Damn, NYS licensure is expensive!

[Anasazi23]

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As is usual, the New York State physician licensure process seems complicated and unduely expensive. I'll need it for fourth year moonlighting, though, and want it on record so that I can get my own DEA, triplicate pad, and have it ready so that it's official when I apply for fellowship.

How much is licensure in your state?

How long does it last?

How many CE credits do you need annually?

NYS:
$735

 

[fiatslug]

Don't know @ CE units/yr, but CA licensure is $900! Fortunately paid for by our residency... wish I could say the same for DEA license fees.

 

[f_w]

Connecticut takes the cake for the maintenance fees. It is $450, annually !

It never ceases to amaze me how some states can give you an initial license for $242 with a biannual renewal of $192, and others need twice as much for the same service.
The real joy is once you had a couple of licenses and you apply for a new one. Some of the old medical boards charge you $10 for printing out a confirmation of licensure (seems appropriate for printing out a piece of paper and putting it into an envelope), others need $50 for the same service. And don't get me started on our own specialty boards. Every time I need a confirmation of my board certification, these bastards charge $100 (for printing out a piece of paper from their database and sticking it into an envelope).

 

[Poety]

My residency encourages us to take step 3 this year (as early as possible) and get our licenses ASAP - is this not standard practice? Do most wait until 3rd year? Many of the residents moonlight here during 2nd year though.

 

[fiatslug]

Poety, our residency is pretty much requiring that we have licensure by early in the 2nd year. And it's my understanding that you can't proceed to 3rd year unless you have your state license--Anasazi, is that not true in NY? Anyway, our GME sec'y essentially has to suspend us if we're not CA licensed by July 1st at start of 3rd year. You don't have to have the DEA license to proceed as a 3rd year, but everyone gets it, b/c it's a pain to have to find an attd'g in clinic every time you need to refill an Rx!

Of course you've gotta be licensed for moonlighting. There are a few scattered opportunities for 2s in this area, but most don't do it, b/c we're so friggin' busy as 2s! Looking forward to it as a 3, though... 🙂

 

[Anasazi23]

Poety, our residency is pretty much requiring that we have licensure by early in the 2nd year. And it's my understanding that you can't proceed to 3rd year unless you have your state license--Anasazi, is that not true in NY? Anyway, our GME sec'y essentially has to suspend us if we're not CA licensed by July 1st at start of 3rd year. You don't have to have the DEA license to proceed as a 3rd year, but everyone gets it, b/c it's a pain to have to find an attd'g in clinic every time you need to refill an Rx!

Of course you've gotta be licensed for moonlighting. There are a few scattered opportunities for 2s in this area, but most don't do it, b/c we're so friggin' busy as 2s! Looking forward to it as a 3, though... 🙂

Weird...
Our residency doesn't even require us to have passed step III even after graduation. I know of at least one fourth year and even a fellow that hasn't passed Step III yet. The only conceivable reason that we would need Step III and licensure is to moonlight. We write scrips in the clinic using the hospital's DEA. They've done this for years. Of course, many residents do use their own DEAs, and have their own script pads.

How much is the DEA #? I haven't even looked at that yet. I'll go check it out now... 🙁

 

[f_w]

How much is the DEA #? I haven't even looked at that yet. I'll go check it out now...

approx $400

I know of at least one fourth year and even a fellow that hasn't passed Step III yet.

Good luck to them finding a job. Step3 is one of these things best done during pgy-1 or 2 when you still have some idea about all the general medicine and statistics stuff they are harping on.

 

[fiatslug]

DEA=$390 (I just paid that one myself--painful...).

CA licensure is good for 2 years. Nice to have to fork over nearly a grand to Arnold 👎 every 2 years on my birthday!

We have had residents suspended in the past b/c they didn't take Step III in time to get licensed by 3rd year--which is why they want it done early in 2nd year (esp. taking/passing Step III). Maybe this is a California thing? All my med school classmates I've kept in touch with are licensed.

Damn, I would not want to take Step III 3 or 4 years out from medicine! It would be nice to use a generic clinic DEA #--painful to pay for that one as a resident. Not sure how often you have to renew your DEA license... or if it costs more than the first time. I've heard if you work at a gov't funded hospital (VA... possibly a county facility? don't know the details for sure since it doesn't apply to me), you can get the DEA fee waived.

 

[f_w]

CA licensure is good for 2 years. Nice to have to fork over nearly a grand to Arnold every 2 years on my birthday!

Teacher retirement has to be funded one way or another.

Maybe this is a California thing? All my med school classmates I've kept in touch with are licensed.

Depends on the state and the program. In Wisconsin, you can get a GME permit until about PGY-2, after that you need to apply for a regular license. But their regular license is something like $140, so it is not such an onerous requirement. I knew one program in NY that required you to have A license before you graduate. Instead of shelling out $750 for the NYS license, some people just got an indiana license (back then $42).

It would be nice to use a generic clinic DEA #--

Allways had that. It is a hospital specific# followed by a resident specific suffix.

Not sure how often you have to renew your DEA license... or if it costs more than the first time.

Q2 years. Same price.

I've heard if you work at a gov't funded hospital (VA... possibly a county facility? don't know the details for sure since it doesn't apply to me), you can get the DEA fee waived.

Yes.

And once you are out in the real world, you have your employer pay all these expenses out of pre-tax money. Still, its money but after you are finished with residency it just falls under the cost of doing business.

 

[Poety]

We're outpatient all second year, so theres a ton of moonlighting going on 🙂

 

[fiatslug]

We're outpatient all second year, so theres a ton of moonlighting going on 🙂

Damn, woman, where are you going? 😀 I have a guess... is it in California?

(PS--your daughter is totally adorable!)

 

[whopper]

From what I've been told by my attendings...

The 3 worst states to attempt to get liscence in are NJ, California & Florida.

I have heard that CA and FL are intentionally difficult because several doctors vacation there during the summer months and they want to work perhaps just a few days during their long vacations which can last months. So after giving out too many liscences to out of state docs, they got sick of it and started increasing the fees and adding more obstacles.

NJ is tough from what I understand just because NJ blows when it comes to bureacracy. If you're in NJ you'll know what I mean. In NJ anything that involves the gov takes 10 times longer and is 10x more frustrating than anywhere else.

 

[MBK2003]

Weird...
Our residency doesn't even require us to have passed step III even after graduation. I know of at least one fourth year and even a fellow that hasn't passed Step III yet. The only conceivable reason that we would need Step III and licensure is to moonlight. We write scrips in the clinic using the hospital's DEA. They've done this for years. Of course, many residents do use their own DEAs, and have their own script pads.

That's weird, because we are required to have a license absolutely no later than the 1st day of PGY-3. In NYS you need to be a licensed physician to do a physician certification to involuntarily admit someone. What do you do in the ER if you need to "2PC" someone?

MBK2003

 

[Anasazi23]

That's weird, because we are required to have a license absolutely no later than the 1st day of PGY-3. In NYS you need to be a licensed physician to do a physician certification to involuntarily admit someone. What do you do in the ER if you need to "2PC" someone?

MBK2003

ER patients get 9.39'd. We use 2-PCs for floor transfers and other such stuff. You have to use 2-PCs in your psych ER?

 

[MBK2003]

ER patients get 9.39'd. We use 2-PCs for floor transfers and other such stuff. You have to use 2-PCs in your psych ER?

We 2PC everyone from the CPEP except one of our inpatient units will accept a 9.39 on a weekend only (when we aren't guaranteed to have 3 physicians for the app and 2 pc's). Where I moonlight we 9.39 everyone from the ER, but that's because I'm the only psychiatrist in the house.

Having worked in both places, I like the 2PC with the family doing an application upon bringing them to the ER. It's a b&*ch to get families to come to the inpatient unit to do an application when you do the 2PC on the floor, mostly because they have a million excuses once the patient is on the unit and out of their hair. It's a different story when they are bringing them to the ER asking you to help them and you can say, "It makes it hard for us to keep them against their will without you documenting the reasons in writing why they need hospitalization."

The DEA license was another $400+, but well worth it once the scripts arrive and you can call in refills with a normal DEA number and not have to explain why you are using an institutional one.

MBK2003

 

[Anasazi23]

We 2PC everyone from the CPEP except one of our inpatient units will accept a 9.39 on a weekend only (when we aren't guaranteed to have 3 physicians for the app and 2 pc's). Where I moonlight we 9.39 everyone from the ER, but that's because I'm the only psychiatrist in the house.

Having worked in both places, I like the 2PC with the family doing an application upon bringing them to the ER. It's a b&*ch to get families to come to the inpatient unit to do an application when you do the 2PC on the floor, mostly because they have a million excuses once the patient is on the unit and out of their hair. It's a different story when they are bringing them to the ER asking you to help them and you can say, "It makes it hard for us to keep them against their will without you documenting the reasons in writing why they need hospitalization."

The DEA license was another $400+, but well worth it once the scripts arrive and you can call in refills with a normal DEA number and not have to explain why you are using an institutional one.

MBK2003

Hmm...I'm still not sure why you can't 9.39 patients from the ER. It at least gives you two weeks to come up with a 2-PC, or even d/c the patient if they clean up quickly enough. Better yet, you don't need three physicians to come up with the assessment for the PC. Interesting that you have the family fill the application out. I hadn't seen that. We usually get a hospital psychiatry administrator to do that.

 

[MBK2003]

Hmm...I'm still not sure why you can't 9.39 patients from the ER. It at least gives you two weeks to come up with a 2-PC, or even d/c the patient if they clean up quickly enough. Better yet, you don't need three physicians to come up with the assessment for the PC. Interesting that you have the family fill the application out. I hadn't seen that. We usually get a hospital psychiatry administrator to do that.

I'm not exactly certain whether it's a hospital policy or more of an OMH statute since our patients in our CPEP are already admitted to us under the 9.?? for the 72hr CPEP hold. Knowing our CPEP, it's more likely to be a CPEP policy, than stated law. The vast majority of pt's we admit from our CPEP go to other hospitals and the hospitals we have relationships with expect the involuntary pts to come on a 2pc (and often want the voluntary ones on a 2pc too, but that's a different story). Getting 3 physicians for the assessment is usually easy, in part because we get the sign out, stop on by to see the pt, and then tell them they're being admitted involuntarily and do they have any questions. Yeah, we clearly fudge the need for an extensive examination by the 2nd PC. As far as I understand, the applicant physician does not need to have personally examined the patient based upon the written law, so it's based upon the signout as well.

I have seen the family application work quite favorably when the inpatient unit is taking the pt to court to medicate over objection or to extend the 2PC another 2 months. Judges like to know where the family weighed in originally when the patient was brought to the ER, and having the mom state in writing that her schizophrenic, med nonadherent son physically assaulted her, is usually pretty good for that.

MBK2003

 

[Anasazi23]

I'm not exactly certain whether it's a hospital policy or more of an OMH statute since our patients in our CPEP are already admitted to us under the 9.?? for the 72hr CPEP hold. Knowing our CPEP, it's more likely to be a CPEP policy, than stated law. The vast majority of pt's we admit from our CPEP go to other hospitals and the hospitals we have relationships with expect the involuntary pts to come on a 2pc (and often want the voluntary ones on a 2pc too, but that's a different story). Getting 3 physicians for the assessment is usually easy, in part because we get the sign out, stop on by to see the pt, and then tell them they're being admitted involuntarily and do they have any questions. Yeah, we clearly fudge the need for an extensive examination by the 2nd PC. As far as I understand, the applicant physician does not need to have personally examined the patient based upon the written law, so it's based upon the signout as well.

I have seen the family application work quite favorably when the inpatient unit is taking the pt to court to medicate over objection or to extend the 2PC another 2 months. Judges like to know where the family weighed in originally when the patient was brought to the ER, and having the mom state in writing that her schizophrenic, med nonadherent son physically assaulted her, is usually pretty good for that.

MBK2003

The family application seems like a great idea - particularly for court as you mention. Having them around conveniently to start the app in practicality probably is trickier, as you mention.

I can see that it would be the policy of the CPEP to 2-PC, particularly if you send most patients out. That is the preferred mode of status for transport.

Interesting how different hospitals operate differently.

 

[Anasazi23]

Getting back to the original part of the thread....

Does anyone know the name of the federal licensing board (or have a website) for the office that collects your materials, for a $300 fee, and distributes them to all the state boards for which you are applying for licensure?

 

[f_w]

Getting back to the original part of the thread....

Does anyone know the name of the federal licensing board (or have a website) for the office that collects your materials, for a $300 fee, and distributes them to all the state boards for which you are applying for licensure?

http://www.fsmb.org/fcvs.html

It is more like $600 after they are done and it takes about 6 months to complete the process. After you have the 'profile', it still takes 3 weeks and another $100 for them to send it to a licensing board. About 40 states accept the 'profile' for what it contains: verification of your personal identity, medical degree, residency, internship and usmle scores. Most medboards have other stuff you have to submit. National practicioner database abstract, board action history report etc.

If you are a US graduate, it is probably not worth the hassle. If you are a foreign grad, the hassle of getting confirmation from your medschool every time you apply for a license makes the FCVS ordeal a worthwhile endeavour.

 

[Anasazi23]

Great. Thanks a lot.

I'm an American grad, but have many friends from foreign med schools who claim the service is very useful. But one friend told me that even for American grads, the ability to have everything pre-verified in one place is very helpful. He cited examples of moving to different states and not having to re-get all the letters and authorizations and diplomas from all the institutions and whatnot. It seems to greatly streamline the process for obtaining hospital privilages. Which for working at multiple hospitals, would be much less time-consuming.

I don't plan to stay in NY after I graduate...should I think about using this? Or is it only a little more work to do it by hand?

 

[f_w]

It seems to greatly streamline the process for obtaining hospital privilages.

It seems like it should streamline the process. The idea is great, but the implementation is fairly tedious.

I don't think too many hospital credentialing committees accept the FCVS file. It is more a licensing thing.

It comes in really handy (even as US grad) if the secretary at your internship place is either lazy or a vindictive b####. There are internship programs that take weeks to confirm your graduation or 'loose' repeated requests by the medical boards. With the FCVS thing you have to do this torture only once.

 

[Anasazi23]

That's too bad that you say in practicality the FCVS doesn't work as well as it shoudl for hospital privilages. That seems to be a selling point from their website. It should be mandated that all hospitals accept the FCVS application. It is a federal agency after all. I've heard about the nightmare of waiting for medical schools and internship sites to send materials....sometimes months. It's completely unacceptable.

 

[f_w]

It should be mandated that all hospitals accept the FCVS application. It is a federal agency after all.

It is a private club of state licensing boards, not any sort of goverment agency.

The federal goverment has no say in how states and hospitals regulate healthcare credentialing.

 

[Anasazi23]

It is a private club of state licensing boards, not any sort of goverment agency.

The federal goverment has no say in how states and hospitals regulate healthcare credentialing.

Yes, it just seems that things could be much more streamlined if there was a universal application for physicians to obtain licensure or obtain hospital privilages, with perhaps a supplemental application for each individual hospital. The point being that a federal credentialing service ought to suffice for basic information required for hospital privilage and credentialing. Then again, there's lot of things that should be streamlined and easier in medicine.
😳