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How Can A Foreign Trained Doctor Obtain A Florida Medical License?

Doctors from around the world may decide that they would like to practice medicine in the State of Florida. Maybe it’s because of the beautiful weather and white sandy beaches, no state income taxes, its proximity to Latin America and the Caribbean, large immigrant and tourist population and Florida’s world-renowned hospitals and healthcare providers. No matter the reason, the process of moving to Florida to practice medicine has its challenges. These challenges may seem insurmountable without guidance from experienced attorneys. There’s a two-step process to practicing medicine in Florida: (1) the immigration visa process and (2) obtaining your license to practice medicine in Florida.

 

Certification and Residency Programs

Foreign Doctors wishing to practice clinical medicine in an unsupervised setting must be licensed by the Florida Board of Medicine (or Board of Osteopathic Medicine). All Doctors including those trained outside the U.S. are required to pass all four tests of the United States Medical Licensing Exam (USMLE) in order to obtain their Florida Medical License. International Medical Graduates (IMG) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). To become certified by ECFMG, an IMG must pass three USMLE exams, consisting of 1 multiple choice exam and two separate exams testing clinical knowledge and clinical skills.

Once a doctor receives ECFMG certification, she may apply for a hospital residency. The Electronic Residency Application Service (ERAS) is the most common way for doctors to enter into a residency program, which can last from three to eight years depending on the specialty that the IMG is seeking. Doctors have to complete a residency program regardless of their overseas training. IMGs who have received a visa are eligible to apply for a residency program in the United States.

Doctors are encouraged to apply to a minimum of 20 or more programs to increase their odds of “matching” or being accepted into a residency program. Registration can be completed through the National Resident Matching Program (NRMP), which can match you to a residency program based on individual preferences.

 

Licensure by Examination

According to Fla. Stat. §458.311, Any person desiring to be Florida licensed physician, who does not hold a valid license in any state may submit an application to the Florida Department of Health (DOH). The DOH has to certify that the person has: (a) completed the application form and paid the application fee; (b) is at least 21 years of age; (c) is of good moral character; (d) has not committed any act or offense in this or any other jurisdiction which would constitute the basis for disciplining a physician; and (e) if you graduated from medical school after October 1, 1992 you can prove that you have completed the equivalent of 2 academic years of pre-professional, post-secondary education prior to entering medical school.

Additionally, there are several medical education and postgraduate training requirements. A foreign doctor may satisfy this requirement if they can show that they graduated from an allopathic (or osteopathic) foreign medical school registered with the World Health Organization and certified pursuant to Florida statute as having met the standards required to accredit medical schools in the United States or reasonably comparable standards. If the language of instruction of the foreign medical school is other than English, the doctor must demonstrate competency in English through presentation of the ECFMG English proficiency certificate or by a satisfactory grade on the Test of Spoken English of the Educational Testing Service or similar test approved by the rule of the board. Finally, they must have completed an approved residency of at least 1 year.

Alternatively, if the doctor graduated from an allopathic foreign medical school which has not been certified pursuant to Florida statute, she may still be eligible if she has had her medical credentials evaluated by the ECFMG, holds an active, valid certificate issued by the ECFMG and has passed the examination used by the ECFMG. The doctor is also required to have completed an approved residency of at least 1 year, unless they graduated after October 1, 1992, then the applicant is required to have completed and approved residency or fellowship of at least 2 years in one specialty area.

The applicant also has to submit their fingerprints to the DOH for a criminal background check to be conducted. The Board of Medicine will not certify to the DOH any applicant for licensure who is under investigation in another jurisdiction for an offense which would constitute a violation of the laws pertaining to medical doctors until the investigation is completed.  Finally, the applicant has to obtain a passing score on the USMLE.

In spite of those doctors who have graduated from foreign medical schools which have not been certified pursuant to Florida statute, a graduate of a foreign medical school is not required to present the certificate issued by the ECFMG or pass the examination utilized by the ECFMG if they have: (a) received a bachelor’s degree from an accredited United States college or university; (b) studied at a medical school which is recognized by the World Health Organization; (c) completed all of the formal requirements of the foreign medical school, except the internship or social service requirements, and has passed part I of the National Board of Medical Examiners examination or the ECGMG examination equivalent; and (d) has completed an academic year of supervised clinical training in a hospital affiliated with a medical school approved by the Council on Medical Education of the American Medical Association and upon completion has passed part II of the National Board of Medical Examiners examination or the ECFMG examination equivalent.

 

Licensure by Endorsement

According to Fla. Stat. §458.313, a doctor can obtain a Florida medical license by endorsement if they apply and the board certifies that: (a) she has met the requirements of paragraphs (b)-(g) for licensure by examination; (b) obtained a passing score on the USMLE after January 1, 2000; and (c) has submitted evidence of active licensed practice of medicine in another jurisdiction, for at least 2 of the immediately preceding 4 years, or evidence of successful completion of either a board-approved postgraduate program within 2 years preceding filing of an application or a board-approved clinical competency examination within the year preceding the filing of an application for licensure.

“Active licensed practice of medicine” means the practice of medicine by physicians, including those employed by any governmental entity in community or public health, medical directors who are practicing medicine, and active teaching faculty of an accredited medical school. The Board of Medicine may require an application for licensure by endorsement to take and pass the appropriate licensure examination prior to certifying the applicant as eligible for licensure.

 

Conclusion

 There are tens of thousands of unlicensed foreign-trained doctors throughout the U.S. who have medical training and experience but are unable to practice in the United States. By the year 2030, experts anticipate that the US will be facing a shortage of roughly 100,000 doctors throughout the country. Spanish-speaking doctors and other foreign language speaking doctors are in high demand. Unfortunately, thousands of foreign doctors living in the US are working as waiters, parking garage attendants and other jobs that don’t utilize their medical training because they are unable to obtain their license. Florida lawmakers have used Fla. Stat. §456.021(1) to express their desire to encourage the use of foreign-speaking Florida residents duly qualified to become actively qualified in their professions so that all people of this state may receive better services. To this end, legislators passed a law stating that all persons who have successfully completed their studies and are deemed qualified for examination for a professional license must take that examination in English unless 15 or more applicants request that examination be administered in their native language. If you are able to obtain a Florida medical license you would be helping to alleviate the physician shortage and provide healthcare services to those who are in desperate need of doctors who speak the same language and have similar cultural backgrounds.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Implementing Policies and Procedures into your Medical Practice

As a child, my mother always stressed the importance of being neat and organized. She told me that I should be able to walk into my house in the dark and find anything that I need because I know exactly where it is. At the time, I didn’t know how those values would apply to not only my personal life but also my business life. With that being said, life gets in the way and there are days when my office or my house is in disarray. This reduces my productivity because I have to spend time searching for important documents at my office or my car keys at home.

I place a lot of emphasis on maintaining a neat and organized medical practice for all of my clients because it will make their life easier for numerous reasons. The best way to maintain a neat and organized medical practice is to implement policies and procedures that you and your employees must strictly follow. These policies and procedures can range from physical security of the facility, security of HIPAA protected information, employee time-keeping, janitorial services, medical substances and pharmaceutical drug internal audits, etc.

Everyone on the staff should be held accountable for the tasks that they perform or fail to perform. As the owner of the practice, you should periodically review the procedural tasks to make sure that everyone is performing their duties adequately and on-time. It only takes one missed log entry for a crisis to arise. This brings me to my next point, you should implement a policy where everyone on your staff must sign off on or use a unique identifier and password that only they have. This is important so that you can trace most of the activities that occur in your practice. Providers have to play “big brother” and watch over their practice because as you let things slide so will your staff and certain policies and protocols will be abandoned.

It is not unusual for a provider to contact me after a regulatory authority, such as the Florida Department of Health (“DOH”) or the Centers for Medicare & Medicaid Services (“CMS”) has contacted them about a potential violation within their practice (i.e. billing). Typically, these regulatory bodies make certain requests for documentation in their correspondence. I am often surprised by how unorganized the medical practice’s files are and the lack of adequate policies and procedures within the practice. As I mentioned earlier, I understand that life gets in the way, but being organized and having policies and procedures in place to maintain organization should be a priority. Lack of time will not be a valid excuse for the regulators. In fact, there are several state and federal record-keeping requirements that a medical practice must strictly adhere to or run the risk of receiving fines and penalties. Take one day or weekend and work alongside your staff to clean up those files and perform an audit of your inventory.

The following is a sample of some of the steps that I would take to ensure that my medical practice is neat and organized:

  • Create a formal policy and procedure manual that every employee must sign and adhere to.
  • Document everything and save it on-site as well as off-site on a cloud-based service and limit employee access to those documents.
  • Maintain employee files, including, but not limited to, emergency contacts, termination letters with reason for termination, professional and drivers licenses, periodic drug test results, personal and medical history, progress reports, professional and academic performance evaluations etc.

In the event that you have to self-report or if any state or federal regulatory authorities contacts your practice for a potential violation of a law or rule you should be as prepared as possible. Implement policies and procedures into your medical practice that will protect you and will ensure that your practice runs efficiently and smoothly. A healthcare attorney can assist you in creating a fully functioning policy and procedure manual specific to your practice.

My DEA Number was Stolen by an Employee and Used to Buy Controlled Substances

Most doctors have various licenses that provide them with unique identification numbers. If any of these identification numbers find their way into the wrong hands it can be detrimental to the healthcare provider’s practice, their patients, and the public. Doctors hire support staff to run their practice efficiently by perform tasks that they don’t have time to do or don’t have the training to perform. This employer-employee relationship requires a certain level of trust from both parties because a bad act by either party can have a negative impact on the other party’s license, privileges, or reimbursement for services. Some of the support staff working in a doctor’s office may have access to HIPAA-protected information and a doctor’s unique identification numbers, such as his NPI and DEA numbers. What should you do if one of your employees steals your DEA number and uses it to self-prescribe controlled substance through e-prescribing or traditional prescription pads? What if they use your DEA number to order controlled substances for the practice without your knowledge or consent? Doctors should also be concerned with their potential liability for the unauthorized use of their DEA number.

Keys to Successfully Operating a Multi-Disciplinary Medical Practice

Throughout Florida, a healthy number of licensed healthcare practitioners and healthcare entrepreneurs are joining or investing in multi-disciplinary practices for numerous reasons. The primary reason for their foray into this modern approach to the delivery of medicine is usually due to the rising costs of administering treatment. They are attracted to the idea of increasing revenue, minimizing administrative duties, and partnering with like-minded individuals that may grow their individual practice. However, there are several business and legal challenges that members of a multi-disciplinary practice must consider prior to participating in the practice.

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