Licensed MD without full residency. Work options?

[Flodoc]

I'm trying to help someone out and can't really find any leads. She has completed her intern year and is a licensed MD. She is a great person and extremely intelligent. However, she is ready to give up residency and she is scared of not having any decent job options (obviously). She has been approached about working in the med spa setting, which she seems to be okay with. Is there any way to get credentialed through any of the insurance companies without ABMS board certification? Are there other boards to be certified under that dont require a full residency? Same question for mal practice insurance too. Any companies offer that to licensed MDs who arent board certified or eligible? Thanks so much for your help.

BTW, she is not interested in entering a field that is beyong her knowledge/comfort zone.....like cosmetic surgery. She just wants a legitimate opportunity to be involved in medicine.

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[atsai3]

I'm trying to help someone out and can't really find any leads. She has completed her intern year and is a licensed MD. She is a great person and extremely intelligent. However, she is ready to give up residency and she is scared of not having any decent job options (obviously). She has been approached about working in the med spa setting, which she seems to be okay with. Is there any way to get credentialed through any of the insurance companies without ABMS board certification? Are there other boards to be certified under that dont require a full residency? Same question for mal practice insurance too. Any companies offer that to licensed MDs who arent board certified or eligible? Thanks so much for your help.

BTW, she is not interested in entering a field that is beyong her knowledge/comfort zone.....like cosmetic surgery. She just wants a legitimate opportunity to be involved in medicine.

Even for IHS you need to be board-eligible if not board certified. There are probably some fields where you don't need board certification to get a job, but you do need to be board eligible (e.g., psychiatry).

I can't think of any clinical options for your friend. Certainly with an MD she could go into research, pharma, etc or even (if her MD is from a prestigious medical school) management consulting, etc.

 

[MD forever]

She can try house call jobs they need help, and may be will to take her, with her current status. As a matter of fact this business is growing specially after "Independence at Home Demonstration". Some leaders in the field think even the regular residency did not prepare physicians to this type of service, and feel the need for special training that tailor to this type of career. Majority of providers do not have geriatric fellowship which is the heart of this career. Bottom line there is patient doctor bilateral satisfaction, saving money for CMS when preventing hospital readmission and you are practicing medicine not SPA money making machine.

 

[NotAProgDirector]

The honest truth is that she should finish her residency. Even if she can find a job today, there is no guarantee it will still be possible in 5-10 years.

 

[Knicks]

Why is she "ready to give up residency"? Just curious.

 

[ForbiddenComma]

There are options here. The med spa you mentioned is one. She could also work at the PA/NP level; there are urgent care clinics; there are non-medical options in some fields such as research. Not all clinics are obsessed with board-eligibility in their new hires.

It would be better for her to finish residency, either at her current program or somewhere else. But if she is the victim of a malignant PD, as you seem to be hinting at, then this is not possible.

 

[Law2Doc]

The honest truth is that she should finish her residency. Even if she can find a job today, there is no guarantee it will still be possible in 5-10 years.

Yeah, the number of spas that go bankrupt in prolonged economic downturns isn't small -- this is a luxury business. It would be shortsighted to drop out of residency to take this job which might not even exist in a couple of years. Now if you are telling us she's not getting her residency contract renewed, that's a different story.

 

[DrAwsome]

Yeah, the number of spas that go bankrupt in prolonged economic downturns isn't small -- this is a luxury business. It would be shortsighted to drop out of residency to take this job which might not even exist in a couple of years. Now if you are telling us she's not getting her residency contract renewed, that's a different story.

You'd be surprised! Spas do very very well for the most part, and well managed ones do even better. I'm not sure that the statement that "might not even exist in a couple of years" is accurate. Although I agree that this should be something done on the side for extra income. I know a few docs who have spa type practices only and do well, but they are well established and have serious pedigrees in affluent areas, and they are few and far in between!

I do think it's a great way to make extra cash though.

 

[mlw03]

I'm trying to help someone out and can't really find any leads. She has completed her intern year and is a licensed MD. She is a great person and extremely intelligent. However, she is ready to give up residency and she is scared of not having any decent job options (obviously). She has been approached about working in the med spa setting, which she seems to be okay with. Is there any way to get credentialed through any of the insurance companies without ABMS board certification? Are there other boards to be certified under that dont require a full residency? Same question for mal practice insurance too. Any companies offer that to licensed MDs who arent board certified or eligible? Thanks so much for your help.

BTW, she is not interested in entering a field that is beyong her knowledge/comfort zone.....like cosmetic surgery. She just wants a legitimate opportunity to be involved in medicine.

Then she needs to do at least 3 years of post-graduate training. Ie, a residency.

 

[highlyfavoured]

have here contact me via private message so I can chat with her more.... I have a suggestion for a job she might be interested in

Thanks

 

[Flodoc]

Thanks everyone. Anyone know specifics about getting credentialed through insurance companies..... and if she could get malpractice insurance?

 

[mohderm]

Like you said, she is a licensed MD. While definately not recommended or encouraged she could still work as a physician. The jobs would be limited, but I personally know 2 physicians that did not complete 3 year residencies, but function in the role of a family practice physician in rural areas. There are alot of people who have no comprehension of the true need of physicians in many rural areas. One of the docs is my brother in law so I speak with some experience. There were certain family needs that forced him to not finish. He currently works in a clinic as well as takes call in local ED for 5-6 shifts per month. Easily makes over 200K and is very happy. While there will be people who read this post with disgust, he is serving in an otherwise underserved community. He is the only doc in a town of 2000 people, 15 miles from the nearest 20 bed hospital, 50 miles from a hospital with an ICU or cardiac/stroke care. Would you rather see a MD who went through 4 years of med school and 1+ years of residency or go a clinic staffed only by a NP whose preceptor is 50 miles away?

This path is not for everyone and if she is not up for something like this then maybe the research or medi-spa route would be the way to go. You don't even need an MD to do those jobs

 

[ForbiddenComma]

Would you rather see a MD who went through 4 years of med school and 1+ years of residency or go a clinic staffed only by a NP whose preceptor is 50 miles away?

And remember, the NP had just 2-3 years of a part-time, easy-to-get-into grad school with very limited clinical exposure compared to med school. And the NP likely had no residency whatsoever.

Someone please explain to me how an MD with 1-2 years of residency is an inferior pick for a clinic than an NP or PA fresh out of school with 0 years of residency. Does that make any sense?

Fortunately, not all employers are blinded by the obsession with board-eligibility. Including mine. And, I am indeed covered by medmal.

 

[silverjack]

Like you said, she is a licensed MD. While definately not recommended or encouraged she could still work as a physician. The jobs would be limited, but I personally know 2 physicians that did not complete 3 year residencies, but function in the role of a family practice physician in rural areas. There are alot of people who have no comprehension of the true need of physicians in many rural areas. One of the docs is my brother in law so I speak with some experience. There were certain family needs that forced him to not finish. He currently works in a clinic as well as takes call in local ED for 5-6 shifts per month. Easily makes over 200K and is very happy. While there will be people who read this post with disgust, he is serving in an otherwise underserved community. He is the only doc in a town of 2000 people, 15 miles from the nearest 20 bed hospital, 50 miles from a hospital with an ICU or cardiac/stroke care. Would you rather see a MD who went through 4 years of med school and 1+ years of residency or go a clinic staffed only by a NP whose preceptor is 50 miles away?

This path is not for everyone and if she is not up for something like this then maybe the research or medi-spa route would be the way to go. You don't even need an MD to do those jobs

Which states are good for non board eligible but licensed docs?

 

[HondoCrouch]

She needs to decide if her desire to "give up residency" outweighs the very real prospect of having to move to the boonies to work in rural ER/urgent care centers...because that is the only legitimate scenario where she will be able to practice medicine. Other options become shady, pill mills and such.

 

[Law2Doc]

You'd be surprised! Spas do very very well for the most part, and well managed ones do even better. I'm not sure that the statement that "might not even exist in a couple of years" is accurate...

Um no. Actually you'd be surprised. Some of us did some work with bankrupt organizations/workouts in our prior careers, and spas were actually not rarities. More of them fail than you seem to believe. It's a business that thrives in good economies and runs big risk in bad ones. Plus it's hard to know which is a "well managed one" from the outside. As a deal lawyer I can tell you that many many businesses that look profitable aren't, once you get down to the financials.

 

[ForbiddenComma]

She needs to decide if her desire to "give up residency" outweighs the very real prospect of having to move to the boonies to work in rural ER/urgent care centers...because that is the only legitimate scenario where she will be able to practice medicine. Other options become shady, pill mills and such.

There are options to be had, depending on the state.

Yes, there is no question it is far better to complete a residency and become board-eligible due to our current GME set-up, one that favors hospitals and program directors at the expense of residents. If you are not directly in a program director's crosshairs, my advice is to always tough it out no matter how lousy the program is.

But if you ARE in the crosshairs of a dishonorable PD, as I was, then there is nothing that can save you. It is irrelevant how competent of a physician you are. There is no check on the PD's power worth mentioning and they WILL find a way to get you canned sooner or later, as any resident in the country can be unilaterally canned by their PD if the PD wants them gone badly enough and is willing to work at it. In this situation, exploring work options outside of residency may be a superior choice for some people than waiting around for the inevitable termination.

 

[Gastrapathy]

Fortunately, not all employers are blinded by the obsession with board-eligibility. Including mine. And, I am indeed covered by medmal.

But the pressure to hire BC physicians will only increase. Its in the interest of the recertification apparatus to make us all stay BC ($$$) and they have proven that they are an effective lobby.

OP, if your friend can stick it out in any way, she has to do it.

 

[ForbiddenComma]

But the pressure to hire BC physicians will only increase. Its in the interest of the recertification apparatus to make us all stay BC ($$$) and they have proven that they are an effective lobby.

True, and I will have to return to residency someday... but we are not quite there yet. What I dread more than anything is submitting myself to a PD who turns out to be another Mussolini-wanna-be. Sure would be nice if this GME system of ours could be reformed just a little.

OP, if your friend can stick it out in any way, she has to do it.

Agreed

 

[myhandsarecold]

correctional medicine, dont need to be BE/BC

 

[Igor4sugry]

I always wondered why its not possible for someone who finished 4years of med school or finished internship to get a Physician Assistant license and work for great pay.

We have way more training than the curriculums of PA programs, why is that job restricted only to those who finished PA programs even though they have less training/knowledge?

 

[peerie]

Consider the legal aspects of why a physician cannot be a PA. A PA receives a license that qualifies them to be a PA with a PA's knowledge, you are being licensed against the knowledge that is commonly held for a physician's assistant and which is acknowledged in many programs and state licensing boards.

A physician has a greater depth of knowledge and cannot be covered legally by a PA's license. A PA's license will not cover the true extent of the knowledge that you would have. There would always be the risk that you would diagnose and treat according to your physician knowledge and yet you only hold the PA license. The area of responsibility is legally different and this is why PAs must have physician supervision in most states. It might sound strange, but it is a legal definition. This is also why physicians cannot really become nurses, for the most part. Your knowledge will always surpass your license, and in any legal situation you are considered a liability.

It's important to respect the integrity of a license, and what that means both for practice as well as for the liability and the implications of any potential legal issues. While I am sure there are exceptions, as there always are in life - these are important distinctions that are made for a reason and should be respected.

 

[Samoa]

Consider the legal aspects of why a physician cannot be a PA. A PA receives a license that qualifies them to be a PA with a PA's knowledge, you are being licensed against the knowledge that is commonly held for a physician's assistant and which is acknowledged in many programs and state licensing boards.

A physician has a greater depth of knowledge and cannot be covered legally by a PA's license. A PA's license will not cover the true extent of the knowledge that you would have. There would always be the risk that you would diagnose and treat according to your physician knowledge and yet you only hold the PA license. The area of responsibility is legally different and this is why PAs must have physician supervision in most states. It might sound strange, but it is a legal definition. This is also why physicians cannot really become nurses, for the most part. Your knowledge will always surpass your license, and in any legal situation you are considered a liability.

It's important to respect the integrity of a license, and what that means both for practice as well as for the liability and the implications of any potential legal issues. While I am sure there are exceptions, as there always are in life - these are important distinctions that are made for a reason and should be respected.

This reasoning is specious. There is no defined limit on what a PA is allowed to diagnose or treat. The requirement is only that they be supervised by a physician, and in some states have limits on controlled-substance prescribing. Aside from this, they are allowed to do anything within their supervising physician's scope of practice, that said physician is comfortable delegating to them.

This is no different, qualitatively, than a resident's level of practice.

 

[dragonfly99]

I think she should try to finish SOME kind of residency, if there is any way she can. If she can get into a family practice program, IM, physical med/rehab, or occupational medicine, etc.
Also, she could look in to doing some sort of fellowship at NIH or the CDC...it might be hard or impossible to get with only a partial residency, though.
It will be very hard (maybe impossible?) to get credentialed at a hospital or by insurance companies without finishing residency. If she gets hired by someone else, they are assuming some responsibility for her and I guess would take care of that. I think that places like an independent urgent care clinic, etc. that is owned by a physician(s) could hire her if they wanted to, but a lot wouldn't take the risk.
I have received emails and letters from time to time from vein clinics and one from a company that sends docs to do wound care at nursing homes - the latter one mentioned they would take people without completed residency (this is the ONLY) time I've seen that stated in a job solicitation.

 

[1992btw]

Like you said, she is a licensed MD. While definately not recommended or encouraged she could still work as a physician. The jobs would be limited, but I personally know 2 physicians that did not complete 3 year residencies, but function in the role of a family practice physician in rural areas. There are alot of people who have no comprehension of the true need of physicians in many rural areas. One of the docs is my brother in law so I speak with some experience. There were certain family needs that forced him to not finish. He currently works in a clinic as well as takes call in local ED for 5-6 shifts per month. Easily makes over 200K and is very happy. While there will be people who read this post with disgust, he is serving in an otherwise underserved community. He is the only doc in a town of 2000 people, 15 miles from the nearest 20 bed hospital, 50 miles from a hospital with an ICU or cardiac/stroke care. Would you rather see a MD who went through 4 years of med school and 1+ years of residency or go a clinic staffed only by a NP whose preceptor is 50 miles away?

This path is not for everyone and if she is not up for something like this then maybe the research or medi-spa route would be the way to go. You don't even need an MD to do those jobs

Hello,
I am considering working as a GP in rural Wisconsin now that I got my medical lisence. Could you give me the contact of your relative so that I could have his thoughts about practicing without completing residency? I finished 21 months of family medicine when my contract was not renewed, so I have a good base to practice outpatient medicine. Thank you for your post; I feel that I could practice in some capacity now.

 

[grandhe]

If you have a California State Medical License, you can send your resume to [email protected] to apply for Non-Accredited Pain Fellowship program at CVPM, Central Valley, CA.

 

[1992btw]

If you have a California State Medical License, you can send your resume to [email protected] to apply for Non-Accredited Pain Fellowship program at CVPM, Central Valley, CA.

Thank you for your response, but I only have a Wisconsin medical license and don't qualify for a cali license because the it requires 24 months of residency.

 

[Obnoxious Dad]

Thank you for your response, but I only have a Wisconsin medical license and don't qualify for a cali license because the it requires 24 months of residency.

If you have a Wisconsin license, you can get a job. Call Randy Munson at the Wisconsin Office for Rural Health. He's the chief physician recruiter for WORH. I am sure that he could offer you some ideas.

 

[Shikima]

You can also work in the Federal BOP - plenty of jobs on usajobs.gov to peruse. Get a couple of years in working there, get some good LORs and return back to residency, perhaps in a different field or complete OcMed?

 

[1992btw]

I spoke to Dr. Munson, who offered frank and detailed feedback. Basically, in his 20 years of recruiting, he was not able to find a licensed but not BC/BE doctor a job due to insurance companies requiring BC/BE for payment. I have applied to all applicable jobs at the Indian Health Service (1 good lead), BOP via USAjobs (2 jobs; too early to tell), and the WI dept of Health (3 positions; also too early to tell), and finally I have an active offer to do Home Health Assessments in WI (no patient management and seems a bit mechanical). I think Shikima's advice is reasonable, especially if I can land a job in which I manage patients so that I could use that experience to return to residency.
I have another idea: work over the next year as a GP while completing an MPH at U of WI and then applying to Preventive med or Occ Med for the 2015 match. Would this be too short of a time frame? I would complete the MPH by the July 2015 start date for residents.
I have also considered opening a humble cash-only clinic, but starting a business is very complicated and I have little experience with this. My girlfriend is a certified esthetician and massage therapist, so a cash only clinic could work as a combination of primary care and wellness/cosmetology.
Finally, I am also considering transitioning out of clinical medicine altogether and somehow using the credentials I have in the pharmaceutical industry, research (I did 1.5 years of hematology research in medical school), or some other field that I currently don't even know exists. Despite the setback of contract non-renewal, I am very optimistic about the future because I sense a deep desire to enjoy whatever is next and am willing to try new things rather than fear the withdrawal of getting off the high school/college/med school/residency/attending/nirvana mindset. I am young and have time to reinvent my career, but it will be my last chance, so I am all in as long as the venture is interesting an I am good at it I can sustain it.
Thank you all for your suggestions and comments.

 

[Shikima]

Why not work for the federal government in the prison system? Happened to a friend of mine who was canned after 2 yrs residency, and after a couple of years, he is now completing his MPH and Oc Med residency. BOP is a good place to work. Easy work environment. No need to worry about reimbursements for being BE/BC. You can also continue to work in a lab if you so choose.

 

[1992btw]

You offer sage advice; the more I consider my options, the BOP offers the best opportunity to maintain patient contact. By the way, how many years did he practice at the BOP before resuming residency? Thank you for giving me a real-world experience of someone else who crawled out of my situation. I am starting to see things with more clarity now.

 

[Shikima]

Yes. He was out of work with only a WI license. Worked 3 years at BOP, developed a good reputation and earned glowing letters. Oc Med was happy to accept him. It always seems the most bleak when emotionally crushed, however you can return like a pheonix. If you choose. Look on usajobs.gov for your specialty (typically primary care) and get your contacts to agree to write you a letter of recommendation and develop an unemotional attachment to the past.

 

[Dral]

You offer sage advice; the more I consider my options, the BOP offers the best opportunity to maintain patient contact. By the way, how many years did he practice at the BOP before resuming residency? Thank you for giving me a real-world experience of someone else who crawled out of my situation. I am starting to see things with more clarity now.

One typically applies for prevent. med during intern year. Many already have an MPH built in to the curriculum.

 

[1992btw]

Why not work for the federal government in the prison system? Happened to a friend of mine who was canned after 2 yrs residency, and after a couple of years, he is now completing his MPH and Oc Med residency. BOP is a good place to work. Easy work environment. No need to worry about reimbursements for being BE/BC. You can also continue to work in a lab if you so choose.

Sorry to email you again, but did your friend complete all 2 years of residency (24 months of rotations) or or just part of PGY2? All of the USAjobs.com employment opportunities say that minimum requirements are a WI license (needs only 12 months of training) and Internship, but then at the bottom it mentions 2 full years of training. I completed 21 months only, so I was just curious. Did your friend also qualify for loan repayment incentives (the BOP benefits package mentions this). Tomorrow will be the SOAP/Scramble, but I don't my hopes up, so I am putting my effort finding employment ASAP so that I could return to residency in the future.

 

[Shikima]

Sorry to email you again, but did your friend complete all 2 years of residency (24 months of rotations) or or just part of PGY2? All of the USAjobs.com employment opportunities say that minimum requirements are a WI license (needs only 12 months of training) and Internship, but then at the bottom it mentions 2 full years of training. I completed 21 months only, so I was just curious. Did your friend also qualify for loan repayment incentives (the BOP benefits package mentions this). Tomorrow will be the SOAP/Scramble, but I don't my hopes up, so I am putting my effort finding employment ASAP so that I could return to residency in the future.

Not sure, I can inquire about the total time spent in residency. Keep your fingers crossed for SOAP/Scramble, may get lucky! Back-up plan would be BOP! Check your in-box..

 

[fellow2020]

Hello,
I am considering working as a GP in rural Wisconsin now that I got my medical lisence. Could you give me the contact of your relative so that I could have his thoughts about practicing without completing residency? I finished 21 months of family medicine when my contract was not renewed, so I have a good base to practice outpatient medicine. Thank you for your post; I feel that I could practice in some capacity now.

 

[fellow2020]

Hi, I am in a similar situation. Couldn't complete residency. What did you finally do? WOuld appreciate your help

 

[1992btw]

This posting will be my first in years and much has changed since I initially posted. From 4/2014-3/2016, I performed in-house Medicare risk assessments, which did not entail any clinical management. Finally in 4/2016, I caught a break and returned to clinical medicine in various locums assignments in family, urgent and correctional medicine through 8/2019. With that experience, I joined the Bureau of Prisons in 9/2019 as a Medical Officer and later became Clinical Director of a facility with 2000 inmates. I am now in the process of joining the US Public Health Service to open opportunities in public health while also practicing clinical medicine. In all six years of practicing medicine, I have not had any adverse outcomes or any medical malpractice claims. I am now posting again to gather guidance about completing my training. As I mentioned in my initial post, I am a USIMG and completed 21 of 36 months of family medicine residency training before my contract was terminated due to late charting and late arrival to work on several occasions despite multiple warnings. After review of preventive medicine program requirements, I am only eligible to apply to a single program due to not meeting the 24-month criterion for residency training. As for family medicine, I have likely exceeded the CME funding limits due to completion of part of my residency. In my present position, I have assumed more professional responsibility as a physician than in residency and have performed strongly. However, the credentialing issues still will interfere with my ability to match and complete my training. Once in the PHS, I will have options to practice in the IHS and possibly VA system, so part of me doesn't see the point of mounting an unlikely application when I could practice medicine at a high level of competence, have stability, excellent compensation, ability to finally start a family and leave behind my nomadic life in the PHS. Yet, I also acknowledge that without BC, many doors will remain closer forever. I have plenty of drive and although no longer young, I still have the intellectual curiosity and work ethic to complete residency training. If my recent work load is often greater than my demands in residency and I have exceeded expectations, I don't see why I should not be able to complete residency training. I understand that eligibility criteria exist for a reason, but I am hoping that programs could consider where I am today as well as my previous setbacks. I would like to hear thoughts about how to proceed.
PS to shikima- Thank you for your guidance so many years ago. Your comments kept a flicker of hope alive in me and helped to salvage my medical career.

Why not work for the federal government in the prison system? Happened to a friend of mine who was canned after 2 yrs residency, and after a couple of years, he is now completing his MPH and Oc Med residency. BOP is a good place to work. Easy work environment. No need to worry about reimbursements for being BE/BC. You can also continue to work in a lab if you so choose.

 

[xffan624]

This posting will be my first in years and much has changed since I initially posted. From 4/2014-3/2016, I performed in-house Medicare risk assessments, which did not entail any clinical management. Finally in 4/2016, I caught a break and returned to clinical medicine in various locums assignments in family, urgent and correctional medicine through 8/2019. With that experience, I joined the Bureau of Prisons in 9/2019 as a Medical Officer and later became Clinical Director of a facility with 2000 inmates. I am now in the process of joining the US Public Health Service to open opportunities in public health while also practicing clinical medicine. In all six years of practicing medicine, I have not had any adverse outcomes or any medical malpractice claims. I am now posting again to gather guidance about completing my training. As I mentioned in my initial post, I am a USIMG and completed 21 of 36 months of family medicine residency training before my contract was terminated due to late charting and late arrival to work on several occasions despite multiple warnings. After review of preventive medicine program requirements, I am only eligible to apply to a single program due to not meeting the 24-month criterion for residency training. As for family medicine, I have likely exceeded the CME funding limits due to completion of part of my residency. In my present position, I have assumed more professional responsibility as a physician than in residency and have performed strongly. However, the credentialing issues still will interfere with my ability to match and complete my training. Once in the PHS, I will have options to practice in the IHS and possibly VA system, so part of me doesn't see the point of mounting an unlikely application when I could practice medicine at a high level of competence, have stability, excellent compensation, ability to finally start a family and leave behind my nomadic life in the PHS. Yet, I also acknowledge that without BC, many doors will remain closer forever. I have plenty of drive and although no longer young, I still have the intellectual curiosity and work ethic to complete residency training. If my recent work load is often greater than my demands in residency and I have exceeded expectations, I don't see why I should not be able to complete residency training. I understand that eligibility criteria exist for a reason, but I am hoping that programs could consider where I am today as well as my previous setbacks. I would like to hear thoughts about how to proceed.
PS to shikima- Thank you for your guidance so many years ago. Your comments kept a flicker of hope alive in me and helped to salvage my medical career.

PM only requires one year of internship.

Preventive Medicine Residency Programs

Looking for Preventive Medicine residency Programs? We offer students an exciting blend of clinical medicine with special skill sets. Find opportunities here.

www.acpm.org

 

[Mad Jack]

This posting will be my first in years and much has changed since I initially posted. From 4/2014-3/2016, I performed in-house Medicare risk assessments, which did not entail any clinical management. Finally in 4/2016, I caught a break and returned to clinical medicine in various locums assignments in family, urgent and correctional medicine through 8/2019. With that experience, I joined the Bureau of Prisons in 9/2019 as a Medical Officer and later became Clinical Director of a facility with 2000 inmates. I am now in the process of joining the US Public Health Service to open opportunities in public health while also practicing clinical medicine. In all six years of practicing medicine, I have not had any adverse outcomes or any medical malpractice claims. I am now posting again to gather guidance about completing my training. As I mentioned in my initial post, I am a USIMG and completed 21 of 36 months of family medicine residency training before my contract was terminated due to late charting and late arrival to work on several occasions despite multiple warnings. After review of preventive medicine program requirements, I am only eligible to apply to a single program due to not meeting the 24-month criterion for residency training. As for family medicine, I have likely exceeded the CME funding limits due to completion of part of my residency. In my present position, I have assumed more professional responsibility as a physician than in residency and have performed strongly. However, the credentialing issues still will interfere with my ability to match and complete my training. Once in the PHS, I will have options to practice in the IHS and possibly VA system, so part of me doesn't see the point of mounting an unlikely application when I could practice medicine at a high level of competence, have stability, excellent compensation, ability to finally start a family and leave behind my nomadic life in the PHS. Yet, I also acknowledge that without BC, many doors will remain closer forever. I have plenty of drive and although no longer young, I still have the intellectual curiosity and work ethic to complete residency training. If my recent work load is often greater than my demands in residency and I have exceeded expectations, I don't see why I should not be able to complete residency training. I understand that eligibility criteria exist for a reason, but I am hoping that programs could consider where I am today as well as my previous setbacks. I would like to hear thoughts about how to proceed.
PS to shikima- Thank you for your guidance so many years ago. Your comments kept a flicker of hope alive in me and helped to salvage my medical career.

Most PM programs require an intern year, though some specify that 8 months of that intern year must be in a primary care field. You almost certainly met this standard. The 24 total months for board eligibility is including the required 12 months of clinical rotations that are a part of the PM program itself, as most programs operate on a 12 month clinical/12 month MPH or research format after you complete an intern year. Given your strong commitment to public health as evidence by your career, this seems like an excellent option for you, as the process occurs outside of the Match and your app would be strong.

Funding issues are hit or miss. Some larger programs don't rely heavily on resident funding to function. VA programs do not receive their funding through Medicare so these wouldn't be an issue either. So if you're going for family med, aiming for programs with these characteristics in the match (larger programs or those with large systems backing them, VA programs) would be ideal

 

[1992btw]

PM only requires one year of internship.

Preventive Medicine Residency Programs

Looking for Preventive Medicine residency Programs? We offer students an exciting blend of clinical medicine with special skill sets. Find opportunities here.

www.acpm.org

Yes, for US medical graduates; for a USIMG like me, we need 24 months or completion of residency altogether.

 

[gutonc]

Yes, for US medical graduates; for a USIMG like me, we need 24 months or completion of residency altogether.

Curious if you can point us to that requirement on the ACPM page. I didn't see that anywhere. The only requirement I saw was the need to complete a full year of training in an ACGME or RCPSC training program.

 

[Redpancreas]

This thread has a lot of gems and wish I would have read it a few months ago. It's pretty scattered so I thought I'm pull everything together. OP, you ask what to do if you graduate medical school, but quit residency, but want to practice clinically.

1. Licensure is required. It varies per state but is usually an intern year and completion of Steps 1-3 along with an application which is basically verification above + background check. (note someone above is saying for IMGs it's 24 months?)

2. Determine if you are looking for something short-term/locums or more long term.

Short term:
-In-house insurance assessments for patients (this job is highly unsatisfying, but pays a decent amount). The key here is that cheap malpractice is provided by companies but not needed because you're basically filling out a survey. They'd rather have MDs do it than midlevels because even the worst MD picks up on things PAs may not.
-Correctional facility medicine (do not require BC/BE). Sadly I guess malpractice insurance isn't needed.
-Do what @1992btw did, which I don't fully understand. Not sure how he/she got a FM gig without BC/BE.

Long term:
-Try wound care. Currently it's not a specialty and they're looking for career-physicians looking to pick up their field.
-You can try opening your own business and market yourself in a technically correct way that doesn't reveal you aren't an actually fully trained physician. I highly discourage this.

3. REALLY reconsider residency. This is the only way to get board eligible. This opens up infinite doors (relative to simply licensure). Even a FM board certification and there are millions of opportunities available to you in the short/long term not limited to office based primary care, hospitalists, etc. Recruiters will find you.

 

[Redpancreas]

This posting will be my first in years and much has changed since I initially posted. From 4/2014-3/2016, I performed in-house Medicare risk assessments, which did not entail any clinical management. Finally in 4/2016, I caught a break and returned to clinical medicine in various locums assignments in family, urgent and correctional medicine through 8/2019. With that experience, I joined the Bureau of Prisons in 9/2019 as a Medical Officer and later became Clinical Director of a facility with 2000 inmates. I am now in the process of joining the US Public Health Service to open opportunities in public health while also practicing clinical medicine. In all six years of practicing medicine, I have not had any adverse outcomes or any medical malpractice claims. I am now posting again to gather guidance about completing my training. As I mentioned in my initial post, I am a USIMG and completed 21 of 36 months of family medicine residency training before my contract was terminated due to late charting and late arrival to work on several occasions despite multiple warnings. After review of preventive medicine program requirements, I am only eligible to apply to a single program due to not meeting the 24-month criterion for residency training. As for family medicine, I have likely exceeded the CME funding limits due to completion of part of my residency. In my present position, I have assumed more professional responsibility as a physician than in residency and have performed strongly. However, the credentialing issues still will interfere with my ability to match and complete my training. Once in the PHS, I will have options to practice in the IHS and possibly VA system, so part of me doesn't see the point of mounting an unlikely application when I could practice medicine at a high level of competence, have stability, excellent compensation, ability to finally start a family and leave behind my nomadic life in the PHS. Yet, I also acknowledge that without BC, many doors will remain closer forever. I have plenty of drive and although no longer young, I still have the intellectual curiosity and work ethic to complete residency training. If my recent work load is often greater than my demands in residency and I have exceeded expectations, I don't see why I should not be able to complete residency training. I understand that eligibility criteria exist for a reason, but I am hoping that programs could consider where I am today as well as my previous setbacks. I would like to hear thoughts about how to proceed.

Hey man, it's very heartening to see how you never lost interest in clinical medicine and forged your own path. I do have 2 questions.

1. How were you able to secure a locums assignment in family and urgent care medicine without BC/BE? It seems like the industry standard.

2. Could you outline the path to practicing VA medicine? I understand the notion that it is not funded through medicare and hence does not require the BC/BE but what exactly is the process like? Why did you need the US PHS and clinical work to get you there? Why not just apply directly to the VA after you left residency?
--------------
3. Also, this is my advise. If you're not taking it, explain why?

Consider reapplying to residencies ASAP. Yes, you are older. Yes, you're going to be reapplying to the same field (FM)...but at least from my admittedly naïve vantage point, you seem really dedicated to clinical medicine and seem much more accountable now. You may get interest from several FM programs. The funding's an issue, but there are several places that choose to run over cap...even if they're not, you still get a lot of funding even if you are over your primary care residency cap. Why not at least give it one go? Your career options would exponentially increase with BC/BE. You're best off doing it NOW as each year you wait creates less openness for programs to take you. I can't fully make out from your post but it seems like you are considering some form of a residency but are looking to do that later if I'm understanding you correctly? I disagree with that outlook, I think the sooner the better. You can keep working/doing what you're doing but why not submit an ERAS this year. Get references from whoever you've worked with clinically recently and get an ERAS token from your international school however that is done and apply this Fall 2021.

 

[Redpancreas]

This reasoning is specious. There is no defined limit on what a PA is allowed to diagnose or treat. The requirement is only that they be supervised by a physician, and in some states have limits on controlled-substance prescribing. Aside from this, they are allowed to do anything within their supervising physician's scope of practice, that said physician is comfortable delegating to them.

This is no different, qualitatively, than a resident's level of practice.

I can see how you're saying the knowledge/practical skills are roughly the same between a mid-residency MD/DO and a PA-C. That does not mean the law treats them the same. A PA-C who makes a mistake while practicing with supervision of a physician was doing what they trained to do and will be seen completely differently than an MD/DO who is working under another physician (outside of an GME residency) and makes a mistake. The latter is going to get sued like crazy without malpractice insurance which is why it's so difficult to find clinical work with just a physician license.

BC/BE (needs residency) is what gets Medicare to reimburse your work. If you don't have that, any serious physician employer (locums, clinics, etc.) that can actually pay for malpractice will see no reason to invest $$$ in you.

EDIT: did not realize this post was from 9 years ago....

 

[Splenda88]

@BacktotheBasics

Going back to residency is not for everyone if they have a stable job and/or they have a family. For instance, my friend is a general practitioner and is working for Indian Health Service. He makes ~200k/yr seeing <10 patients/day M-F 8am-5pm with all the benefits of the feds. There is no incentive for someone like that to go back and start residency all over again or try to 'finish' residency.

 

[Redpancreas]

@BacktotheBasics

Going back to residency is not for everyone if they have a stable job and/or they have a family. For instance, my friend is a general practitioner and is working for Indian Health Service. He makes ~200k/yr seeing <10 patients/day M-F 8am-5pm with all the benefits of the feds. There is no incentive for someone like that to go back and start residency all over again or try to 'finish' residency.

I’m not advocating for the whole world to go back to residency. I’m not sure what the point of your response to my post is. I am asking @1992btw specific questions given that he is someone who has actually spent years without board certification pursuing clinical work, grinding through this process and is willing to share his experience. That is the scope of this discussion and the context behind my questions.

The hearsay example of your general practitioner friend (who I suspect likely already completed residency) doing IHS work doesn’t seem to have anything to do with what I’m talking about. With the IHS, I’ve looked and, like the majority of clinical work outside correctional facilities, you need to be board certified.

***Please correct me if I’m wrong about IHS and if you can provide any specific information on positions that provide highly compensated, sustainable clinical work to physicians without board certification.

 

[Splenda88]

***Please correct me if I’m wrong about IHS and if you can provide any specific information on positions that provide highly compensated, sustainable clinical work to physicians without board certification.

My friend only completed 1-yr internship; he is not BC or BE

Job Opportunities | Physicians

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized Tribes grew out of the special...

www.ihs.gov

 

[Redpancreas]

My friend only completed 1-yr internship; he is not BC or BE

Job Opportunities | Physicians

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized Tribes grew out of the special...

www.ihs.gov

OK. I apologize that I assumed he did not. I still have questions about that though. I have looked and all the positions in my area are saying BC/BE. I have also clicked about 20 random ones and ctrl-f "cert" and all of them say something along the lines of "must maintain appropriate board certification". I personally am trying to find a locums job before I restart residency in July. I'll look harder I guess.