Motivated by its consumer-oriented mission and spurred by the opioid epidemic, the Medical Board of California has escalated the frequency, speed and depth of its enforcement investigations and prosecutions. The Board has pushed to increase reporting obligations, make the reasons for probationary conditions more publicly available, and impose greater penalties for those who shirk their responsibilities. At the same time, the Board is re-establishing a Physician Health Program for doctors with substance abuse challenges, changing its application questions relating to mental health and past criminal history, and shifting the training criteria so applicants are required to have completed 3 years of qualified residency prior to applying for licensure.