Do doctors go see other doctors when they're sick?

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Maybe I didn't find anything through search because it's a really stupid question, but generally, do family doctors see other family doctors or do they take care of their own business?

Is this legal? Can you prescribe yourself medicine?

Originally Posted by Parklife

Maybe I didn't find anything through search because it's a really stupid question, but generally, do family doctors see other family doctors or do they take care of their own business?

Is this legal? Can you prescribe yourself medicine?

When it comes to simple things, the ethics of this are mostly up in the air. Ex: If a physician sees themselves (or one of their family members) with a sore throat, hx of a recent fever, noticeable tonsilar exudates, palpable lymphadenopathy, and no recent cough, most people will say it's OK to prescribe abx.

On the other hand, if you think you need any sort of narcotic, benzo, or anything else that requires a DEA number, no way in hell should you prescribe that to yourself or anyone that might even tangentially be related to you. Not unless you want to lose your license.

(Also, depending on where you work, a lot of doctors will just see each other for free. No copays, etc)

[QUOTE=Parklife;12934711]Maybe I didn't find anything through search because it's a really stupid question, but generally, do family doctors see other family doctors or do they take care of their own business?

i agree with teh above post

Originally Posted by Raryn

When it comes to simple things, the ethics of this are mostly up in the air. Ex: If a physician sees themselves (or one of their family members) with a sore throat, hx of a recent fever, noticeable tonsilar exudates, palpable lymphadenopathy, and no recent cough, most people will say it's OK to prescribe abx.

Most people might say it is okay, but no ethics committee would agree with them. There is no reason you should ever be prescribing for yourself or anyone that would be a conflict of interest. It doesn't matter how 'obvious' the need is or how benign the script is. It is wrong to write it. The general public may not care, but hospital ethics committees, courts and state licensing boards do.

Originally Posted by mimelim

Most people might say it is okay, but no ethics committee would agree with them. There is no reason you should ever be prescribing for yourself or anyone that would be a conflict of interest. It doesn't matter how 'obvious' the need is or how benign the script is. It is wrong to write it. The general public may not care, but hospital ethics committees, courts and state licensing boards do.

I don't think you'll find any instance where a court or licensing board ever disciplined someone for writing for antibiotics for a sinus infection for themselves. I have only ever heard of issues when it involved a controlled substance.

Originally Posted by TheProwler

I don't think you'll find any instance where a court or licensing board ever disciplined someone for writing for antibiotics for a sinus infection for themselves. I have only ever heard of issues when it involved a controlled substance.

I doubt that you could find an instance of an abx prescription leading to an issue, agreed. But, that isn't the point. There is a line that exists somewhere between abx and narcotics that is hard to delineate. People who get in trouble have patterns of unethical script writing. It is hard to defend someone in the grey areas if they have shown a history of writing relatively benign scripts for people they shouldn't be writing for. It is also a slippery slope. The few cases that I know about all centered around a physician that simply escalated from antibiotics to an inhaler to Norco or something similar. People will convince themselves that it is just one step beyond what they are already doing and keep going.

There is no good reason to self-prescribe except convenience. The hospital that I'm at has a blanket policy of investigation and possible termination for questionable script writing for self/family/friends. Someone asked about emergencies and their response was, case by case, but it is really hard to come up with an 'emergency' that could possibly qualify.

Originally Posted by mimelim

Most people might say it is okay, but no ethics committee would agree with them. There is no reason you should ever be prescribing for yourself or anyone that would be a conflict of interest. It doesn't matter how 'obvious' the need is or how benign the script is. It is wrong to write it. The general public may not care, but hospital ethics committees, courts and state licensing boards do.

and I believe it will be inconsequential up until it shows up in an unrelated case where a patient is suing you

better to just not take the risk and potentially open yourself up to questions of ethical behavior.

Originally Posted by mimelim

I doubt that you could find an instance of an abx prescription leading to an issue, agreed. But, that isn't the point. There is a line that exists somewhere between abx and narcotics that is hard to delineate. People who get in trouble have patterns of unethical script writing. It is hard to defend someone in the grey areas if they have shown a history of writing relatively benign scripts for people they shouldn't be writing for. It is also a slippery slope. The few cases that I know about all centered around a physician that simply escalated from antibiotics to an inhaler to Norco or something similar. People will convince themselves that it is just one step beyond what they are already doing and keep going.

I don't think it's that slippery. Don't ever prescribe scheduled medications to yourself or your family/friends, or anyone with whom you don't have a physician/patient relationship that you have documented.

There is no good reason to self-prescribe except convenience. The hospital that I'm at has a blanket policy of investigation and possible termination for questionable script writing for self/family/friends. Someone asked about emergencies and their response was, case by case, but it is really hard to come up with an 'emergency' that could possibly qualify.

Which, in the case of something minor, seems like a good enough reason to me. I can't write for myself, because my program prohibits it, so I never have.

As Sir William Osler said, "A physician who treats himself has a fool for a patient."

I guess the question is why do licensing boards, hospitals, residencies, etc, have a problem with this behavior? The answer is because it is bad medicine at best, dangerous at worst. It should be obvious that you can't objectively diagnose and treat your own problems.

As far as getting in trouble goes, nonscheduled substances probably won't come back to haunt you. But still, it's a lot smarter to call your own physician or even just sideline a colleague at the hospital and ask them to help you out.

Prescribing for family/friends also usually a bad idea. Keep in mind that all requirements of documentation and standards of care hold true no matter who you are treating. In other words, you shouldn't be doling out the abx without taking a history and physical and documenting it. As a resident you can't prescribe for anyone not seen in the context of residency activities with appropriate supervision.

You may be thinking to yourself, what's the big deal? What could happen? It's just a little cipro for a UTI or something. How are you going to feel when Aunt Millie or whoever comes down with fulminant c. diff colitis after your rx? Probably pretty terrible. And that probably will happen, because as a rule friends, family, and hospital employees usually have bad outcomes and complications.

Originally Posted by TheProwler

I don't think it's that slippery. Don't ever prescribe scheduled medications to yourself or your family/friends, or anyone with whom you don't have a physician/patient relationship that you have documented.


Which, in the case of something minor, seems like a good enough reason to me. I can't write for myself, because my program prohibits it, so I never have.

Bingo.

I've written something for myself twice, both times on a Sunday, and both times just a 1 day supply until I could talk to a fellow resident on Monday about my problem.

Originally Posted by cpants

Prescribing for family/friends also usually a bad idea. Keep in mind that all requirements of documentation and standards of care hold true no matter who you are treating. In other words, you shouldn't be doling out the abx without taking a history and physical and documenting it. As a resident you can't prescribe for anyone not seen in the context of residency activities with appropriate supervision.

Untrue, how else do you explain moonlighting? Once you have a permanent license, you're generally in the clear to go be a doctor as far as your state board is concerned. Your malpractice situation is still iffy, but that's a whole different ballgame.

Originally Posted by VA Hopeful Dr

Untrue, how else do you explain moonlighting? Once you have a permanent license, you're generally in the clear to go be a doctor as far as your state board is concerned. Your malpractice situation is still iffy, but that's a whole different ballgame.

Yeah should revise. Your residency malpractice coverage will not cover anything you do outside of supervised residency activity. If you have your permanent license, you can do what you want at your own risk. Better use your own prescription pad and DEA number though.

Originally Posted by mimelim

I doubt that you could find an instance of an abx prescription leading to an issue, agreed. But, that isn't the point. There is a line that exists somewhere between abx and narcotics that is hard to delineate. People who get in trouble have patterns of unethical script writing. It is hard to defend someone in the grey areas if they have shown a history of writing relatively benign scripts for people they shouldn't be writing for. It is also a slippery slope. The few cases that I know about all centered around a physician that simply escalated from antibiotics to an inhaler to Norco or something similar. People will convince themselves that it is just one step beyond what they are already doing and keep going.

There is no good reason to self-prescribe except convenience. The hospital that I'm at has a blanket policy of investigation and possible termination for questionable script writing for self/family/friends. Someone asked about emergencies and their response was, case by case, but it is really hard to come up with an 'emergency' that could possibly qualify.

Whenever this topic comes up there's always these guys coming out of the woodwork saying oh my lord no, never in a million years would I prescribe aspirin to myself, somebody take that man's license!

Yet when it comes to other instances of poor clinical judgment by a healthcare practitioner out on the wards where patients actually get hurt / sick / suffer / die ...the silence from the peanut gallery is deafening.

Never understood that. Still don't.

Originally Posted by hrandani

Whenever this topic comes up there's always these guys coming out of the woodwork saying oh my lord no, never in a million years would I prescribe aspirin to myself, somebody take that man's license!

Yet when it comes to other instances of poor clinical judgment by a healthcare practitioner out on the wards where patients actually get hurt / sick / suffer / die ...the silence from the peanut gallery is deafening.

Never understood that. Still don't.

This makes no sense, but okay. Your first paragraph describes nothing that I said. Your second paragraph is ridiculously vague. How is there silence when someone makes a mistake? Are you posting in the thread that you meant to? Why are you quoting me?

Wait a minute. So you're actually allowed by law more or less to write a script for yourself, or your family if you wanted to? Ignoring the consequences, a doctor could write a script for antibiotics and walk right into Walgreen's and pick it up?

That seems wrong to me.

As far as I know physicians can buy prescription medications in bulk without a prescription for a particular person. It's how small practices and free clinics can stock medications.

There are companies that support it:
http://www.physicianspractice.com/ma...462168/1780335

I'm curious how it actually works. How you'd order a case of Lipitor or whatever.

This opens up all sorts of potential abuse, but I guess is essential to providers in rural areas.

Anyone here about the urologist who did his own vasectomy?

Originally Posted by DreadfulGlory

Wait a minute. So you're actually allowed by law more or less to write a script for yourself, or your family if you wanted to? Ignoring the consequences, a doctor could write a script for antibiotics and walk right into Walgreen's and pick it up?

That seems wrong to me.

Explain why

Originally Posted by DreadfulGlory

Wait a minute. So you're actually allowed by law more or less to write a script for yourself, or your family if you wanted to? Ignoring the consequences, a doctor could write a script for antibiotics and walk right into Walgreen's and pick it up?

That seems wrong to me.

Why. The general public can go pick up tylenol, NSAID's and PPI's if they think it is needed so why shouldn't a licenced physician be able to do so for abx

Originally Posted by DreadfulGlory

Wait a minute. So you're actually allowed by law more or less to write a script for yourself, or your family if you wanted to? Ignoring the consequences, a doctor could write a script for antibiotics and walk right into Walgreen's and pick it up?

That seems wrong to me.

Every physician I know treats themselves and their family for anything minor, including short course antibiotics.

Perhaps you're early on in your training, but it seems to me that physicians value this independence greatly, and I can see why.

Well Sheldor is correct. I am new to things like this.

I am not necessarily worried about the general use of abx or minor drugs like that. I guess what I should be asking is can they also get the narcotics and more powerful substances? Obviously they might have it stocked alamo4 pointed out.

As far as treating loved ones, I don't see the problem with that more or less. I know there is that boundary where you might not be able to make the right judgment call, but I would hope that you are better trained than that as a doctor to begin with. For example, my own mother right now has a UTI. No, these typically don't cause any sort of problem and can easily be dealt with. In many cases, doctors don't like prescribing abx for these because it is so easy to develop tolerances for antibiotics. Nevertheless, lets say I'm a doctor now. My mom can drink a whole bunch of cranberry juice and try to flush her system out which has worked in the past. But what if this time that is not helping. She comes to me and wants me to write her a script for some antibiotics. Well, I don't see the harm in that. I may be missing something in reality but I really don't see any harm in that. I can see what the industry frowns on it, and I can see where it is safer to just not partake in any sort of activity like that. But come on, I am going to write her a friggin script for abx. Now if she came to me with back pain and wanted me to write her a script for Vicodin, I'm probably going to tell her to go jump in a ****ing lake.

Originally Posted by cpants

As far as getting in trouble goes, nonscheduled substances probably won't come back to haunt you. But still, it's a lot smarter to call your own physician or even just sideline a colleague at the hospital and ask them to help you out.

Prescribing for family/friends also usually a bad idea. Keep in mind that all requirements of documentation and standards of care hold true no matter who you are treating. In other words, you shouldn't be doling out the abx without taking a history and physical and documenting it.

I think that sidelining a colleague is a particularly bad idea, unless you and they are willing to document the encounter in your medical record, and at that point, you're just asking them for pro bono work. Now you might be getting them in trouble too.

Originally Posted by DreadfulGlory

I am not necessarily worried about the general use of abx or minor drugs like that. I guess what I should be asking is can they also get the narcotics and more powerful substances? Obviously they might have it stocked alamo4 pointed out.

No, because those are scheduled drugs, like I pointed out.

An interesting ethical issue related to this came up at one of the institutions I worked at and now physicians are being scrutinized for prescribing certain abx and antivirals.


What happened was that quite a few physicians Rx'd antivirals to themselves and relatives during the H1N1 outbreak, even if those people weren't actually sick yet, or for people who were sick but didn't meet the recommended guidelines to get the antivirals . Since there was a shortage of some of the drugs and some patients who were sick and definitely did need them couldn't get them. It was definitely a problem for the physicians to do this. The institution is evaluating it's policy and sent out a strongly worded notice about it.

Originally Posted by wholeheartedly

An interesting ethical issue related to this came up at one of the institutions I worked at and now physicians are being scrutinized for prescribing certain abx and antivirals.


What happened was that quite a few physicians Rx'd antivirals to themselves and relatives during the H1N1 outbreak, even if those people weren't actually sick yet, or for people who were sick but didn't meet the recommended guidelines to get the antivirals . Since there was a shortage of some of the drugs and some patients who were sick and definitely did need them couldn't get them. It was definitely a problem for the physicians to do this. The institution is evaluating it's policy and sent out a strongly worded notice about it.

Definitely an interesting case, and a case which shows why sometimes benign scripts aren't so benign. However, that's a very special case.

I have physician parents, and they've always called in / written scripts for our family for minor things. Great example being I traveled abroad at high altitude, my mom called in my mefloquine, diamox, and a stash of abx for me to have for the trip without having to go to a travel med clinic. I don't see anything ethically wrong with that, and I certainly expect unless they pass a law or the state board makes a rule about it I will do the same for my own family.

I guess we can argue about whether it constitutes good ethics or good medicine, but it's certainly widely practiced among physicians. Obviously narcs are a no-no (and nobody is dumb enough to call those in for themselves, or so you'd hope), but day-to-day scripts? eh.

Originally Posted by TheProwler

I think that sidelining a colleague is a particularly bad idea, unless you and they are willing to document the encounter in your medical record, and at that point, you're just asking them for pro bono work. Now you might be getting them in trouble too.

In my experience, this is limited to partners in your practice. I think this is somewhat better.

Originally Posted by VA Hopeful Dr

In my experience, this is limited to partners in your practice. I think this is somewhat better.

I saw an anesthesiologist ask an ED doc for some Augmentin for cellulitis on his leg. He gave it to him, but I also saw that he was documenting it in his medical record.

Originally Posted by hrandani

Whenever this topic comes up there's always these guys coming out of the woodwork saying oh my lord no, never in a million years would I prescribe aspirin to myself, somebody take that man's license!

Yet when it comes to other instances of poor clinical judgment by a healthcare practitioner out on the wards where patients actually get hurt / sick / suffer / die ...the silence from the peanut gallery is deafening.

Never understood that. Still don't.

Originally Posted by mimelim

This makes no sense, but okay. Your first paragraph describes nothing that I said. Your second paragraph is ridiculously vague. How is there silence when someone makes a mistake? Are you posting in the thread that you meant to? Why are you quoting me?

He's posting in the correct thread...to the correct post, and he's quoting you because you don't see his point.

The first paragraph describes the basic reaction from early practioners/students to this thread, which is, "Nope, no sir...I wouldn't do it, I wouldn't prescribe for anything unless I immediately and completely documented it. The liability is too high and I'm not risking my freshly earned prescribing privileges."

Not that this attitude is wrong in any way! But from the other half of the comments, it's pretty apparent that a bit of scripting goes on between friends and relatives. In my experience, that's never been a problem either. But I think that hrandani is noticing this because it's doctors critiquing doctors, not the lay public or lawyers.

The second paragraph notices that physicians as a group tend to stick together and close ranks when one of their own is accused of malpractice. Especially since a lot of cases (esp. ones that make the news) that get paid out are not due to any actual negligence on the part of the doctor, but are ADRs, nosocomial infections or something else adversely random that happened even while all the best practices were being adhered to...and since the lay public and lawyers are the ones doing the accusing, physicians clam up, e.g., 'the silence from the peanut gallery is deafening.'

Claro? Let's hope!

In my state, once you get your DEA # and medical license (at the beginning of your PGY2 year) you can write for people outside the hospital. Not covered by hospital malpractice, of course. You can write for yourself. No specific policy against it. I see no reason why not.
After all, if the insurance agent down the street is insuring his own cars and house through his company for really cheap, and the mason across the street from me is remodeling his own house for free, I can't give my gf a script for birth control?!
As mentioned above, controlled substances are a big no-no, for yourself or people who are not your patients. Plus, unless it's a small thing, it's always better to go see someone else. I also like being a regular patient (not asking a friend for special treatment). I want the physician full time and attention if I have an issue, not just 5 minutes to do me a favor.

Originally Posted by plauto

After all, if the insurance agent down the street is insuring his own cars and house through his company for really cheap, and the mason across the street from me is remodeling his own house for free, I can't give my gf a script for birth control?!

I agree with this...little things you've been taking for ages should be no big deal to write for (generalizing here, I'm sure there are exceptions) such as birth control or albuterol for exercise induced asthma, etc. Easier than calling for a refill from your doc - then he/she forgets - you call again - call the pharmacy to see if it went through - ....etc.

I'm an Eagle Scout and when I was a teenager we would go on week(s)-long wilderness adventure trips each summer. There was usually a doctor from our church group who came along to tend to any medical problems that arose. It was usually just minor things, and we all had to sign liability waivers in order to go.

He would bring a suitcase of "doctor stuff" which, in addition to your typical first aid kit paraphernalia, also included suture supplies (including local anesthetic) and in case of a true emergency atop some mountain I believe he even carried a couple prescription inhalers and a little narcotic pain medication (although he never had to use them as far as I know).

Is that type of thing OK to do, or was he stretching the limits? What about emergency first aid kits to keep in the trunk of your car? Intuitively it seems like it should be alright for a physician's emergency kit to be a lot more advanced than your layman's emergency kit, as long as they are adequately trained to use it.

Or maybe that's just a ridiculous idea in today's uber-regulated and litigious world. The doc I mentioned was from a different generation.

Originally Posted by Morzh

I'm an Eagle Scout and when I was a teenager we would go on week(s)-long wilderness adventure trips each summer. There was usually a doctor from our church group who came along to tend to any medical problems that arose. It was usually just minor things, and we all had to sign liability waivers in order to go.

He would bring a suitcase of "doctor stuff" which, in addition to your typical first aid kit paraphernalia, also included suture supplies (including local anesthetic) and in case of a true emergency atop some mountain I believe he even carried a couple prescription inhalers and a little narcotic pain medication (although he never had to use them as far as I know).

Is that type of thing OK to do, or was he stretching the limits? What about emergency first aid kits to keep in the trunk of your car? Intuitively it seems like it should be alright for a physician's emergency kit to be a lot more advanced than your layman's emergency kit, as long as they are adequately trained to use it.

Or maybe that's just a ridiculous idea in today's uber-regulated and litigious world. The doc I mentioned was from a different generation.

I don't see how that would get you in trouble unless there was an adverse event related to treating someone in the wilderness. I mean, the dude is there to provide medical care, so it's perfectly legit for him to have the tools to do so.

EDIT: I am reading the policies of various medical boards. In general, it seems like prescribing your mother or your wife a short course of cipro for an uncomplicated UTI would be absolutely fine if they couldn't get this in a timely fashion from another physician. Also, it is obviously ethical to treat a loved one in an emergency situation (chest compressions, etc.) Someone mentioned something about prescribing their girlfriend birth control; this is probably not such a great idea. Birth control is a long-term medication and you might have to make several adjustments based on how they react to it, so they should probably start a new prescription with their own provider, because it's inappropriate to be your girlfriend's PCP (you might actually get in trouble for sexual abuse, at least in Ontario. Yup, not making it up.)

Originally Posted by Morzh

I'm an Eagle Scout and when I was a teenager we would go on week(s)-long wilderness adventure trips each summer. There was usually a doctor from our church group who came along to tend to any medical problems that arose. It was usually just minor things, and we all had to sign liability waivers in order to go.

He would bring a suitcase of "doctor stuff" which, in addition to your typical first aid kit paraphernalia, also included suture supplies (including local anesthetic) and in case of a true emergency atop some mountain I believe he even carried a couple prescription inhalers and a little narcotic pain medication (although he never had to use them as far as I know).

Is that type of thing OK to do, or was he stretching the limits? What about emergency first aid kits to keep in the trunk of your car? Intuitively it seems like it should be alright for a physician's emergency kit to be a lot more advanced than your layman's emergency kit, as long as they are adequately trained to use it.

Or maybe that's just a ridiculous idea in today's uber-regulated and litigious world. The doc I mentioned was from a different generation.

That is perfectly fine to do. He wasn't stretching anything. Michael Jackson's doctor was stretching....in the above situation the good Samaritan doctrine might even apply.

Originally Posted by plauto

That is perfectly fine to do. He wasn't stretching anything. Michael Jackson's doctor was stretching....in the above situation the good Samaritan doctrine might even apply.

But I've always been curious about how a physician supplies his own "doctor bag" with medications that require a prescription and DEA #? There's nobody to really write a prescription for since it's "just in case".

Well, most of the first aid stuff is not controlled substances so access is easy...plus who says you can't get stuff just in case?

Hey, guys, sorry to intervene, but I have a related question. I am an MS3. I have medical insurance through my wife, but that insurance is sub mediocre, to say the least. So, if I happen to have a medical problem (sore throat, dermatitis, etc.) would be OK for me to ask an attending that I happen to work with at that moment for help?
Thanks!

Originally Posted by Morzh

I'm an Eagle Scout and when I was a teenager we would go on week(s)-long wilderness adventure trips each summer. There was usually a doctor from our church group who came along to tend to any medical problems that arose. It was usually just minor things, and we all had to sign liability waivers in order to go.

He would bring a suitcase of "doctor stuff" which, in addition to your typical first aid kit paraphernalia, also included suture supplies (including local anesthetic) and in case of a true emergency atop some mountain I believe he even carried a couple prescription inhalers and a little narcotic pain medication (although he never had to use them as far as I know).

Is that type of thing OK to do, or was he stretching the limits? What about emergency first aid kits to keep in the trunk of your car? Intuitively it seems like it should be alright for a physician's emergency kit to be a lot more advanced than your layman's emergency kit, as long as they are adequately trained to use it.

Or maybe that's just a ridiculous idea in today's uber-regulated and litigious world. The doc I mentioned was from a different generation.

I don't see what it would be inappropriate. The biggest issue would be proper security for the controlled substances. For example, when ambulances carry schedule 2 controlled substances, they either need to be in direct control of someone authorized to have them (i.e. the paramedic), or behind 2 locks (generally the ambulance doors are 1 lock and a locked safe inside the ambulance would be the second lock).

Originally Posted by VA Hopeful Dr

Untrue, how else do you explain moonlighting? Once you have a permanent license, you're generally in the clear to go be a doctor as far as your state board is concerned. Your malpractice situation is still iffy, but that's a whole different ballgame.

How do you get a permanent license without finishing residency?

Originally Posted by dantt

How do you get a permanent license without finishing residency?

In most (all?) states the requirement is to finish an internship (PGY1), not residency.

I always go to this one doctor because my penis is always getting chafed from the Levi's I wear. She's a doppelganger of that PA on Royal Pains



Anyway each week she does the genital exam and tells me to put some boxers on underneath, but I'm always forgetting. I've saved up another $100 for next weeks visit.

Originally Posted by Fortress

Hey, guys, sorry to intervene, but I have a related question. I am an MS3. I have medical insurance through my wife, but that insurance is sub mediocre, to say the least. So, if I happen to have a medical problem (sore throat, dermatitis, etc.) would be OK for me to ask an attending that I happen to work with at that moment for help?
Thanks!

I'd avoid this.

Originally Posted by thepoopologist

I always go to this one doctor because my penis is always getting chafed from the Levi's I wear. She's a doppelganger of that PA on Royal Pains



Anyway each week she does the genital exam and tells me to put some boxers on underneath, but I'm always forgetting. I've saved up another $100 for next weeks visit.

It's even funnier if you imagine Cartman saying that.

Originally Posted by Morzh

It's even funnier if you imagine Cartman saying that.

Omg you're right

Originally Posted by dantt

How do you get a permanent license without finishing residency?

In my state you only have to have finished internship and passed step 3... assuming you're an american grad. Foreign grads have to have finished residency (or be within 6 months which amounts to the same thing).