The transition to practice can be a hectic time for physicians. You’re working a demanding residency or fellowship and thinking about what you want the next phase of your career to look like, as well as applying to and interviewing for your first physician job.
It may come as no surprise, then, if certain bureaucratic tasks take a backseat. But John Andrews, MD, the AMA’s vice president for medical education and professional development, urges residents to tackle the digital paperwork, which can be overwhelming if left to the last second. And they should do it “as soon as possible,” depending on their specialty, where they are in the job search process and how many of the steps they’ve already taken.
In his role with the AMA, Dr. Andrews has helped lead the Reimagining Residency initiative to transform residency training to best address the workplace needs of our current and future health care system.
Dr. Andrews recommended that physician residents and fellows aim to accomplish those preparatory transition tasks as early as they can.
“Many of those transition-to-practice issues will be dictated by the job you take and where you practice,” Dr. Andrews noted. “Most residents probably obtain licenses during their training, but if you're moving states, you need to start that licensure process as soon as you know where you're going. And the hospital credentialing process can seem eternal. To start that as soon as possible is well-advised.”
With that in mind, here are some of the ways to fast-track your transition to practice and tips for where you can get going in advance of the end of your residency or fellowship training. Though the timing will be specific to the individual physician, the process contains many of the same steps.
Get your medical license
If you are moving to a new state where you have not already obtained your full, unrestricted medical license during residency, now is the time to get the ball in motion as it can take months to complete the process.
Many states verify medical school and graduate medical education through the AMA. In states that do not, contacting and following up with medical schools, training programs and appropriate hospitals will motivate these institutions to verify credentials more quickly. Following up with the licensing boards in other states where licenses are held may also assist in shortening the time for licensure.
The Federation Credentials Verification Service (FCVS) provides a direct, source-verified profile of physician core credentials that is accepted by all state medical boards. In many states, license applicants are required to use FCVS. Call FCVS at (817) 868-5000 or email [email protected] for more information.
Start the board-certification process
When pursuing board certification, schedule the exam as soon as possible to avoid delays in credentialling and privileging. Employers may require or expect certification for certain specialties, and some boards will allow you to sit for the exam before or soon after graduation.
Speaking generally, board certification will require a physician to have a full medical license and to have completed an accredited residency or fellowship program. You are also going to need to pass a board-certification examination, which can be pricey. Fees for the initial written exam vary by specialty, with some being less than $1,000 but others exceeding $2,000. Meanwhile, some medical specialty boards also require an oral exam for initial certification, and this may carry substantial additional cost.
Keep in mind that you can’t just take a board exam whenever you want.
“The biggest barrier to board certification is sitting the exam because it will only be offered on certain dates,” Dr. Andrews said. “But once you’ve taken the exam, the results are typically turned around pretty quickly, usually within a month or two.”
Apply for your NPI number
Essential for dealing with insurance and billing, residents can obtain a National Provider Identifier (NPI) number before beginning their first job out of training. When applying, you must select a taxonomy. Residents who aren’t yet licensed should use the “Student, Health Care” taxonomy (390200000X) and update it once they are licensed in the state in which they intend to practice.
Apply for your DEA registration
To prescribe controlled substances after residency or fellowship training, you must register with the U.S. Drug Enforcement Administration (DEA). Prior to graduation, residents and fellows can use their training institution’s number—adding their own unique identifier—but transitioning to practice, you will need to complete your own DEA registration process. You can apply for your DEA registration before starting a new role, as long as you have a state license number, an NPI number and any additional controlled-substance licensing required by your home state. Prior to application, physicians also need to complete Medication Access and Training Expansion (MATE) Act-required training on treating and managing patients with opioid- or other substance-use disorders.
AMA members have access to mini-CME tracks designed to help them meet DEA training requirements. Get your exclusive, AMA members-only certificate for opioid and substance-use disorder CME.
Update your CV, references
If you haven’t already done so, you should refresh your curriculum vitae (CV) and references, both of which may be required by employers and licensing bodies for background checks. If you haven’t recently connected with your professional references, take this opportunity to reach out. Not only will it ensure your information about them is up to date and complete, you’ll also be able to share with them the exciting stage you’re at in your career.
Get legal advice on your contract offer
Once you have a job offer in hand, have a lawyer trained in health care employment law review your employment contract. There are many provisions that need to be checked for pitfalls before you accept the role.
The AMA has teamed up with Resolve to provide custom contract review to AMA members at a discount. Resolve offers personalized legal experience to help physicians secure the best employment contract terms, no matter where they are in their careers. Ready to access your AMA-member Resolve discount? Learn more now.
Square away insurance
When it comes to medical professional liability insurance, there may be a learning curve for residents, who typically are covered under their training institution’s claims-made policies. Whether you will be in private practice, employed at a hospital or working locum tenens, you will need to make sure that you’re up to speed on your medical liability insurance plan—also called medical malpractice insurance—and find out whether you are better off obtaining your own coverage.
In response to the growing need for comprehensive, cost-effective medical professional liability insurance coverage, AMA Insurance has forged relationships with top-rated national insurance carriers to offer physicians robust coverage choices.
Their team of knowledgeable insurance specialists have more than 60 years of combined experience in medical professional liability insurance. They are noncommissioned, salaried employees, and have no sales quotas to meet. And with the recent rate increases for this coverage, it’s recommended that you shop your plan annually through a trusted source such as AMA Insurance.
Work on credentialing and privileging
If you have accepted a job offer, even tentatively, ask for the credentialing and privileging packet. Verifying your education and training is called credentialling. And privileging is the granting of specific clinical privileges at your new institution. Together, the process of securing both physician credentials and privileges can take months.
For residents, having a knowledge base about the process and how it can be used can go a long way. A video called "Physician Credentialing Demystified”—produced by FREIDA™, the AMA Residency & Fellowship Database®—offers insight on the process.
“From a resident's perspective, the biggest thing is to know that this process exists—that you need to be prepared for it,” said Tammy Weaver, the AMA’s vice president of physician professional data. “There is a lot of information and documentation to pull together and fill out.”
Remember financial planning
In all likelihood, you will be making a higher salary than you did during residency or fellowship training, and it’s important to learn how to manage that increased income. If you haven’t already met with a financial adviser, consider doing so. Begin or adjust your physician retirement planning, taking into consideration your new salary.
AMA Insurance offers the Physicians Financial Partners program, where you can access vetted financial professionals to address an array of financial strategies. From medical school to residency training and throughout your career, the Physicians Financial Partners program helps you prepare for a healthy financial future.
Graduation from residency or fellowship training represents the culmination of a long road, one that began years or even decades ago. Regardless of how many—or how few—of the preceding tasks you complete before that milestone, don’t despair. Your top priority should be your own well-being, preparing yourself for a long and fulfilling career as the physician you’d always hoped to be.
If you’re searching for your first physician job after residency, get your cheat sheet from the AMA now.
