Physician Licensing Data

1. Physician Licensing Data Physicians Data Technical Workgroup October 12, 2006 Tampa, Florida

2. Mandatory Licensing Data General Information: Mailing Address Practice Location Address Satellite Location Address Staff Privileges Other State Licensure Year Began practicing

3. Mandatory Licensing Data Education and Training: Medical Degree (e.g., school, dates attended, date graduated, and a description of all graduate medical education completed) Professional and Post-graduate Training Academic Appointments Specialty Certifications Financial Responsibility

4. Mandatory Licensing Data Proceedings and Actions: Criminal Offenses Final Disciplinary Actions: Florida Board Specialty Board Another Licensing Agency Health Maintenance Organization (HMO) Pre-paid Health Clinic Nursing Home Hospital Surgical Center

5. Mandatory Licensing Data Proceedings and Actions (continue): Resignation from a HMO, Pre-paid Health Clinic, Nursing Home, Hospital or Ambulatory Surgical Centers Medical Staff Privileges Restricted or Revoked from a HMO, Pre-paid Health Clinic, Nursing Home, Hospital or Ambulatory Surgical Centers Liability Claims (exceeding $100,000) Bankruptcies (if the Department receives information)

6. Mandatory Licensing Data Information from the National Practitioner Data Bank (NPDB) Information Received from the Healthcare Integrity and Protection Data Bank (HIPDB)

7. Reporting Requirements Physicians must submit updates to the mandatory data within 15 days after a change is made to the information (456.042, F.S.). NPDB, HIPDB, and FDLE criminal background screen information is requested by the Department within 45 days following a renewal cycle (456.041(1)(b), F.S. and 456.039(4)(b), F.S.).

8. Optional Licensing Information General Information: Participation in Medicaid Program E-mail Address Education and Training: Other Health Related Degrees Committees/Memberships Professional or Community Service Awards

9. Optional Licensing Information Publications Professional Web Page Languages Other than English Other Affiliations

10. Physician Workforce Questionnaire The Department of Health partnered with key physician workforce stakeholders to develop a questionnaire that will collect data on the geographic distribution and specialty mix of licensed Florida Physicians. The questionnaire was incorporated into the online and paper renewal application and released to approximately 29,000 physicians earlier this month.

11. Physician Workforce Questionnaire Do you practice medicine in Florida during the year? How many months/years do you practice medicine in Florida? In what counties do you practice? Is more than 20% of your practice non-clinical? Are you a resident or fellow? What is the primary specialty area(s) of your current clinical practice? Do you plan to retire, relocate outside of the state of Florida, or significantly reduce the scope of your practice within the next 5 years? Do you currently take emergency call or otherwise work clinically in a hospital emergency department or provide for the immediate, acute care of trauma patients?

12. Physician Workforce Questionnaire A report will be available in 2008, after the data is complied for both allopathic and osteopathic physicians. An effort will be made to compare results of this questionnaire with reliable, national data sources and use in conjunction with population data and other demographic and economic data to better determine the physician manpower status in Florida.

13. Contact Information Lola Pouncey Chief, Bureau of Operations Department of Health � Division of Medical Quality Assurance (850) 245-4064 Lola_Pouncey@doh.state.fl.us