Florida Statutes Chapter 458, known as the Medical Practice Act, is the law that governs how allopathic physicians (M.D.s) get licensed in Florida, keep their licenses active, supervise physician assistants, and answer for professional misconduct. It defines what counts as practicing medicine, sets the requirements for initial licensure and biennial renewal, requires proof of financial responsibility for malpractice claims, lists the grounds for discipline, and makes unlicensed practice a felony. Osteopathic physicians (D.O.s) are covered by a parallel statute, Chapter 459.
Who Needs a License Under Chapter 458
The statute defines the practice of medicine as diagnosing, treating, operating on, or prescribing for any human disease, pain, injury, deformity, or other physical or mental condition.1Online Sunshine. Florida Code 458.305 – Definitions Anyone doing those things for patients in Florida needs a license under Chapter 458 unless an exemption applies.
Two exemptions matter most. Licensed health care practitioners working within their own statutory scope, such as nurses, dentists, or chiropractors, don’t need a separate physician license. Commissioned medical officers on active military duty are also exempt. Everyone else who holds themselves out as a physician without a valid Florida license is exposed to the criminal penalties described later in this article.
Getting Licensed for the First Time
Licensure by examination runs through the Florida Board of Medicine, which sits within the Department of Health and certifies applicants who clear every requirement in Section 458.311. The application carries a nonrefundable fee of up to $500.2Online Sunshine. Florida Code 458.311 – Licensure by Examination You must be at least 21, show good moral character, and have no history of conduct that would be grounds for discipline under Section 458.331. Fingerprints for state and national background checks are required.
Education and training requirements depend on where you went to medical school:
- U.S. graduates: an allopathic medical degree from a school accredited by an agency recognized by the U.S. Office of Education, plus at least one year of an approved residency.
- Foreign graduates from a school certified under Section 458.314: graduation from a WHO-registered school found reasonably comparable to U.S. accreditation, English proficiency if the school taught in another language, and at least one year of approved residency.
- Foreign graduates from a non-certified school: an active ECFMG certificate, a passing ECFMG exam score, and at least one year of approved residency.
Anyone who graduated from medical school after October 1, 1992 must also have completed two academic years of preprofessional postsecondary coursework in fields like anatomy, biology, and chemistry before medical school.2Online Sunshine. Florida Code 458.311 – Licensure by Examination All applicants must pass a national licensing examination, most commonly the USMLE.
International medical graduates carry an extra layer. ECFMG certification requires passing USMLE Step 1 and Step 2 Clinical Knowledge and completing a clinical and communication skills pathway, and every pathway applicant must reach a satisfactory score on the Occupational English Test (OET) Medicine regardless of native language or citizenship.3Intealth ECFMG. Requirements for 2026 Pathways for ECFMG Certification Certificates issued through a pathway expire when the pathway expires unless you revalidate or meet the requirements to make the certificate valid indefinitely.
Renewing a Florida Medical License
Florida licenses run on a two-year cycle. To renew, you must show that you have actively practiced medicine or taught at an accredited medical school for at least two of the preceding four years, or pass a clinical competency exam if you haven’t.4Online Sunshine. Florida Code 458.319 – Renewal of License The renewal fee is capped at $500. Residents, fellows, and interns in approved postgraduate training pay no more than $100 per year.
Each cycle requires at least 40 hours of continuing medical education.5Online Sunshine. Florida Code 456.013 – Department; General Licensing Provisions Several hours are earmarked:
- A 2-hour Board-approved course on medical errors prevention, covering root-cause analysis, error reduction, and the five most misdiagnosed conditions from the prior biennium.6Florida Board of Medicine. Medical Doctor (MD) Renewal
- A 2-hour Board-approved course on controlled substance prescribing for every DEA-registered physician.
- A 2-hour domestic violence course every third renewal cycle.
- The remaining hours as AMA Category I credits.
The first renewal is lighter: courses on HIV/AIDS, medical errors prevention, and controlled substance prescribing (if DEA-registered).6Florida Board of Medicine. Medical Doctor (MD) Renewal Up to 25 percent of required CME hours can be fulfilled through pro bono services to indigent or underserved populations if the Board approves the services in advance.
Financial Responsibility for Malpractice
Every physician with an active license must demonstrate financial responsibility for malpractice claims. You can do that through professional liability insurance, an escrow account of cash or eligible assets, or an irrevocable letter of credit.7Online Sunshine. Florida Code 458.320 – Financial Responsibility The minimums:
- General practice: at least $100,000 per claim with a $300,000 minimum annual aggregate.
- Surgery in ambulatory surgical centers, or physicians with hospital staff privileges: at least $250,000 per claim with a $750,000 minimum annual aggregate.
Those amounts cannot be used for litigation costs or defense attorney fees, so real-world coverage has to sit comfortably above the required floor. If an adverse final judgment is entered and you’re relying on an escrow account or letter of credit, you have 60 days from the date the judgment becomes final to pay up to the required amount.
Supervising Physician Assistants
Section 458.347 sets the rules for supervising physician assistants. A supervising physician must be qualified in the medical areas where the PA practices and is responsible and liable for the PA’s performance.8Florida Senate. Florida Code 458.347 – Physician Assistants No physician may supervise more than 10 licensed PAs at any one time.
Supervision means being easily available for consultation and direction, either physically present or reachable by telecommunication, and that availability must be continuous in non-emergency situations. Supervising physicians are not required to review and cosign PA charts. PAs can authenticate most of the same documents a physician can, including do-not-resuscitate orders, death certificates, school physicals, and orders for physical or occupational therapy.
Telehealth and Out-of-State Physicians
Florida-licensed physicians can provide telehealth services without extra registration, but the standard of care is the same as for in-person visits.9FL HealthSource. FAQs – Telehealth Telehealth providers generally cannot prescribe Schedule II controlled substances remotely, with narrow exceptions for psychiatric treatment, inpatient hospital care, hospice services, and nursing home residents.
Out-of-state physicians who want to treat Florida patients by telehealth can apply for an out-of-state telehealth provider registration. That requires an active, unencumbered license in another state, a Florida registered agent for service of process, and liability coverage meeting or exceeding Florida’s financial responsibility requirements. Out-of-state registrants cannot open a Florida office or see Florida patients in person.
Physicians moving between states can also use the Interstate Medical Licensure Compact, enacted in Florida through Section 456.4501. The compact does not create a national license; it streamlines applying for a full license in each participating state through a centralized system, and requires a designated State of Principal License, a clean disciplinary record, and ABMS or AOABOS board certification.10Online Sunshine. Florida Code 456.4501 – Interstate Medical Licensure Compact
What Can Cost You Your License
Section 458.331 lists the conduct that can get a license denied, restricted, suspended, or revoked. The categories most physicians encounter fall into a few groups.
Fraud and Misrepresentation
Trying to get or renew a license through bribery or fraudulent misrepresentation, filing false reports, intentionally failing to file records required by law, and deceptive advertising are all grounds for discipline.11Online Sunshine. Florida Code 458.331 – Grounds for Disciplinary Action
Competence and Standard of Care
Gross or repeated malpractice is one of the more serious grounds. The statute also reaches physicians who cannot practice with reasonable skill and safety because of substance abuse or a mental or physical condition. Knowing that another licensee is violating Chapter 458 and failing to report it is independently actionable, though a physician struggling with substance use may be reported to an impaired practitioner program instead of the Department.
Prescribing Violations
Prescribing controlled substances outside the prevailing standard of care, presigning blank prescription forms, and prescribing to yourself are all prohibited. Controlled-substance prescribing violations carry a mandatory minimum penalty of at least six months of suspension and a fine of at least $10,000 per count, with escalating penalties for repeat offenses.12Online Sunshine. Florida Code 456.072 – Grounds for Discipline; Penalties; Enforcement
Financial Misconduct and Referrals
Paying or receiving kickbacks for patient referrals is prohibited. So is referring patients to a business entity in which you hold a 10 percent or greater equity interest without first disclosing that interest and the patient’s right to go elsewhere. Delegating professional responsibilities to someone unqualified to handle them is also grounds for discipline. Action taken against your license in another state, including voluntary surrender in response to pending disciplinary charges, is an independent basis for Florida discipline.
Penalties the Board Can Impose
Once the Board finds a violation, Section 456.072 gives it broad options, and it can stack them.12Online Sunshine. Florida Code 456.072 – Grounds for Discipline; Penalties; Enforcement The Board can refuse to certify an application, or certify it with restrictions on where, when, or how you practice. It can suspend a license temporarily or revoke it permanently. Administrative fines run up to $10,000 per count, and a $10,000 fine per count is mandatory for fraud or fraudulent misrepresentation. Probation can require treatment, supervised practice, additional education, or reexamination. The Board can also issue a reprimand or letter of concern, order remedial education, and require refunds of fees billed to patients or insurers.
A physician found guilty of repeated malpractice can face suspension, a fine, probation with supervision, and mandatory remedial education in a single order. The Board’s stated priority is protecting the public rather than punishing the physician, but the practical effect can end a career.
Criminal Penalties for Unlicensed or Lapsed Practice
Practicing or attempting to practice medicine in Florida without a license is a third-degree felony under Section 458.327.13Online Sunshine. Florida Code 458.327 – Penalty for Violations14Online Sunshine. Florida Code 775.082 – Penalties; Applicability of Sentencing Structures; Notification Requirements15Florida Senate. Florida Code 775.083 – Fines The same felony classification covers:
- Using or attempting to use a suspended or revoked license
- Obtaining a license through knowing misrepresentation
- Misrepresenting your education, training, or experience to secure a position as a medical practitioner or resident
- Knowingly operating an unregistered pain-management clinic that must be registered
- Dispensing a Schedule II or Schedule III controlled substance in violation of pharmacy dispensing rules
The statute also creates several first-degree misdemeanors punishable by up to a year in jail: knowingly concealing information about violations of Chapter 458, making a willfully false oath required by the chapter, practicing with an inactive or delinquent license, and leading the public to believe you are a licensed physician when you are not. Practicing without ever having a license is the felony; practicing on a license that has simply lapsed into inactive status is the misdemeanor. Either way, the Department of Health can pursue cease-and-desist orders and administrative fines on top of any criminal prosecution.