In terms of your competence to practice medicine, 4 months is not a very long time. And state medical boards don’t require anything special for re-entry after 4 months, according to the document linked at this site with data from 2010: http://physician-reentry.org/physician-reentry-regulations-by-state/ I don’t know exactly why they are asking about a gap of more than 3 months, but I imagine they are probably just fishing for information: were you in prison? rehab? do you have trouble keeping jobs? And if you answer that you had a 5-year gap, then they probably do have some additional rules about that. But I don’t think a 4-month gap to move your family out of state would raise any red flags. But you are right, practicing medicine halfway through that 4-month period will mean that you do not have to report a gap. Even if you are not paid to do it, even if it was only one patient, it should count as medical practice. You will avoid having to answer “yes” to that question and it will make things easier. Good luck!