important rotations question

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game24

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Hello,

I have an option of doing clinical rotations at two different hospitals. One hospital offers all 72 weeks of rotations but it only has an FM residency with all other specialties covered under the FM umbrella. The other hospital is ACGME accredited for all six cores and also offers all 72 weeks of rotations. What difference does this make for licensing? I strongly prefer the 1st hospital's location, but I don't want to deal with licensing problems in the future. Mods please move this thread to a forum for Caribbean/IMG medical students.

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Hello,

I have an option of doing clinical rotations at two different hospitals. One hospital offers all 72 weeks of rotations but it only has an FM residency with all other specialties covered under the FM umbrella. The other hospital is ACGME accredited for all six cores and also offers all 72 weeks of rotations. What difference does this make for licensing? I strongly prefer the 1st hospital's location, but I don't want to deal with licensing problems in the future.
 
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I'm sorry but your post makes no sense to me. You are pre-pharm but you are talking about clinical rotations that are done for medical school and licensing that comes after residency. What exactly is your question?
 
I'm sorry but your post makes no sense to me. You are pre-pharm but you are talking about clinical rotations that are done for medical school and licensing that comes after residency. What exactly is your question?
I am a third year medical student. I don't know how to change my status.
 
to update your status, click on your name and there is a space at the bottom of the choices that says "update your status" it's faint, but it's there. Back to what was your question?
 
to update your status, click on your name and there is a space at the bottom of the choices that says "update your status" it's faint, but it's there. Back to what was your question?

From what I understand 35 states don't require greenbook rotations. 10 states require all 6 core rotations be greenbook. 5 states require all core and elective rotations to be greenbook. So if a hospital has an ACGME accredited family medicine residency with all specialties covered under the FM umbrella what exactly does that mean ?
Which category does it belong to?
 
From what I understand 35 states don't require greenbook rotations. 10 states require all 6 core rotations be greenbook. 5 states require all core and elective rotations to be greenbook. So if a hospital has an ACGME accredited family medicine residency with all specialties covered under the FM umbrella what exactly does that mean ?
Which category does it belong to?

I don't know what any of this means.
 
From what I understand 35 states don't require greenbook rotations. 10 states require all 6 core rotations be greenbook. 5 states require all core and elective rotations to be greenbook. So if a hospital has an ACGME accredited family medicine residency with all specialties covered under the FM umbrella what exactly does that mean ?
Which category does it belong to?
WTF?? This all sounds like gibberish.
 
OK, I found this, it is for IMG's. No wonder none of us know what the OP is talking about. I just cut and pasted this so please don't ask me to clarify anything.

Greenbook Rotations
It is very difficult to define Green Book Rotations as many states have different criteria in order to recognize rotations done as international medical "students" in the U.S. The word "Green Book" comes from the book called "Green Book", which is the paper version of www.acgme.org. This is where all ACGME approved residency programs are listed.

Another factor that will affect your candidacy for specific clinicals is whether you're a medical student or a graduate. Please use caution to distinguish yourself as an International Medical Graduate (IMG) or an International Medical Student (IMS) when looking for clinicals. By mistake, we classify ourselves as IMG, eventhough we may still be medical students.

The most important thing you should be concerned about is licensure and the ability to practice medicine (not just residency) in the U.S. For this reason, we have formulated the following definition:

Green Book Rotations – unofficial - are clinical clerkships conducted in a hospital with at least one residency program, or one of their satellite clinics, or in a facility with an ACGME listed affiliation with a medical school that offers that residency (since they will most likely send those residents and their medical students to their affiliate sites). The same teaching institution’s GME office, or a representative of the GME office for the non-LCME program must document and supervise these very same rotations. Students must have officially been accepted at that institution prior to rotation start date, gone through orientation, and carry appropriate identification. Personally setting up rotation with attending, even those who are employed by residency programs, will not guarantee “rotation verification” for IMG licensure. Many states (i.e. Georgia) require this for both Cores and Electives... so its safe to account for all rotations. For example, Greenville Hospital, a minor affiliate of X School of Medicine who rotates their Psychiatry residents and students at Greenville Hospital, AND who will verify your rotations (not just the attending signature on evaluation) will suffice for most clinical rotation criteria section of IMG licensure.

This is completely different for International Medical Graduates, as they don't need to have their clinicals verified. As a matter of fact, an entirely different universe of rules and regulations (both documented and verbal) apply to this set of individuals who have already graduated from a non-U.S. medical school, not done residency in the U.S., have no U.S. medical license and need to fulfill the various residency program's U.S. clinical experience requirements before they can apply. These sub-set of doctors need to make sure that they abide specifically know each states medical board rules when it comes to clinicals, and not be engaged in the practice of medicine without a license. I'll go as far as saying that they shouldn't even wear a white lab coat (short or long) when in clinicals, not call their clinicals "rotations" or "externships" or "clerkships".

Certainly, there are variations to this definitions and parameters. However, we at AmeriClerkships have expanded and propose to change the term of "Greenbook Rotations" to "Verifiable Rotations". In 2007/8, there are 20 states that will qualify IMG rotations done in the U.S., and most-all will want to see the GME/MSO's seal and verification of the rotation. Basically, if the hospital doesn't officially know you're there, they won't seal and verify the rotation.

You might have also heard about Blue Book Rotations – unofficial; we speculate this to refer to conducting any core or elective rotation in a hospital who possesses the ACGME status for a Family Practice residency program. This is for the international medical student (IMS) to practice medicine in the not-so-difficult states. Once again, this is used by only a couple of caribbean medical schools. I don't necessarily agree with this since there is only one state (California) that allows for required green book rotations to be done in FP residency programs... not all states do this.
 
From what I understand 35 states don't require greenbook rotations. 10 states require all 6 core rotations be greenbook. 5 states require all core and elective rotations to be greenbook. So if a hospital has an ACGME accredited family medicine residency with all specialties covered under the FM umbrella what exactly does that mean ?
Which category does it belong to?
This is not as difficult as you (and everyone else) is making it seem.

Yes "Greenbook" rotations is an old term referring to the fact that before ERAS there was literally a Green pleather bound book which listed all the ACGME accredited residencies in the US - when it came time to apply for residency you sat down with this book and snail mailed programs a residency application with your supporting documents; thus "Greenbook rotations" refers to clinicals at locations with ACGME accredited residencies in that specialty. This is important in terms of obtaining an allopathic state medical license; it is mostly an issue for IMGs.

I'm not sure what you mean "all specialties covered under the FM umbrella". Some states require that ALL rotations be completed in a location with an ACGME accredited residency in that specialty in order to be eligible for a medical license; you have noted that yourself above. That means that a location which only has an FM residency does NOT COUNT as meeting the requirements for 15 states. This prevents you (or your school) from arranging rotations with your Uncle Joe in his FM office, etc. and have them count toward the minimum required for a medical license. For example, I had a classmate who did a rotation with a family friend in an outpatient setting and the state of Pennsylvania refused to allow that rotation to count (fortunately, it was an elective and he had enough weeks of clinicals otherwise).

Therefore, you are much better off doing your clinicals in a location which offers ACGME accredited residencies in all cores in order to maximize your chances for residency, as it will not unduly restrict you geographically.
 
This is not as difficult as you (and everyone else) is making it seem.

Yes "Greenbook" rotations is an old term referring to the fact that before ERAS there was literally a Green pleather bound book which listed all the ACGME accredited residencies in the US - when it came time to apply for residency you sat down with this book and snail mailed programs a residency application with your supporting documents; thus "Greenbook rotations" refers to clinicals at locations with ACGME accredited residencies in that specialty. This is important in terms of obtaining an allopathic state medical license; it is mostly an issue for IMGs.

I'm not sure what you mean "all specialties covered under the FM umbrella". Some states require that ALL rotations be completed in a location with an ACGME accredited residency in that specialty in order to be eligible for a medical license; you have noted that yourself above. That means that a location which only has an FM residency does NOT COUNT as meeting the requirements for 15 states. This prevents you (or your school) from arranging rotations with your Uncle Joe in his FM office, etc. and have them count toward the minimum required for a medical license. For example, I had a classmate who did a rotation with a family friend in an outpatient setting and the state of Pennsylvania refused to allow that rotation to count (fortunately, it was an elective and he had enough weeks of clinicals otherwise).

Therefore, you are much better off doing your clinicals in a location which offers ACGME accredited residencies in all cores in order to maximize your chances for residency, as it will not unduly restrict you geographically.

Thanks for the advice. I had no idea that it affected residency. I thought it only affected licensing after completing residency which ultimately wouldn't matter because of reciprocity.
 
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Thanks for the advice. I had no idea that it affected residency. I thought it only affected licensing after completing residency which ultimately wouldn't matter because of reciprocity.
Im afraid you're still not completely understanding it.

In most cases, you must be eligible for a medical license in the state where you do your residency, even if you have no intention of ever obtaining an unrestricted license to practice. Often one of the requirements for residency is "eligibility for medical license". Some states require a training license and other programs require an unrestricted license for senior residents. As an IMG, however, in most states you will not be eligible for an unrestricted license until you have completed several years of residency.

I'm not sure what you mean by "reciprocity" in the case above. Very few states have that. Just because you obtain a state license in say, New Jersey, (for example), that does not mean you are automatically eligible for a Pennsylvania state license.

This is probably all semantics and it likely will not make a difference but if you choose to do your clinicals in a state which will not accept the location of your rotations then you have limited your options for residency as well as future practice. But if you know for a fact that the programs you apply to will not require that you have a medical license during residency or that you are eligible for one, then it probably doesn't matter. FWIW, I'd rather rotate at a program with experience training physicians in all the core rotations.
 
Im afraid you're still not completely understanding it.

In most cases, you must be eligible for a medical license in the state where you do your residency, even if you have no intention of ever obtaining an unrestricted license to practice. Often one of the requirements for residency is "eligibility for medical license". Some states require a training license and other programs require an unrestricted license for senior residents. As an IMG, however, in most states you will not be eligible for an unrestricted license until you have completed several years of residency.

I'm not sure what you mean by "reciprocity" in the case above. Very few states have that. Just because you obtain a state license in say, New Jersey, (for example), that does not mean you are automatically eligible for a Pennsylvania state license.

This is probably all semantics and it likely will not make a difference but if you choose to do your clinicals in a state which will not accept the location of your rotations then you have limited your options for residency as well as future practice. But if you know for a fact that the programs you apply to will not require that you have a medical license during residency or that you are eligible for one, then it probably doesn't matter. FWIW, I'd rather rotate at a program with experience training physicians in all the core rotations.

From Cabin builder's post: "Certainly, there are variations to this definitions and parameters. However, we at AmeriClerkships have expanded and propose to change the term of "Greenbook Rotations" to "Verifiable Rotations". In 2007/8, there are 20 states that will qualify IMG rotations done in the U.S., and most-all will want to see the GME/MSO's seal and verification of the rotation. Basically, if the hospital doesn't officially know you're there, they won't seal and verify the rotation."

How important is hospital verification for rotations ? For the hospital with all 6 cores with ACGME accredited residencies in that specialty, the rotations are verified through the attending physician and not the hospital. Is this more restrictive in terms of applying for residency than the other hospital that I mentioned which has hospital verification but only an FM residency?
 
1) AmeriClerkships is a service which preys on the fears of IMGs. I would not take what they state as the truth or use it for guidance in any matters. They are not associated with any medical licensing board, ACGME, RRC etc. and their advice, even if correct, should not be interpreted as gospel.

2) They are the ones who are using the term "Verifiable Rotations". This is not a term used by the ACGME; I am not sure what the "verification" process means or entails. Obviously if the hospital "doesn't know you're there" (which I can't imagine happening in this day and age of HIPAA and all other sorts of documentation) no one will accept that as a formal rotation.

3) Medical licensing for the purpose of residency will vary from state to state. There are some states which require all your Core Rotations be done in hospitals with ACGME residencies; that doesn't necessarily mean that you have to do Surgery at a hospital with a Surgery residency, FM at a hospital with an FM residency and so on, but generally they are going to prefer academic sites or those with an academic affiliation where there is some standardization to the training and education.

4) I advise you to check with states where you contemplate doing residency and see what the requirements are - to start residency, to be licensed and for medical education. These are usually easily obtainable on-line.

Again, you are making this more difficult than it needs to be. Even without any state restrictions, you are usually better off at a site which has experience in educating/training students and residents. You have your answer. It is safest and gives you the most options for residency placement to do your rotations in a program which has an ACGME residency in the Core rotations because then there will be no question about the validity of the rotations. However, this does not mean that doing it in a site with only a FM residency is wrong, just that there *may* be *some* issues and *some* states may question that, making things more difficult. Many many residents have rotated at sites without residencies in all the Core specialties and have done fine. Just pick a site and be done with it.
 
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1) AmeriClerkships is a service which preys on the fears of IMGs. I would not take what they state as the truth or use it for guidance in any matters. They are not associated with any medical licensing board, ACGME, RRC etc. and their advice, even if correct, should not be interpreted as gospel.

2) They are the ones who are using the term "Verifiable Rotations". This is not a term used by the ACGME; I am not sure what the "verification" process means or entails. Obviously if the hospital "doesn't know you're there" (which I can't imagine happening in this day and age of HIPAA and all other sorts of documentation).

3) Medical licensing for the purpose of residency will vary from state to state. There are some states which require all your Core Rotations be done in hospitals with ACGME residencies.

4) I advise you to check with states where you contemplate doing residency and see what the requirements are - to start residency, to be licensed and for medical education. These are usually easily obtainable on-line.

Again, you are making this more difficult than it needs to be. Even without any state restrictions, you are usually better off at a site which has experience in educating/training students and residents. You have your answer. It is safest and gives you the most options for residency placement to do your rotations in a program which has an ACGME residency in the Core rotations because then there will be no question about the validity of the rotations. However, this does not mean that doing it in a site with only a FM residency is wrong, just that there *may* be *some* issues and *some* states may question that, making things more difficult. Many many residents have rotated at sites without residencies in all the Core specialties and have done fine. Just pick a site and be done with it.

Thank You for your advice. I really appreciate it.
 
Im afraid you're still not completely understanding it.

In most cases, you must be eligible for a medical license in the state where you do your residency, even if you have no intention of ever obtaining an unrestricted license to practice. Often one of the requirements for residency is "eligibility for medical license".
Not entirely true. State medical boards have no jurisdriction over requirements and criteria of residency programs
 
Not entirely true. State medical boards have no jurisdriction over requirements and criteria of residency programs
You're misinterpreting my response.

State medical boards have no jurisdiction over residency program requirements. I agree with that statement.

My comment said that one of the common requirements for a RESIDENCY PROGRAM is that you be "eligible for a medical license" in the state in which you are doing a residency. This has nothing to do with the state medical board and their jurisdiction.

This is not a state medical license requirement but rather a requirement of the individual residency program. They are well within their rights to require you to be eligible for a license to be eligible for training in their program.
 
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You're misinterpreting my response.

State medical boards have no jurisdiction over residency program requirements. I agree with that statement.

My comment said that one of the common requirements for a RESIDENCY PROGRAM is that you be "eligible for a medical license" in the state in which you are doing a residency. This has nothing to do with the state medical board and their jurisdiction.

This is not a state medical license requirement but rather a requirement of the individual residency program. They are well within their rights to require you to be eligible for a license to be eligible for training in their program.

Full licensure or just restricted? Because in order for you to be eligible for full licensure, some states need your clinical rotations verified by each institution and thats way beyond the boundaries of residency programs.
 
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Full licensure or just restricted?
That depends on the residency program but it doesn't matter because the requirements that these programs are speaking of are generally things that would make you ineligible or eligible for both.


There are very few things that make someone ineligible for a medical license but it can include going to a medical school unapproved by that particular state, having certain federal or felony convictions, or having your license revoked etc.

As always, this will vary by state and residency program. If you are at all worried, check the requirements for licensure in the state where you think you may be doing residency and make sure you meet those requirements.
 
That depends on the residency program but it doesn't matter because the requirements that these programs are speaking of are generally things that would make you ineligible or eligible for both.


There are very few things that make someone ineligible for a medical license but it can include going to a medical school unapproved by that particular state, having certain federal or felony convictions, or having your license revoked etc.

As always, this will vary by state and residency program. If you are at all worried, check the requirements for licensure in the state where you think you may be doing residency and make sure you meet those requirements.

Well the reason why Im curious is because for example some states require your rotations to be verified by the institution before you can become eligible for licensure. With that being how will a residency program know whether or not you completed your rotations there?
 
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