding and abetting the unlicensed practice of medicine.
It is important to note that pursuant to BPC, section 2417.5, a business organization that offers to provide, or provides, outpatient elective cosmetic medical procedures or treatments that is not in compliance with the ban on the corporate practice of medicine is guilty of knowingly making or causing to be made a false or fraudulent claim for payment of a health care benefit pursuant to paragraph (6) of subdivision (a) of Section 550 of the Penal Code.
Prescription drug misuse and abuse, specifically opioids, is a huge problem in the United States. The Medical Board of California (Board) has joined forces with the California Department of Public Health, the California State Board of Pharmacy, and many other State agencies and stakeholders to expand prevention and treatment strategies as well as to decrease the amount of misuse in California. However, it is important to recognize that these medications are needed and have “an appropriate use”.
The Board is dedicated to working with the “Statewide Opioid Safety Workgroup” in educating and informing physicians and consumers, in conjunction with the Board’s number one mission of “consumer protection.”
- Resources for Providing Medication-Assisted Treatment for Opioid Use Disorder
- Statewide Opioid Safety Workgroup
- California’s Approach to the Opioid Epidemic
- Naloxone Prescription Requirements
- Board of Pharmacy Naloxone Information
- Guidelines for Prescribing Controlled Substances for Pain (November 2014)
- SAMHSA Opioid Overdose Prevention Toolkit
- Free Pocket Guide to Tapering Opioids for Chronic Pain Available from the Centers for Disease Control and Prevention
- California Department of Public Health - Prescriber Guidance Letter
- Centers for Disease Control and Prevention - Guideline for Prescribing Opioids for Chronic Pain
- Centers for Disease Control and Prevention - Opioid Overdose
- Centers for Disease Control and Prevention Online Training for Providers
- Medication-Assisted Treatment (MAT)
- Are Your Prescription Forms Compliant?
Most California-licensed physicians and surgeons must complete a one-time continuing medical education (CME) course in pain management and the treatment of terminally ill and dying patients. This course must also include the subject of the risks of addiction associated with the use of Schedule II drugs. Pathologists and radiologists are exempted from this requirement.
A physician and surgeon may meet the requirement in one of the following methods.
- By completing 12 CME hours in pain management and the treatment of terminally ill and dying patients. The 12 hours may be divided in any way that is relevant to the physician's specialty and practice setting. Acceptable courses may address either topic individually or both topics together. For example, one physician might take three hours of "pain management education" and nine hours of "the appropriate care and treatment of the terminally ill;" another physician might opt to take one 12-hour course that includes both topics. The Medical Board of California will accept any combination of the two topics totaling 12 hours. However, all courses must also include the risks of addiction associated with the use of Schedule II drugs. Physicians must complete the mandated hours by their second license renewal date after licensure. OR
- By completing a one-time mandatory 12-hour CME course on the treatment and management of opiate-dependent patients. This course must include 8 hours of training in buprenorphine treatment or other similar medicinal treatment for opioid use disorders. Physicians who choose this alternative must complete the CME requirements by their next license renewal date after licensure. Physicians who meet the definition of a “qualifying physician” as determined by the Board pursuant to 21 U.S.C. section 823(g)(2)(G)(ii) as read on January 1, 2018, shall be deemed to have met these requirements.
The courses or programs must be presented by an organization accredited to provide CME by the Accreditation Council for Continuing Medication Education, the American Medical Association (AMA), the California Medical Association (CMA), or the American Academy of Family Physicians (AAFP). In addition to accrediting CME providers, AMA, CMA, and AAFP may also present CME programs that will be accepted.
The 12 required hours would count toward the 50 hours of approved CME each physician is required to complete during each biennial renewal cycle.
Physicians are prohibited by BPC Section 651 (h)(5)(C) from advertising as “board certified” unless they are certified by:
- An ABMS member specialty board;
- A specialty board with an Accreditation Council for Graduate Medical Education (ACGME) accredited postgraduate training program; or
- A specialty board with equivalent requirements approved by the Board prior to January 1, 2019.
The Board has approved, and will continue to evaluate, the following specialty boards:
- American Board of Facial Plastic and Reconstructive Surgery (Approved: February 3, 1995)
- American Board of Pain Medicine (Approved: February 2, 1996)
- American Board of Sleep Medicine (Approved: February 6, 1998)
- American Board of Spine Surgery (Approved: May 10, 2002)
Effective January 1, 2019, Section 651 of the Business and Professions Code (BPC) was amended to remove the Medical Board of California’s (Board) authority to approve non-American Board of Medical Specialties (ABMS) specialty boards.
The law does not prohibit the advertising of specialization, regardless of board certification status, nor does it prohibit the use of diplomate, member, approved by, or any other term that is subject to interpretation by prospective patients.
For complete information on advertising requirements, please refer to BPC section 651(h).
Effective July 1, 2019, AB 2193 (Maienschein, Chapter 755) requires a physician and surgeon, providing prenatal or postpartum care to a patient, to offer screening or ensure the mother is appropriately screened for maternal mental health conditions. A maternal mental health condition, as defined in Health and Safety Code (HSC) section 123640, is an ailment that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression. A physician and surgeon does not need to offer screening to a patient when providing emergency services or care, as defined in HSC section 1317.1.
The law authorized the Board to take disciplinary action against a physician and surgeon for violation of the act, including issuance of a citation and fine.
A physician licensed in California is required by law to notify the Medical Board of certain specific occurrences. Reporting forms are provided for your use, links shown below. Pursuant to California Business & Professions Code:
- § 801.01(b)(2), a licensee must report malpractice settlements over $30,000 and judgments or arbitration awards of any amount, if the licensee does not possess professional liability insurance. (See Report of Settlement, Judgment or Arbitration Award)
- § 802.1, a licensee must report:
- The bringing of an indictment or information charging a felony against the licensee.
- The conviction of the licensee, including any verdict of guilty, or plea of guilty or no contest, of any felony or misdemeanor. (See Physician Reporting - Criminal Actions)
- §2240, a licensee who performs a medical procedure outside of a general acute care hospital, that results in the death of any patient on whom that medical treatment was performed by the licensee, or by a person acting under the licensee's orders or supervision, shall report, in writing, on a form prescribed by the board, that occurrence to the board within 15 days after the occurrence. (See Outpatient Surgery - Patient Death Reporting Form)
- § 2021, each licensee shall report to the board each and every change of address within 30 days after each change. (See Notification of Name Change and Address of Record)
End of Life Option Act – Effective June 9, 2016
ABX2 15 (Eggman, Chapter 1) establishes the End of Life Option Act (Act) in California, which becomes effective on June 9, 2016 and will remain in effect until January 1, 2026. This Act gives a mentally competent, adult California resident who has a terminal disease the legal right to ask for and receive a prescription from their physician to hasten death, as long as required criteria is met.
The law requires physicians to meet specific criteria if they are going to participate in this Act and prescribe aid-in-dying drugs to patients. The following resources give an overview of the requirements of the law for both physicians and patients:
- The Medical Board of California’s (Board) analysis of this bill
- Overview of the California End of Life Option Act - Winter 2016 Newsletter
- California Medical Association On Call Document
The law requires specified forms to be completed before the aid-in-dying drugs can be prescribed and additional forms after the drugs have been prescribed. These forms must be submitted to the California Department of Public Health (CDPH) and also included in the individual’s medical record.
- Attending Physician Checklist and Compliance Form
- Consulting Physician Compliance Form
- Patient’s Request for Aid-in-Dying Drug
- Interpreter Form (if one is used)
Final Attestation for Aid-in-Dying Drug – Pursuant to the Act, Section 443.5(a)(12), the physician must give this form to the patient when the aid-in-dying drug is prescribed and the patient must fill out the form within 48 hours prior to ingesting the aid-in-dying drug. Upon receiving the final attestation form, the attending physician must add this form to the medical records.
Attending Physician Follow Up Form – This form must be filled out by the physician within 30 calendar days following the death of a patient from ingesting the aid-in-dying drug, or any other cause, and submitted to CDPH.
For questions regarding this Act and its implementation, please contact the following:
- Regarding physician requirements: email EndOfLife@mbc.ca.gov
- Regarding forms that must be submitted to CDPH: visit CDPH's website at https://www.cdph.ca.gov/Programs/CHSI/Pages/End-of-Life-Option-Act-.aspx
Background and regulations:
Business and Professions Code Section 650 states in part that the: “…offer, delivery, receipt, or acceptance by any person licensed under this division of any rebate, refund, commission, preference, patronage dividend, discount, or other compensation…as…compensation or inducement for referring patients…to any person…is unlawful.”
Violation of the above is punishable by imprisonment, a fine of up to $50,000, or both. This law applies to referrals by physicians, dentists, nurses, and other health care professionals including chiropractors. The intent of the law is to protect the public from excessive health care costs, from referrals based on considerations other than the best interests of the patients, deceit and fraud, and payment to a licensee where professional services have not been rendered.
Medical assistants are unlicensed individuals who perform non-invasive routine technical support services under the supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife in a medical office or clinic setting without the need of receiving a certification. The supervisor must be on the premises in order for the medical assistant to perform non-invasive technical support services.Read More About Medical Assistants
What Is A Physician Assistant?
A physician assistant, or PA, is a licensed and highly skilled health care professional, trained to provide patient evaluation, education, and health care services. A PA works with a physician to provide medical care and guidance needed by a patient.Physician Assistant FAQs
The Medical Board does not provide referrals since it is a California state government agency that licenses and disciplines doctors. However, following is a list of organizations that may be able to assist you:
- Academy of Integrative Pain Management
- American Academy of Orofacial Pain
- American Academy of Pain Medicine
- American Chronic Pain Association
- American Headache Society
- American Pain Foundation
- American Pain Society
- American Society of Addiction Medicine
- American Society of Regional Anesthesia and Pain Medicine
- International Association for the Study of Pain
The California Guidelines for the Use of Psychotropic Medication with Children and Youth in Foster Care has been developed by the Department of Health Care Services and the California Department of Social Services. These guidelines were developed with the assistance of many stakeholders and are designed as a statement of best practice for the treatment of children and youth in out-of-home care.
Pursuant to the Department of Health Care Services, while these guidelines are not codified mandates for providers of mental health and/or social services, they have been developed for use in conjunction with existing mandatory State regulations related to the provision of Medi-Cal funded mental health services and community care licensing (CCL) regulations related to foster homes, group homes, and residential treatment centers. The Guidelines outline:
- Basic principles and values;
- Expectations regarding the development and monitoring of treatment plans; the principles for emotional and behavioral health care, psychosocial services, and non- pharmacological treatments;
- Principles for informed consent to medications; and
- Principles governing medication safety.
Although a physician is allowed to sever or terminate the patient/physician relationship, in order to avoid allegations of patient abandonment (unprofessional conduct), a physician should notify patients of the following in writing when the physician wishes to discontinue care:
- The last day the physician will be available to render medical care, assuring the patient has been provided at least 15 days of emergency treatment and prescriptions before discontinuing the physician's availability.
- Alternative sources of medical care, i.e., refer patient to other physicians, by name, or to the local medical society's referral service.
- The information necessary to obtain the medical records compiled during the patient's care (whom to contact, how and where).