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Mission Impossible: Getting A Medical License In California

I first applied for a license to practice medicine in the state of California on July 9, 2008. I was licensed on March 3, 2011 — a whopping 967 days after they first received my application. I haven’t had a problem getting a license in any other state, and I am licensed in six of them. Just to give you a sense of how long it usually takes to process the paperwork for a medical license, Maryland completed mine in under three weeks. So what’s going on in California?

Dr. Val’s Experience

I think the best way to tell this story is with a timeline, and let the facts speak for themselves. I know this represents just one physician’s experience (namely mine), so results may vary:

July 9, 2008 – The Medical Board of California (MBC) received my licensure application and my checks for $493 (for fingerprint and processing fee) and $805 (initial licensing fee), which were cashed soon thereafter.

Sept 29, 2008 – I received a letter in the mail stating that there were four items missing from my application. Two of these four items were already included in the Federation Credentials Verification Service (FCVS) packet they had received from me. The other two items were requests for residency program directors to write letters to support the forms that they had already filled out on my behalf. I immediately requested these letters, and even though I should not have needed to send additional copies of items from the FCVS packet, I did so as well.

December 3, 2008 – I received a letter in the mail from the MBC, stating that there was an additional fee of $25 now required for physicians whose licensure applications were postmarked after December 31, 2008. This obviously didn’t relate to me, but the letter reminded me to follow up with the board to make sure that they had received the four items from the Sept 29th letter. I sent the licensing program administrator an email and left a voice message for follow-up purposes. He gave no response.

January 1, 2009 to September 30, 2009 – I sent five different email requests for follow up information, without response from anyone at the MBC. I decided not to move to California, but to remain in Washington, DC.

October 5, 2009 – I sat next to an attorney on a flight to San Francisco whose law firm specializes in helping physicians get medical licenses in California. I told him that I was having a difficult time communicating with the MBC, and that they wouldn’t even tell me what was missing in my application so that I could rectify it. The attorney told me that lack of communication with the MBC was extremely common, and in fact a large portion of his practice was devoted solely to suing the MBC to get them to process application paperwork. He asked me if I’d like to retain his services, and I said that it would cost too much and that I’d simply keep trying on my own.

October, 2009 to November, 2010 – Every few months I sent an inquiry email about my application status, without any response from the MBC.

November 29, 2010 – The first email response from the MBC arrived, stating that the only remaining item to complete my license application was a “delegation letter” from one of my residency training programs. I immediately asked for this letter from my program, and they explained that they had no idea what a “delegation letter” was. So I asked for clarification from the MBC.

November 30, 2010 – The licensing technician (LT) assigned to applicants with last names beginning with “J” clarified that he needed evidence that the physician who signed my intern year training form had the authority to do so. (The residency program director was to “delegate authority” to the signatory.) As it happened, the department chair had signed the form instead of the residency program director. In essence, the residency program director needed to vouch for her superior. The delegation letter was mailed within two business days.

December, 2010 – Repeated email requests for confirmation of receipt of the delegation letter, as well as assurance that nothing remained outstanding in my application, received no response.

January 26, 2011 – I received an email from the MBC stating that a new LT had been assigned to my case and that she’d be reviewing my application for completeness. She found three items missing: 1) the delegation letter 2) a letter from my medical school registrar, vouching for a line item listed on my transcript, and 3) a new application form with new photo (because so much time had elapsed that they weren’t sure that the application was still current). I responded that the delegation letter had been sent (I confirmed this with the residency program), that there was no one at my medical school’s registrar’s office who knew how to provide any additional assurance of my curriculum beyond the previously notarized signature of the Registrar herself (which was also verified by FCVS), and that I’d be happy to fill out the application form and provide a new passport photo due to the excessive time lapse.

January 28, 2011 – The new LT emailed me to say that she had met with “senior staff” about my application and that there was no record of receipt of a delegation letter, and that I needed to get my former residency program director to again write them a letter that the chairman of the department has the authority to sign my application form. She also said that the senior staff had relented regarding the authorization letter from the registrar’s office.

February 2, 2011 – I was cc’d on an email from my former residency program confirming that the delegation letter had been faxed on December 2, 2010, and a copy had been mailed to MBC on that date, as well as a second copy on February 2nd and an email attachment directly from the residency program director.

February 8, 2011 – The LT informed me via email that the new application that I provided (along with my photo) had the notary’s signature in the incorrect location, and that I needed to provide a re-notarized copy of the application. I asked if another photo was needed.

February 9, 2011 – The LT informed me that a third photo was not needed, and that she could peel the last one off the new application and affix it to the third (and newly notarized) copy of the application form. I was worried that the older photo would be lost, so I got a third passport photo made anyway, and attached it to a new form that I got notarized by another person.

February 21, 2011 – I requested email confirmation of the newly notarized application form (a U.S. Postal Service Delivery Confirmation Receipt showed delivery on February 11). No response offered.

March 3, 2011 – I again requested email confirmation of the completion of my application.

March 3, 2011 (3:49pm) – I received this email response from the LT: “Congratulations! You are now a licensed physician with the State of California. You can access your license number off our web site. It was nice working with you.”

And that’s how I became a licensed physician in the state of California. Of course, the clinical job I was interested in in 2008 — for which I’d originally applied for a CA license — is now long gone, life has moved on, and I just bought a house on the beach in South Carolina.

So if you live in California and are having a hard time finding a doctor, perhaps it’s because physicians like me are being effectively prevented from working in your state by its own medical board? I bet you hadn’t thought of that.

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8 Responses to “Mission Impossible: Getting A Medical License In California”

  1. Anon says:

    Astonishing! This reads like my attempt at a change of address with Medicare/CMS. Val, you are welcome to California any time if you can stomach the bureaucracy. It is important that the Medical Board see your blog. I wonder if they will care in any way. Doubt it!

  2. Elliot Krane says:

    Welcome to the Great State of California!! Imagine the frustration of being a department chair or division chief trying to fill positions, and not being able to recruit from out of state because of this!!

    Our loss is So. Carolina’s gain, and, I love your blog and tweets. Keep it up.

    Elliot Krane, MD
    Chief of Pediatric Pain Management
    Packard Children’s Hospital
    Stanford University

  3. Certainly a sobering story. Would also note that the time you were applying, the US economic crisis was unfolding as well as the weekly furloughs at the state agencies due to decrease in budgets from losses in tax revenue (home foreclosures). That also has resulted in delays.

  4. Dr. Val says:

    I appreciate the open invitation to practice in CA, anon! I tried very hard not to express my exasperation in this blog post, because I hate to “trash” a medical board based on an n=1 experience. However, the bizarre requests for things like residency program directors vouching for their superiors, registrars providing a supplemental authorizing signature for line items on a med school transcript from Columbia U. (not an overseas med school), and the years of refusal to communicate with me after multiple requests via email and voicemail… seem to point to an endemic problem. I think it’s sad that good doctors are trying to come to California, but (as that attorney I met said) are being regularly thwarted. This needs some attention.

    As for Dr. Liu’s comment – I agree that there may have been furloughs at state agencies during my time frame of application. However, I did receive 3 other medical licenses from other states during this period without any problems or delays.

    I wonder if this case study speaks to a greater problem in California’s general way of doing things? After all, the news is constantly relaying sobering data about funds mismanagement, bankruptcy, and excessive bureaucratic red tape. It’s tragic that such a beautiful state is falling apart at the seams. I really hope that other states don’t follow suit.

  5. Dr. Val says:

    Oh, Dr. Krane! That is beyond exasperating. I can’t imagine the disappointment associated with trying to recruit physicians for your department, and having to turn away out-of-state applicants because you know they won’t be able to get their licenses in a timely manner.

    For you the challenge is multiplied exponentially, and salt is added to the wound with each employee search! The only bright spot is that you are a pain management expert, so you may have some additional techniques to treat your own pain caused by the Medical Board of California?

    Thanks for reading the blog… and consider that South Carolina has some lovely ocean front property too. If things get too bad out west… Well, maybe I can welcome YOU over here? ;-)

  6. Chic says:

    Is there any hint that this has an economic reason? For example, already-established MDs have influenced the delays to keep the supply of doctors restrained, increasing the possibility of more income.

  7. mm says:

    That sounds awful. Appreciate the forewarning.

    I would like to add to anyone else applying for a medical liscence.

    All it has done is delay the “gathering” of my information that they ALREADY have on file from the first time I used it.
    WASTE OF TIME. I could have ordered all of my usmle scores on line and sent everything in in 1/5 of the time I spent trying to get any response from the FCVS for updates on my application.


  8. Rehan Sheikh says:

    Well Medical Board of California is an organization as the author explained;

    Good physicians are prevented from practicing in California by this board in order to deny health care services to the people of California.

    The situation is not improving as Gov. Brown of California is behind the conspiracy and the Courts are NOT listening to physicians.

    see my website for more info.

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