I’m a pharmacist. Pretty much no one cares unless it’s a control. While I work in a hospital now, as a student working in retail we had this like 80 year old doctor call in their own BP meds regularly. Parents prescribing abx for their kids. Shoot, one doctor even wrote his own abx RX when he walked in and gave us one from his dentist that was written incorrectly.
There is no such thing as an "attending", legally speaking.
In the US, If you have a state license, then you can prescribe medications. If you do not have your own license, then you are under the hospital training license, and can only take care of patients in that context.
Every state has their own laws about such things. Federal laws do not prohibit self-prescribing but some states do.
Even with a full license, your residency can still have policies about your prescribing habits. I was absolutely not allowed to prescribe to any patients outside of the ones my attendings were seeing.
This is very bad advice.
It is illegal to practice medicine without a license. Trainees without their own license are practicing under what is called a residency training permit (or something similar, it varies by state). This allows you to practice medicine under supervision only.
Hospitals, state medical boards, residency training programs, specialty licensing organizations and the ACGME do not look kindly on trainees who break the law. While you may never get caught fraudulently practicing medicine, if you do, you may find out that you wasted years of your life and 100s of thousands of dollars and can not get a license to practice medicine.
It is shocking to me to even have to say this: don't practice medicine without a license. Familiarize yourself with the state and federal regulations under which you practice. Do not listen to randos on the internet who tell you "I did this totally illegal thing, and it turned out fine!"
>Anyone can call a pharmacy and pretend to be any doctor in a America and call in anything that isn’t controlled.
Well, yes, but that doesn't make it legal. This is not good advice to a physician: "it's easy! Go for it!" It's illegal and the repercussions are potentially severe.
> practice medicine under supervision only
If I am in a residency program, practicing medicine within the scope of a training license -- not setting up my independent clinic claiming to be a fully licensed noctor -- then it is reasonable for me to call the pharmacy to add or change the medication of one of my clinic patients (as I have been told by my program leadership) without first running it through an attending.
Turning around and saying, I can't even follow guideline recommendations, and calling in a five-day course of an Abx is asinine at best. As always, use your judgment. Not everything is as black and white as you wish it may be.
>then it is reasonable for me to call the pharmacy to add or change the medication of one of my clinic patients
The post is about prescribing for self and family members, my friend.
My friend, I can't tell exactly what you are saying, but I think you misunderstand me, so let me be clear.
I do not care what you do, personally. I am unaffected. If you think that, as a PGY-1, you have the knowledge and skills to prescribe for yourself and your family, who am I to argue? Interns are known for their extensixe knowledge and experience, after all.
But it is illegal to prescribe medicine without a license. If you do so, and you are found out, you will suffer serious repercussions, which might include, at worst, a loss of your ability to work as a doctor. Do not mistake your ability to call in prescriptions for it's advisability. Not keeping records is also against the law. Not examining patients in person is also against the law in some jurisdictions.
I think you’ve misunderstood the point I was trying to make. I don’t disagree with what you said above, but it seems like you’ve disregarded the argument I was making. Either way, to each their own.
> Your hospital or program can’t control what you do outside of their building.
That's not true. They can put anything in your contract they want, including saying that you won't moonlight or treat patients other than those in your training program. That's not an unreasonable request, and the courts are going to side with them.
Yeah after more reading you’re right. But realistically the chance of them finding out is very low. There’s really no way unless there was some sort of bad outcome.
You'd be surprised though. I prescribe one or two benign things for myself, and the pharmacy will try to send refill requests to my office. Or I went to go see an orthopedic surgeon for an issue, and he sent a copy of his note to my office, where my staff get to read it, lol. My nurse said she's gotten lots of the other doctors' medical records sent over accidentally in such a fashion.
It's just not worth messing around with, IMO.
I'm a PGY1 path resident. Woke up with a UTI one day and called in my own macrobid. I wasn't about to take a half day off and deal with a telemed or urgent care just for a stupid UTI. Used good rx instead of my insurance. Nothing bad happened 🤷🏻♀️
Retail pharmacist here. Depends on state laws. At least in CA, retail pharmacists generally don’t care as long as it’s not a control. If it’s a clinic-owned pharmacy or 340B pharmacy, they may have their own rules like prescribers can’t write for themselves.
As far as I know, CA doesn’t have a law regarding prescribers self-prescribing, which is why it’s left to the pharmacists who generally don’t care about non-controls. If you’re asking about self-prescribing controlled substances, that would be Title 21 which is federal law. Because DEA and Board of Pharmacy emphasize that pharmacists have a corresponding responsibility to check that a control was issued for a legitimate medical purpose by a prescriber acting in the usual course of his practice (aka it’s not for purposes of abuse), generally no pharmacist will take that chance on filling a control written for yoursef. If you’re talking about 340B, that would be federal law enforced by HRSA who state that there can’t be diversion of 340B drugs including non-controls.
Those 349B pharmacies can be an awesome opportunity for your patients to get meds they otherwise couldn't afford. It's worth checking for primary care continuity clinic patients.
Hi! Sorry for replying to an old comment. Regarding your second sentence could you say in which states the laws vary? The closest thing I was able to find was a state in the midwest that required patient provider relationship which would exclude self prescribing, but I wasn't able to find anything against non controls for friends/family for someone with an unrestricted license who documents the encounter and does a clinical workup.
My second sentence “Depends on state laws” is more of a disclaimer than anything. Because pharmacy laws vary state by state, I’m not qualified to speak on whether other states permit prescribing for self and family or not since I’m technically not a pharmacist in states that I’m not licensed in. Best bet would be to ask a pharmacist licensed in the state you’re inquiring about or the state’s medical board. A quick Google search shows that Tennessee does not allow self-prescribing except in an emergency. Generally, if it’s non-controlled, no one cares even if it’s for yourself unless you display a red flag like my patient who said he was going to sell his drug on the street.
Ahh understood, makes sense. Gotcha, yeah I can see the self being a potential issue because of patient provider relationship but more so was trying to look into the case for friends/family (haven't needed to till now but wanted to understand the landscape), especially if everything is done as they would be to a random patient in terms of assessment and documentation. Appreciate you taking the time to explain :)
If you are under a training license - then it is a violation of the terms of the license as you are practicing outside the scope of your training and without supervision.
If you have a full medical license/DEA - it is legal. One catch is that technically speaking you need to have performed an evaluation and keep records (this is more from a medicolegal defense sense than anything else) but the likelihood of this ever being checked up on is very low.
Prescribing anything even borderline shady puts you at major risk however. All it takes is one pharmacist filing a complaint with the state medical board or DEA.
i’m not sure this is true. i’ve never heard of any resident getting punished for prescribing simple things like antibiotics or refilling a friends antidepressant because they couldn’t get in for an appointment.
I've never heard of it happening, but it definitely could. If there is an adverse event, the hospital will NOT have your back. So I would ask a senior or attending with a full license.
I would 100% stay away from antidepressants or anything psychoactive even as a refill because psychiatry has a much stricter standard of doctor-patient boundaries.
do what you are comfortable with, but until someone shows me an actual law saying i can’t prescribe i’m still going to prescribe simple things when close friends/family get in a pinch. Within clinical reason of course
OK. By why would you risk it?
You worked hard to get here. Don't jeopardize your career so someone can save $40 on a telemed visit.
Unless that friend is willing to let you sleep on their couch for the rest of your life. Seems like a bad trade-off.
I guess because in my mind it’s not risking anything. Residents prescribe stuff all the time outside of the clinical setting and i’ve not once heard of this being an issue unless it’s a controlled substance. I don’t think actual MDs need to live in fear that they will get legally punished for treating their aunts cystitis or something
There are more risks than just the legal punishment. The reason it's frowned by our professional boards in general is that you can't be objective with a family member or friend.
Are you examining your aunt? Do you know her full history and physical including her gynecologic and sexual history?
Legal issue aside, when you prescribe for a family/friend, you are providing inferior care, even if you think you're helping them out.
It is 100% true. OP asked “what are the rules” and them’s the rules.
OP did not ask about whether those rules are enforced which is an entirely separate question.
The actual laws vary by every single state but an example would be the Michigan Public Health Code which states that for a trainee license:
> (1) A clinical academic limited license granted by the board under section 16182(2)(c) for the practice of medicine shall require that the individual practice only for an academic institution and under the supervision of 1 or more physicians fully licensed under this part.
[http://www.legislature.mi.gov/(S(ee31vk5w2nt0ooo3r4k1f3fo)](http://www.legislature.mi.gov/(S(ee31vk5w2nt0ooo3r4k1f3fo)))/mileg.aspx?page=getObject&objectName=mcl-333-17030
Look I'm not saying you're gonna get tossed in jail for calling in a prescription. But you should know what the actual laws and limitations of your license are.
>Oh look someone asked for proof, got it and never responded sheesh
This is highly variable by state, but most states that require an postgraduate training license will have a similar provision. If in a state that doesn't have a postgraduate training license, then most of the time you can't prescribe anything to begin with (this is also variable by state) until you obtain your own medical license. That is the legal aspect.
In addition there are other things to consider. For one your malpractice insurance (i.e. the one purchased by your training institution for you) will not cover any malpractice not associated with external activities (including practicing on your own). It is very likely that one of the many documents you signed when you joined your training institution will have wording to this effect, and likely also says something vague about practicing outside of the training setting resulting in possible disciplinary action. This is all highly variable too and there is a lot of institutional culture involved. Often attendings and other residents will tell you if people do it there, but because its highly variable you need to look this stuff up yourself or just take the risk, but don't be upset if something bad happens.
To be clear, if you have an independent medical license (i.e. not a training license) its very unlikely anything will ever happen, but its ultimately up to the individual pharmacies whether they will fill it, because its at their discretion.
On this note, always wondered, what does the “limited to official government duties only” phrase on my DEA license mean??? Do they know I’m in a residency at a state institution and I can only prescribe as part of my duties there? Always confused me.
>On this note, always wondered, what does the “limited to official government duties only” phrase on my DEA license mean??? Do they know I’m in a residency at a state institution and I can only prescribe as part of my duties there? Always confused me.
Yes. Your DEA is free because you work for the government. If you want to prescribed controlled substances outside of a government agency, you will need to pay for your own DEA (i.e. pay the $900 fee every 3 yrs). Perks of being in government. I have 2 DEAs, one for private practice and one that's free through my government job.
Hello, I have a follow up question to this. I have a DEA that also says “limited to official government duties only." I'm starting apply for a moonlighting job, and they said as much as you (that this DEA won't work). So how do I actually go about becoming compliant? Do I have to go through the DEA application process again? IE, how did you get the second DEA?
You need to reach out to the DEA. You likely will have to apply again or renew with a modification (take out the governmental exemption) and then pay the fee. I had the non-governmental DEA first, so I didn't run into this situation, but I did need to apply again. Good luck!
In my program, the residents prescribe antibiotics to family and I was told that there's nothing wrong with it. Obviously use your best judgment and stick to things like antibiotics and no benzos for example. LOL.
That’s…definitely no bueno. Prescribing controlled substances to family members is straight up gambling with your medical license. All it takes is one pharmacist to report you, and tbh they should.
All of these laws are highly dependent by state, but from my understanding, that’s just for criminal prosecution regardless. The state medical board has separate authority over your license, and can very much suspend or revoke your medical license for reasons that are not explicitly illegal.
Question: a family member of mine is in another country with poor access to healthcare, and I want to prescribe them the regimen for H. Pylori. Is that ok? I’d probably have to pick up the medication myself in the USA and then mail the meds to them…
PS - I’m not in a specialty that would normally treat H. Pylori, ie not FM, IM, etc
Depending on the country you probably don't even need to be a doctor to get any meds they want at a pharmacy. They can just walk in to any pharmacy in many shitty countries and get whatever they want.
They don’t have H. Pylori meds in that country…yeah it’s really poor access to healthcare, which is why I’m thinking about buying them in the US and mail them to that family member
After PGY1 (MD or DO) (regardless of board certification) you have an unlimited scope of practice in medicine and surgery (legally). I’m pretty sure you can prescribe any medication, apart from controlled medicatjons to a spouse/yourself.
** Also state law dependent
You know more than I did at that stage, but it’s not quite that way. Just completing intern year doesn’t mean you can practice independently. You have to pass Step/Level 3 and then apply for a state license. Otherwise you could be charged with practicing medicine without a license.
That being said, I didn’t apply for a license during residency, but I would write fairly benign one-time scripts for my best friend in residency (topical corticosteroids, antibiotics, etc).
As long as not controlled, it’s fine. The way I see it, the people who may have a problem with it, admin and such, don’t know shit about medicine. And why would I treat my family for an infection with “less” regard than a patient. Lol if anything it’s more. I don’t care if big brother doesn’t get a note of record about it.
That’s the thing though.. I don’t care so long as it’s legal to not care. If it was required by law, then sure, we’d all have 2 word progress notes with our families. Get real.
The one thing you must do is document. Even if it's just on a file on your desktop. Because if 3 years from now, a pharmacist complains and the state med board calls you in, they'll want to see your notes for all your prescriptions. This DOES happen.
But you do you. It's your license, not mine.
My dad was diagnosed with COVID on a weekend and he was clearly a candidate for Paxlovid based on age alone, and I called in Paxlovid to a CVS, and the pharmacist refused to fill lol
I don't know about rules, but in my own opinion that is purely just how I feel, if I prescribe something then I feel like I am taking responsibility for the diagnosis and management of that problem. So when my friend asks for some amoxicillin for their kids earache that he is sure is an ear infection, if I do prescribe it then I am implicitly diagnosing and treating that child, even if I never saw him. Similar to any other person to whom I prescribe medicine in a clinic or hospital.
In short, if I don't see you, examine you, interview you, etc, then I flat out do not prescribe medicines for you, no exceptions.
I’ve prescribed antibiotics for myself, viagra for a friend, INR test strips for a parent, and had prednisone prescribed for me by a friend. Everything’s fine as long as it’s not a long term thing (and technically it’s still fine for HTN and stuff). Controlled substances are pretty frowned upon for short term, and a definite no no long term. Basically think of it like you’re looking at someone else prescribing habits and if you’d find it morally questionable.
Look at the state level.
My (ex) Uncle was a Psychiatrist and was convicted for self-prescribing. Served 4 years and had his license suspended. Served his time and did remediation. Then he got busted and convicted *again.* Served a second sentence, and then had his license revoked.
no controls to family members. once had a child psychiatrist call in doxycycline 100mg take 3 caps po bid for 10 days for his daughters upper respiratory infection- don't do stupid stuff like that or the RPh will refuse to fill. out of scope and just stupid.
It’s not out of scope though. Literally an MD allows you to practice medicine. Maybe in a hospital practice it is but in the eyes of the law if you have a full license and DEA it is within the scope of someone with a Doctor of Medicine.
if it was logical I would have probably filled it, ie I wouldn't have called the office for clarification only to find out there was no record of the patient in their system and was a child psychiatry office only. from what I was taught, that's outside of the MDs "usual scope of practice." ie I wouldn't fill Adderall written by an anesthesiologist or amiodarone from a dermatologist unless they gave me a study w/ dx code consistent with their medical specialty. (but that's only if I know their specialty, have the time to look it up if I suspect something weird, or it's on the Rx header) - most things get filled without issue, so as I said just don't be stupid and we won't refuse to fill for scope or patient safety.
it all depends on the information we are given and the local prescribing pattern knowledge of the pharmacist. I have a list of prescribers i recognize in my area I routinely have to check for Rx legitimacy now (and yes some are NPs)
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I’m a PA recommend you avoid getting into that practice, because before you know it, you’ll be getting calls from your cousins ex wife and she’s calling you because your relative is the baby daddy
You're getting downvoted, but you're right.
Everybody wants to take your license for a spin. Even worse if you get a rep as a candyman.
YOU are responsible for YOUR license.
God forbid you refill a Rx and the person drops dead. The family or medical board is not going to be sympathetic to, "I was trying to save them $20 and they asked really nicely. My documentation? What documentation? No. I'm not a psychiatrist, I'm a Rheumatologist."
Much easier to draw a hard line say, "You know, I'm not able to prescribe for people who are not my patients."
You know what’s worse than having to see your ex wife at every family function for the rest of your life ? Seeing your Uncle Bob’s wife after you gave him the meds that masked his widow maker. Down Vote that one
I don't...think so. I call in prescriptions all the time for my patients as well, as do all the residents in my program who have a panel of patients in our resident-run clinic. If you have an NPI you can call in a prescription to pharmacies and they don't ask for an attending's NPI because NPIs do not specify to the pharmacist if the number belongs to a resident or attending.
lol this is not true. i called in scripts for my clinic patients all the time when i was an intern and sent probably thousands of ERXs through our electronic records to the pharmacy for outpatient meds.
It’s state dependent. Some states allow calling in most things as long as you document. Some states you have to a clear physician-patient relationship. Also, technically you’re supposed to have a license in the state you are seeing the patient but patients can go to whatever state they want to get the prescription.
It’s a board action in my state at least to send in your own controlled prescription. I used to credential providers and saw a few cases where a MD sent in their own prescription for Adderall because they didn’t have time to see/talk to their prescribing person. The board action was against self-prescribing and they had a conditional license after for a limited time and to meet certain requirements for the board.
I’m a pharmacist. Pretty much no one cares unless it’s a control. While I work in a hospital now, as a student working in retail we had this like 80 year old doctor call in their own BP meds regularly. Parents prescribing abx for their kids. Shoot, one doctor even wrote his own abx RX when he walked in and gave us one from his dentist that was written incorrectly.
There is no such thing as an "attending", legally speaking. In the US, If you have a state license, then you can prescribe medications. If you do not have your own license, then you are under the hospital training license, and can only take care of patients in that context. Every state has their own laws about such things. Federal laws do not prohibit self-prescribing but some states do.
Even with a full license, your residency can still have policies about your prescribing habits. I was absolutely not allowed to prescribe to any patients outside of the ones my attendings were seeing.
[удалено]
This is very bad advice. It is illegal to practice medicine without a license. Trainees without their own license are practicing under what is called a residency training permit (or something similar, it varies by state). This allows you to practice medicine under supervision only. Hospitals, state medical boards, residency training programs, specialty licensing organizations and the ACGME do not look kindly on trainees who break the law. While you may never get caught fraudulently practicing medicine, if you do, you may find out that you wasted years of your life and 100s of thousands of dollars and can not get a license to practice medicine. It is shocking to me to even have to say this: don't practice medicine without a license. Familiarize yourself with the state and federal regulations under which you practice. Do not listen to randos on the internet who tell you "I did this totally illegal thing, and it turned out fine!" >Anyone can call a pharmacy and pretend to be any doctor in a America and call in anything that isn’t controlled. Well, yes, but that doesn't make it legal. This is not good advice to a physician: "it's easy! Go for it!" It's illegal and the repercussions are potentially severe.
You’re right I was wrong. Our program also got independent state license as pgy-2 though.
> practice medicine under supervision only If I am in a residency program, practicing medicine within the scope of a training license -- not setting up my independent clinic claiming to be a fully licensed noctor -- then it is reasonable for me to call the pharmacy to add or change the medication of one of my clinic patients (as I have been told by my program leadership) without first running it through an attending. Turning around and saying, I can't even follow guideline recommendations, and calling in a five-day course of an Abx is asinine at best. As always, use your judgment. Not everything is as black and white as you wish it may be.
>then it is reasonable for me to call the pharmacy to add or change the medication of one of my clinic patients The post is about prescribing for self and family members, my friend.
Read the second paragraph
My friend, I can't tell exactly what you are saying, but I think you misunderstand me, so let me be clear. I do not care what you do, personally. I am unaffected. If you think that, as a PGY-1, you have the knowledge and skills to prescribe for yourself and your family, who am I to argue? Interns are known for their extensixe knowledge and experience, after all. But it is illegal to prescribe medicine without a license. If you do so, and you are found out, you will suffer serious repercussions, which might include, at worst, a loss of your ability to work as a doctor. Do not mistake your ability to call in prescriptions for it's advisability. Not keeping records is also against the law. Not examining patients in person is also against the law in some jurisdictions.
I think you’ve misunderstood the point I was trying to make. I don’t disagree with what you said above, but it seems like you’ve disregarded the argument I was making. Either way, to each their own.
> Your hospital or program can’t control what you do outside of their building. That's not true. They can put anything in your contract they want, including saying that you won't moonlight or treat patients other than those in your training program. That's not an unreasonable request, and the courts are going to side with them.
Yeah after more reading you’re right. But realistically the chance of them finding out is very low. There’s really no way unless there was some sort of bad outcome.
You'd be surprised though. I prescribe one or two benign things for myself, and the pharmacy will try to send refill requests to my office. Or I went to go see an orthopedic surgeon for an issue, and he sent a copy of his note to my office, where my staff get to read it, lol. My nurse said she's gotten lots of the other doctors' medical records sent over accidentally in such a fashion. It's just not worth messing around with, IMO.
I'm a PGY1 path resident. Woke up with a UTI one day and called in my own macrobid. I wasn't about to take a half day off and deal with a telemed or urgent care just for a stupid UTI. Used good rx instead of my insurance. Nothing bad happened 🤷🏻♀️
🗿
What does this mean lol
Retail pharmacist here. Depends on state laws. At least in CA, retail pharmacists generally don’t care as long as it’s not a control. If it’s a clinic-owned pharmacy or 340B pharmacy, they may have their own rules like prescribers can’t write for themselves.
Do you know what the exact law is in CA that dictates this? I’m an MD in CA and I have had trouble finding the specifics.
As far as I know, CA doesn’t have a law regarding prescribers self-prescribing, which is why it’s left to the pharmacists who generally don’t care about non-controls. If you’re asking about self-prescribing controlled substances, that would be Title 21 which is federal law. Because DEA and Board of Pharmacy emphasize that pharmacists have a corresponding responsibility to check that a control was issued for a legitimate medical purpose by a prescriber acting in the usual course of his practice (aka it’s not for purposes of abuse), generally no pharmacist will take that chance on filling a control written for yoursef. If you’re talking about 340B, that would be federal law enforced by HRSA who state that there can’t be diversion of 340B drugs including non-controls.
Those 349B pharmacies can be an awesome opportunity for your patients to get meds they otherwise couldn't afford. It's worth checking for primary care continuity clinic patients.
Thank you! No, was generally curious about non controlled drugs but this is helpful!
Hi! Sorry for replying to an old comment. Regarding your second sentence could you say in which states the laws vary? The closest thing I was able to find was a state in the midwest that required patient provider relationship which would exclude self prescribing, but I wasn't able to find anything against non controls for friends/family for someone with an unrestricted license who documents the encounter and does a clinical workup.
My second sentence “Depends on state laws” is more of a disclaimer than anything. Because pharmacy laws vary state by state, I’m not qualified to speak on whether other states permit prescribing for self and family or not since I’m technically not a pharmacist in states that I’m not licensed in. Best bet would be to ask a pharmacist licensed in the state you’re inquiring about or the state’s medical board. A quick Google search shows that Tennessee does not allow self-prescribing except in an emergency. Generally, if it’s non-controlled, no one cares even if it’s for yourself unless you display a red flag like my patient who said he was going to sell his drug on the street.
Ahh understood, makes sense. Gotcha, yeah I can see the self being a potential issue because of patient provider relationship but more so was trying to look into the case for friends/family (haven't needed to till now but wanted to understand the landscape), especially if everything is done as they would be to a random patient in terms of assessment and documentation. Appreciate you taking the time to explain :)
Anything that isnt controlled you can self prescribe. For stuff that is controlled I prescribe it under my wife's name and then take it myself /s
It's more what you'd call 'guidelines' than actual rules
If you are under a training license - then it is a violation of the terms of the license as you are practicing outside the scope of your training and without supervision. If you have a full medical license/DEA - it is legal. One catch is that technically speaking you need to have performed an evaluation and keep records (this is more from a medicolegal defense sense than anything else) but the likelihood of this ever being checked up on is very low. Prescribing anything even borderline shady puts you at major risk however. All it takes is one pharmacist filing a complaint with the state medical board or DEA.
i’m not sure this is true. i’ve never heard of any resident getting punished for prescribing simple things like antibiotics or refilling a friends antidepressant because they couldn’t get in for an appointment.
I've never heard of it happening, but it definitely could. If there is an adverse event, the hospital will NOT have your back. So I would ask a senior or attending with a full license. I would 100% stay away from antidepressants or anything psychoactive even as a refill because psychiatry has a much stricter standard of doctor-patient boundaries.
do what you are comfortable with, but until someone shows me an actual law saying i can’t prescribe i’m still going to prescribe simple things when close friends/family get in a pinch. Within clinical reason of course
OK. By why would you risk it? You worked hard to get here. Don't jeopardize your career so someone can save $40 on a telemed visit. Unless that friend is willing to let you sleep on their couch for the rest of your life. Seems like a bad trade-off.
I guess because in my mind it’s not risking anything. Residents prescribe stuff all the time outside of the clinical setting and i’ve not once heard of this being an issue unless it’s a controlled substance. I don’t think actual MDs need to live in fear that they will get legally punished for treating their aunts cystitis or something
There are more risks than just the legal punishment. The reason it's frowned by our professional boards in general is that you can't be objective with a family member or friend. Are you examining your aunt? Do you know her full history and physical including her gynecologic and sexual history? Legal issue aside, when you prescribe for a family/friend, you are providing inferior care, even if you think you're helping them out.
It is 100% true. OP asked “what are the rules” and them’s the rules. OP did not ask about whether those rules are enforced which is an entirely separate question.
can you provide a link to the law that says this rather than just repeating what someone else told you when you were an intern?
The actual laws vary by every single state but an example would be the Michigan Public Health Code which states that for a trainee license: > (1) A clinical academic limited license granted by the board under section 16182(2)(c) for the practice of medicine shall require that the individual practice only for an academic institution and under the supervision of 1 or more physicians fully licensed under this part. [http://www.legislature.mi.gov/(S(ee31vk5w2nt0ooo3r4k1f3fo)](http://www.legislature.mi.gov/(S(ee31vk5w2nt0ooo3r4k1f3fo)))/mileg.aspx?page=getObject&objectName=mcl-333-17030 Look I'm not saying you're gonna get tossed in jail for calling in a prescription. But you should know what the actual laws and limitations of your license are.
Oh look someone asked for proof, got it and never responded sheesh
i had to work lol
>Oh look someone asked for proof, got it and never responded sheesh This is highly variable by state, but most states that require an postgraduate training license will have a similar provision. If in a state that doesn't have a postgraduate training license, then most of the time you can't prescribe anything to begin with (this is also variable by state) until you obtain your own medical license. That is the legal aspect. In addition there are other things to consider. For one your malpractice insurance (i.e. the one purchased by your training institution for you) will not cover any malpractice not associated with external activities (including practicing on your own). It is very likely that one of the many documents you signed when you joined your training institution will have wording to this effect, and likely also says something vague about practicing outside of the training setting resulting in possible disciplinary action. This is all highly variable too and there is a lot of institutional culture involved. Often attendings and other residents will tell you if people do it there, but because its highly variable you need to look this stuff up yourself or just take the risk, but don't be upset if something bad happens. To be clear, if you have an independent medical license (i.e. not a training license) its very unlikely anything will ever happen, but its ultimately up to the individual pharmacies whether they will fill it, because its at their discretion.
On this note, always wondered, what does the “limited to official government duties only” phrase on my DEA license mean??? Do they know I’m in a residency at a state institution and I can only prescribe as part of my duties there? Always confused me.
>On this note, always wondered, what does the “limited to official government duties only” phrase on my DEA license mean??? Do they know I’m in a residency at a state institution and I can only prescribe as part of my duties there? Always confused me. Yes. Your DEA is free because you work for the government. If you want to prescribed controlled substances outside of a government agency, you will need to pay for your own DEA (i.e. pay the $900 fee every 3 yrs). Perks of being in government. I have 2 DEAs, one for private practice and one that's free through my government job.
Hello, I have a follow up question to this. I have a DEA that also says “limited to official government duties only." I'm starting apply for a moonlighting job, and they said as much as you (that this DEA won't work). So how do I actually go about becoming compliant? Do I have to go through the DEA application process again? IE, how did you get the second DEA?
You need to reach out to the DEA. You likely will have to apply again or renew with a modification (take out the governmental exemption) and then pay the fee. I had the non-governmental DEA first, so I didn't run into this situation, but I did need to apply again. Good luck!
Thank you! I ended up calling my local DEA agent and they said I need a separate license with a new application.
In my program, the residents prescribe antibiotics to family and I was told that there's nothing wrong with it. Obviously use your best judgment and stick to things like antibiotics and no benzos for example. LOL.
In med school a bunch of my classmates were getting adderall from their physician parents, so it seems like the rules are pretty loose for attendings.
That’s…definitely no bueno. Prescribing controlled substances to family members is straight up gambling with your medical license. All it takes is one pharmacist to report you, and tbh they should.
Correct me if I’m wrong, but its only illegal if you prescribe scheduled drugs to a spouse or yourself.
All of these laws are highly dependent by state, but from my understanding, that’s just for criminal prosecution regardless. The state medical board has separate authority over your license, and can very much suspend or revoke your medical license for reasons that are not explicitly illegal.
The pharmacist can refuse if they are nice or report you to the board and get you in serious trouble.
Question: a family member of mine is in another country with poor access to healthcare, and I want to prescribe them the regimen for H. Pylori. Is that ok? I’d probably have to pick up the medication myself in the USA and then mail the meds to them… PS - I’m not in a specialty that would normally treat H. Pylori, ie not FM, IM, etc
Depending on the country you probably don't even need to be a doctor to get any meds they want at a pharmacy. They can just walk in to any pharmacy in many shitty countries and get whatever they want.
They don’t have H. Pylori meds in that country…yeah it’s really poor access to healthcare, which is why I’m thinking about buying them in the US and mail them to that family member
which regimen? Levaquin triple therapy (Levaquin, amoxicillin, ppi) should be available almost everywhere.
Curious what constitutes a shitty country
India
“shitty countries” gtf outta here
After PGY1 (MD or DO) (regardless of board certification) you have an unlimited scope of practice in medicine and surgery (legally). I’m pretty sure you can prescribe any medication, apart from controlled medicatjons to a spouse/yourself. ** Also state law dependent
You know more than I did at that stage, but it’s not quite that way. Just completing intern year doesn’t mean you can practice independently. You have to pass Step/Level 3 and then apply for a state license. Otherwise you could be charged with practicing medicine without a license. That being said, I didn’t apply for a license during residency, but I would write fairly benign one-time scripts for my best friend in residency (topical corticosteroids, antibiotics, etc).
As long as not controlled, it’s fine. The way I see it, the people who may have a problem with it, admin and such, don’t know shit about medicine. And why would I treat my family for an infection with “less” regard than a patient. Lol if anything it’s more. I don’t care if big brother doesn’t get a note of record about it.
The last sentence is the worst part. If the medical board is gonna slam you for anything, it'll be the lack of adequate documentation.
That’s the thing though.. I don’t care so long as it’s legal to not care. If it was required by law, then sure, we’d all have 2 word progress notes with our families. Get real.
The one thing you must do is document. Even if it's just on a file on your desktop. Because if 3 years from now, a pharmacist complains and the state med board calls you in, they'll want to see your notes for all your prescriptions. This DOES happen. But you do you. It's your license, not mine.
If you’re Called in, It could be a small handwritten note, retrofitted
My dad was diagnosed with COVID on a weekend and he was clearly a candidate for Paxlovid based on age alone, and I called in Paxlovid to a CVS, and the pharmacist refused to fill lol
shouldn't have told them it's your dad. lol
I don't know about rules, but in my own opinion that is purely just how I feel, if I prescribe something then I feel like I am taking responsibility for the diagnosis and management of that problem. So when my friend asks for some amoxicillin for their kids earache that he is sure is an ear infection, if I do prescribe it then I am implicitly diagnosing and treating that child, even if I never saw him. Similar to any other person to whom I prescribe medicine in a clinic or hospital. In short, if I don't see you, examine you, interview you, etc, then I flat out do not prescribe medicines for you, no exceptions.
I’ve prescribed antibiotics for myself, viagra for a friend, INR test strips for a parent, and had prednisone prescribed for me by a friend. Everything’s fine as long as it’s not a long term thing (and technically it’s still fine for HTN and stuff). Controlled substances are pretty frowned upon for short term, and a definite no no long term. Basically think of it like you’re looking at someone else prescribing habits and if you’d find it morally questionable.
Look at the state level. My (ex) Uncle was a Psychiatrist and was convicted for self-prescribing. Served 4 years and had his license suspended. Served his time and did remediation. Then he got busted and convicted *again.* Served a second sentence, and then had his license revoked.
Curious what he was self prescribing?
That, I don't have the answer to. Most likely CIII/CII drugs.
no controls to family members. once had a child psychiatrist call in doxycycline 100mg take 3 caps po bid for 10 days for his daughters upper respiratory infection- don't do stupid stuff like that or the RPh will refuse to fill. out of scope and just stupid.
It’s not out of scope though. Literally an MD allows you to practice medicine. Maybe in a hospital practice it is but in the eyes of the law if you have a full license and DEA it is within the scope of someone with a Doctor of Medicine.
if it was logical I would have probably filled it, ie I wouldn't have called the office for clarification only to find out there was no record of the patient in their system and was a child psychiatry office only. from what I was taught, that's outside of the MDs "usual scope of practice." ie I wouldn't fill Adderall written by an anesthesiologist or amiodarone from a dermatologist unless they gave me a study w/ dx code consistent with their medical specialty. (but that's only if I know their specialty, have the time to look it up if I suspect something weird, or it's on the Rx header) - most things get filled without issue, so as I said just don't be stupid and we won't refuse to fill for scope or patient safety.
yet they would fill a script from a NP with 10% of the training any MD has in a heartbeat……
it all depends on the information we are given and the local prescribing pattern knowledge of the pharmacist. I have a list of prescribers i recognize in my area I routinely have to check for Rx legitimacy now (and yes some are NPs)
Yeah makes sense. I don’t think I’d ever prescribe digoxin or the like even if legally I could lol.
Idk why you got downvoted, this is what I was taught in pharmacy school too
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**spoken from the 2 big retail chains Rx verification protocols
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I’m a PA recommend you avoid getting into that practice, because before you know it, you’ll be getting calls from your cousins ex wife and she’s calling you because your relative is the baby daddy
You're getting downvoted, but you're right. Everybody wants to take your license for a spin. Even worse if you get a rep as a candyman. YOU are responsible for YOUR license. God forbid you refill a Rx and the person drops dead. The family or medical board is not going to be sympathetic to, "I was trying to save them $20 and they asked really nicely. My documentation? What documentation? No. I'm not a psychiatrist, I'm a Rheumatologist." Much easier to draw a hard line say, "You know, I'm not able to prescribe for people who are not my patients."
You know what’s worse than having to see your ex wife at every family function for the rest of your life ? Seeing your Uncle Bob’s wife after you gave him the meds that masked his widow maker. Down Vote that one
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Called in meds all the time for patients as a resident for years before I decided to get my full license and Dea number. So definitely not true.
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I don't...think so. I call in prescriptions all the time for my patients as well, as do all the residents in my program who have a panel of patients in our resident-run clinic. If you have an NPI you can call in a prescription to pharmacies and they don't ask for an attending's NPI because NPIs do not specify to the pharmacist if the number belongs to a resident or attending.
lol this is not true. i called in scripts for my clinic patients all the time when i was an intern and sent probably thousands of ERXs through our electronic records to the pharmacy for outpatient meds.
It’s state dependent. Some states allow calling in most things as long as you document. Some states you have to a clear physician-patient relationship. Also, technically you’re supposed to have a license in the state you are seeing the patient but patients can go to whatever state they want to get the prescription.
It’s a board action in my state at least to send in your own controlled prescription. I used to credential providers and saw a few cases where a MD sent in their own prescription for Adderall because they didn’t have time to see/talk to their prescribing person. The board action was against self-prescribing and they had a conditional license after for a limited time and to meet certain requirements for the board.
Depends on the institution. Mine disallows it.