Pharmacists are on the front line of patient health during a pandemic like COVID-19, and one of the main reasons is that patients, prescribers, and pharmacies do not know how the virus will impact the future of the international supply chain and drug manufacturing. Some believed that allowing patients to ‘stockpile’ larger than usual quantities of their prescription medications could cause drug shortages. Now, the DEA is more concerned with making sure patients have access to medications during the shelter-in-place orders.

Although the Illinois Department of Financial and Professional Regulation, along with the Pharmacy Board, have not entered the fray, the Illinois Department of Healthcare and Family Services (Medicaid) provided for an override code for Refill Too Soon. This allows a 90-day supply for insulin and waives signature requirements for receipt of prescriptions. It remains to be seen if additional actions will occur by state government.

While the DEA is easing requirements, pharmacies should advocate for insurers to relax rules, too. CMS reminded Medicare Advantage Organizations and Part D sponsors of their inherent flexibility to remove prior authorizations requirements, waive prescription refill limits, and relax other restrictions. Pharmacists should recommend to patients (and possibly caregivers) to check prescription benefit coverages regarding early refills and supply limits.

Do I have to disclose my criminal record to IDFPR? Can my criminal record impact my medical license?

The Illinois Department of Financial and Professional Regulation can and will find out about your criminal record, whether you are about to submit an application for physician licensure by endorsement or examination, or about to renew your existing medical license, or recently convicted and unsure of your next steps.

Will IDFPR and the Illinois Medical Licensing Board or the Illinois Medical Disciplinary Board revoke your license? Will you have any lesser impact of discipline on your license? The answers depend on what you were or are charged with, what the eventual charge to which you pleaded guilty was (or found guilty by a judge or jury), and what kind of sentence was imposed by the criminal court.

Social media has seeped its ways into every facet of our lives of the last decade, even our jobs. The question then becomes, how much, if any, should doctors be using their platforms? And if so, how? Some could make the argument that, especially for private practice, it helps grow their customer base. Others would argue that it is not something to be promoted, and the patient’s confidentiality is at risk.

The benefits of posting on social media are evident in some respect. Doctors, physicians, and osteopaths, especially those who are paid on the amount they bill, can use social media to gain patients. A surgeon might consider whether they can post a surgery they did that day to promote themselves or even to provide teaching opportunities for young doctors. Doing so is dangerous – patient confidentiality laws go very deep, and Illinois law also prohibits the use of a person’s image without consent for commercial purposes. Know also that some health care professionals have been called before IDFPR professional boards to answer for their posting of x-rays and other imaging on social media, when the intent was only to show how ‘not to do’ a procedure.

Some physicians, especially those in residency, have been known to use their social media platform to vent. This can help with some of the problems that have been known to cause physician burnout. But the same rules apply, don’t post anything about your patients, with the caveat that your residency program may take issue with specific types of ‘venting.’

Primary Care Physicians are becoming increasingly hard to find, and the wait time to see them is getting longer and longer (30% longer between 2014 and 2017, according to Merritt Hawkins). Wait times are up to around 24 days per visit. Even worse, in rural areas primary care physicians are almost becoming non-existent.

The question becomes, is it because fewer medical and osteopathic school students want to go into the profession? And if so, why? The demand for these doctors is increasing every day, but there is still a need. One of the most speculated reasons for this is the pay. Primary Care Physicians are among the lowest-paid physicians in the United States, and with mounting school debt, students find themselves more interested in the higher paid positions.

The Washington Post noted in 2019 that “the Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032.” It goes on to state “studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one.”

You may have heard that as of January 1, 2018, Illinois veterinarians were required to register with the Illinois Prescription Monitoring Program (PMP). The obligation to register is mandatory and you can expect your professional license to practice veterinary medicine to be publicly disciplined if you fail to do so. In addition to registering, the law now requires a veterinarian to also consult the PMP “to assess patient access to controlled substances” whenever an initial script is written for any Schedule II narcotic.

You should know that this law does not apply to narcotic prescriptions for cancer treatment, palliative care, or a seven day or less supply provided by a hospital emergency department when treating an acute, traumatic medical condition.

Accordingly, you are required to check the controlled substance patient record in the PMP. You are probably also required to check the controlled substance record of the owner as well, but there is not yet any clear authority on which to rely. Although veterinarians have no clinical training in assessment or diagnosis of human addiction, you would be expected to exercise clinical judgement as to whether it is appropriate to write a Schedule II prescription.

Can a professional licensed in Illinois be subject to discipline only because the license holder was disciplined in another state?

Most likely no, but the Illinois Department of Financial and Professional Regulation won’t let that stop them. While the Medical Practice Act authorizes discipline of doctors based on sanctions imposed in another state, that discipline requires analysis beyond the fact that one was disciplined elsewhere. That is, the Illinois statute may authorize discipline based on out-of-state sanctions, but that does not mean that discipline is reasonable in every case.

In the case of Dr. Cadogan vs Division Of Professional Regulation of the Illinois Department of Financial and Professional Regulation (2013 IL App (1st) 122160-U), the court determined that the Illinois’ discipline was unreasonable based on the relationship between the out-of-state violation, the statutory intent, and the state's justification for punishing the license holder. The court determined that the statutory authorization to discipline a license holder does not, in and of itself, justify the imposition of punishment.

Absolutely not. An IDFPR investigator is a civilian investigator who possesses no police powers. Even if it was a local police officer who demanded that you immediately stop your clinic or office activities and submit to an interview, you are not required to submit. In the police officer scenario, you have an absolute constitutional right to not speak to any police official. The same is true for an IDFPR investigator. A civilian investigator may try to intimidate you into answering questions, but our strong advice is to not answer.

The best practice is to be polite and courteous to the IDFPR investigator. Inform them that you would be happy to answer their questions and will do so as soon as you have a chance to contact your attorney. Then terminate the conversation. It is trickier if the investigator demands to do an impromptu inspection of the premises – you have to determine whether they are authorized to perform a controlled substances inspection. The best practice is to let them inspect what they want. Note that the word inspect means inspect only. It does not mean they can make copies of documents or take documents with them. You or a trusted staff member should accompany the investigator at all times in your office.

As in all enforcement encounters, the best practice is to first copy their IDFPR credentials. Do not speak with anyone – ever – about your practice and never allow them into the employee-only area of the clinic or office unless you are completely confident of their identity. Next, politely ask them to explain the nature of the inquiry. It would help your case to write down all of the answers that you receive. There is no doubt that this action will unnerve the investigator and may convince them to terminate the encounter sooner than expected.

We tell all young professionals just starting out that eventually, they should incorporate. However, the Illinois Veterinary Medicine and Surgery Practice Act of 2004 (“Vet Act”) specifically permits a veterinarian to practice as an individual (the IRS calls this a sole proprietorship). Because there is no registration requirement for a sole proprietor with the Secretary of State and accordingly no registration fees, as well as streamlined tax reporting to the IRS, it might be tempting to see this route as the easiest when one start’s a professional career. But it is not the path that most corporate lawyers or tax accountants would recommend.

As your practice grows, you will undoubtedly start to enter into a variety of standard business relationships: leasing your practice space and equipment, contracts for the purchase of equipment and supplies, and employment relationships with relief vets, veterinary technicians, and other employees. Although the law permits you to conduct your practice as a sole proprietor, one is strongly cautioned against doing so. For example, when practicing as an LLC (a hybrid between a partnership and a corporation), your liability for the debts of the LLC is limited to your investment in the LLC. As a sole proprietor, you are personally liable for all the debts incurred by the practice. A creditor could go after your home, your personal checking and savings accounts, and your car to satisfy a debt obligation. There can also be significant tax savings if an LLC or a corporation is structured properly.

Our strongest advice to any professional contemplating the start-up of a private practice is to seek out a corporate lawyer and a tax accountant with whom you are comfortable. Obtaining advice and assistance upfront can save you time, frustration and money over the course of your career.

The quick answer is yes, but you must follow strict guidelines as set forth in your Act and Rules. We take no position on whether veterinarians should allow chiropractors, physical therapists, medical orthopedic or plastic surgeons to “crossover” into veterinary medicine. Instead, veterinarians should be aware of the risks and responsibilities of asking a healthcare provider, who is licensed to treat only human ailments, for assistance in a veterinary medical case.

There are six sections of the Veterinary Medicine and Surgery Practice Act of 2004 (“Act”) and the Rules for Administration of the Act (“Rules”) that must be read together. When looked at as a whole, they  determine the regulations governing the “complementary, alternative or integrative therapies” in veterinary medicine. Section 4 of the Act exempts a medical or chiropractic physician or a physical therapist (and others) from prosecution for practicing veterinary medicine without a license providing you follow these requirements:

1.       The responsible vet must make a written request for assistance to the non-vet;

After spending 20 years in school and countless hours studying, who doesn’t want to go straight into a job working 60-80 hours a week? Most doctors don’t go into medicine for the money, they go into it because they have a passion for helping people, but at what point is it too much? Depending on your specialty, you could be working these long weeks for 7+ years after receiving your medical or osteopathic degree and even further into an attending position; so how do doctors avoid burnout? According to the New England Journal of Medicine and the American Medical Association, the two main areas to focus on are your relationships and your physical health. If you don’t curb burnout, you will cause serious issues down the line with your medical license and your career that you spent so long building.

Relationships:

One of the main factors that leads to physician burnout is the feeling of seclusion. This feeling could be because you are new to the area and don’t know anyone, or because you don’t recognize everyone is going through the same thing. Taking the time to make friends inside and outside of your program can help. Talking to fellow residents will help you find ways to make your days easier and gives you the ability to vent your frustrations. Don’t forget to keep in contact with your friends and family who may not live close can help as well. Your family may not understand all your problems at work, but they will give you the ability to talk about something outside of the hospital. A support network is critical for both young and experienced physicians.

Physical Health:

Ensuring you are eating correctly and exercising and sleeping enough is extremely important to avoiding burnout. Since you are likely a physician and reading this, you already know this but maybe don’t always act on it. Taking small steps to ensure that you go to the gym, eat a few healthy meals, and try to get an extra 30 minutes of sleep a night can go a long way. You are busy, you don’t always have time to focus on your physical health but taking small steps can drastically decrease your likelihood of burnout.