Practice as a doctor after just a transitional year?

[Ruban]

Hi all,

I don't plan on doing it, but it is my understanding that if you have internship under your belt, you can basically hang out a shingle and start practicing medicine.

My question: I have heard that this ONLY applies to prelim medicine years, but not a transitional year. Anyone know if this is the case? I'm planning on doing radiology after my transitional year, and in a worst case scenario (e.g. radiology doesn't work out for some reason) I'd like to have something to fall back on.

Thanks!

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[colbgw02]

i'm pretty sure as long as you've completed an internship (any internship) pass step 3, and get a license from a state, then yeah, you can basically hang out your shingle and go to work.

the only exception may be if you do your PGY-1 in pathology, since that residency no longer requires a separate internship. anyone know?

 

[Blade28]

I thought you could apply for a license after ANY PGY1 year and passing Step 3, but I could be wrong.

 

[21JumpStreet]

This is actually the path that an indian health service doctor takes. They finish a transitional year and go to serve in an area. So, this is another path that you could consider taking.

I don't know how all patients feel about a doctor having not completed a residency. However, I have noticed that many patients won't see doctors that aren't board certified. I had even run in to a woman at a clinic that had asked me whether or not a particular doctor was board certified. She told me that she would never again see one that wasn't. I told her about the American Board of Specialists directory to find out. Back to the point. You can't even get board certified in anything unless you have successfully completed a residency.

 

[lowbudget]

A lot of military doctors do this. Transitional year. Work as "flight surgeon" or "general medical officer" to pay back some time, get some experience. Go back to residency.

 

[docB]

You can work as a doctor with just a license and no residency training but be careful. For example in NV you must have at least three years of post grad training to apply for a license. You are also at a big disadvantage when it comes to billing M&M and various insurers if you are not boarded and you can't be boarded with just 1 year of training.

 

[Winged Scapula]

As others note, there is no requirement that you finish residency to be able to practice medicine. All it takes it a license, which various states require various amounts of post-graduate training to obtain.

However, as docB notes, you are severely limiting yourself in the type of practice you can have. Most insurance companies and MediCare will not reimburse physicians who are not BE/BC - which you won't be without finishing a full residency, regardless of the field.

Most hospitals will not grant you priviledges to admit, treat or do procedures without appropriate training. Therefore, you are left essentially to hang out your own shingle and work on a cash basis, since it will be tough to make money otherwise. See hair transplant clinics, Botox and other cosmetic practices for individuals who have taken this road. There's also shilling for various diet pills I see advertised on tv.

 

[erichaj]

I agree. It's only two more years anyway (for FP). you come all this way only to stop at the door steps. Get a board certification. If you want extra cash, you can moonlight.

I had a friend who was a captain in the army. He was based in california. He would always ask me if I wanted to fly in for the weekend and work the urgent care. They payed 65 an hour. It was federal so all I needed was any state license. I never took him up on it because I was moonlighting already.

Anyway, go through some pain, finish residency, it will pay off.

 

[lattimer13]

This is actually the path that an indian health service doctor takes. They finish a transitional year and go to serve in an area. So, this is another path that you could consider taking.

I don't know how all patients feel about a doctor having not completed a residency. However, I have noticed that many patients won't see doctors that aren't board certified. I had even run in to a woman at a clinic that had asked me whether or not a particular doctor was board certified. She told me that she would never again see one that wasn't. I told her about the American Board of Specialists directory to find out. Back to the point. You can't even get board certified in anything unless you have successfully completed a residency.

hmmmmmm...

i did my family med rotation at an IHS site and all of them had completed their full residencies. maybe that's the way it was back in the day, but i know at least the docs from the early '80s had all done complete residencies prior to their stint with IHS.

 

[lattimer13]

A lot of military doctors do this. Transitional year. Work as "flight surgeon" or "general medical officer" to pay back some time, get some experience. Go back to residency.

this i can verify as i've known a few to have done this.

 

[21JumpStreet]

hmmmmmm...

i did my family med rotation at an IHS site and all of them had completed their full residencies. maybe that's the way it was back in the day, but i know at least the docs from the early '80s had all done complete residencies prior to their stint with IHS.

The few that I know personally did a transitional year and already served with IHS. Two of them pursued and completed a competitive residency AFTER serving with IHS.

 

[LADoc00]

I know many a doc who simply did a prelim year, got a medical license then opened a biz. In fact one of the most prosperous "dermatologists" in my community is one of those, much to the dismay of all the boarded dermies who were AOA and did fellowships.....its all MARKETING guys. Seriously, this guy graduated from some butt crack medical school too, but you would never know it from his super flashy website and ad campaign. If you really want to make the bucks, skip residency, its a waste. Stick to easy, cash paying modes of healtcare delivery.

On the same note, I met a Vietnamese guy, around 25, did 1 year of gsurg, bailed and is now doing medical directorships for laser skin centers........net yearly pay: 1million+.

all us working stiffs are pure suckers!!!!

 

[Disciple]

So in other words, he doesn't personally supervise any of these laser skin centers but is liable for any screw ups by the aestheticians or nurses performing the procedures?

 

[erichaj]

So in other words, he doesn't personally supervise any of these laser skin centers but is liable for any screw ups by the aestheticians or nurses performing the procedures?

Thats actually true for every laser or medical spa out there. The doctor does usually do the injections like botox and dermal fillers.

sometimes they even do the thermage procedures.

If they are doing a laser peel, the physician will do that. But not all spas do laser peels and thermage.

if its a nurse practitioner, then they usually have their own malpractice. All others are covered under you.

 

[Roadie9]

I know of a guy who graduated from our TY program about 10 years back and now practices as a GP. He now does a bunch of alternative stuff, like crystals and vitamin megadoses. Needless to say, he rakes in the cash.

If you look at any income table for physicians, you'll find GPs mentioned. By definition, they have not completed a residency but are board certified.

 

[docB]

I know of a guy who graduated from our TY program about 10 years back and now practices as a GP. He now does a bunch of alternative stuff, like crystals and vitamin megadoses. Needless to say, he rakes in the cash.

If you look at any income table for physicians, you'll find GPs mentioned. By definition, they have not completed a residency but are board certified.

What are they board certified in? It's pretty hard to sit for any boards without a residency.

 

[Faebinder]

Actually.. it depends on what state you go to and if you are an AMG vs FMG.

Here are the requirements of each state for you to practice.

http://www.fsmb.org/usmle_eliinitial.html

The transitional year is not enough for states like: Alaska, Maine, Illinois, Michigan (unless you are a DO, they let you get a license if you are a DO with only 1 year but not an MD), Montana, Nevada, New Hamp, New Mexico (unless you are a DO, they let DOs practice with only 1 year), Pennsilvanya (unless you are a DO, thel let DOs practice with only 1 year), Rhode Island, South Dakota (forget this state, they want you to finish residency), Utah, Washington (DOs only need 1 year)...

Note Tennessee doesn't even require the DO to finish a year of internship to get a license!

Also note if you are an an IMG then you will be required by a lot of states to have more years in residency to get a license.

 

[docB]

Actually.. it depends on what state you go to and if you are an AMG vs FMG.

Here are the requirements of each state for you to practice.

http://www.fsmb.org/usmle_eliinitial.html

The transitional year is not enough for states like: Alaska, Maine, Illinois, Michigan (unless you are a DO, they let you get a license if you are a DO with only 1 year but not an MD), Montana, Nevada, New Hamp, New Mexico (unless you are a DO, they let DOs practice with only 1 year), Pennsilvanya (unless you are a DO, thel let DOs practice with only 1 year), Rhode Island, South Dakota (forget this state, they want you to finish residency), Utah, Washington (DOs only need 1 year)...

Note Tennessee doesn't even require the DO to finish a year of internship to get a license!

Also note if you are an an IMG then you will be required by a lot of states to have more years in residency to get a license.

I'm not sure if you were responding to my question or not. If not then yes, everything you said above is correct. If you were then everyone needs to keep in mind that being "board certified" or "boarded" is not the same as being licensed. The requirements for getting a license vary by state. To become board certified you have to meet the requirements to take the test offered by one of the specialty boards within the American Board of Medical Specialties (eg. the American Board of Emergency Medicine). Licensure and board certification are two seperate things. All the want ads looking for BC/BE docs are not looking for someone who just has a license.

http://www.abms.org/

 

[3dtp]

What are they board certified in? It's pretty hard to sit for any boards without a residency.

GPs are not board certified. But, they've been in practice before the current "bc/be" mania. They're grandfathered, retain hospital privileges and insurance panels. Simple because they've been at it a long time.

Today, if you go the conventional route, you cannot get hospital privileges without bc/be, you have a harder time and will pay more for med-mal if you are not bc/be, many insurers will not pay your bills if you are not bc/be. I know of several GPs who after practing for 5, 10 even 15 years as a GP either went to a straight cash for service basis (ie no insurance, no medicare, no medicaid), or finally threw in the towel and did a FP residency. Most of 'em continued to practice while they did it, but it was brutal. And the IHS will not hire docs who are not bc/be. And the times they are a changing!

 

[glorytaker]

What's the diff between BC/BE? Is board equivilent means you couldn't pass your boards?

 

[mick2003]

What's the diff between BC/BE? Is board equivilent means you couldn't pass your boards?

Board Certified (BC) is pretty self explanatory.

Board Eligible (BE) can mean a few things:

1. You successfully completed a residency and are eligible to take the specialty boards, but choose not to

2. You are currently in the exam process. For example, the process to become board certified in anesthesiology takes about 9 months to a year. After graduating in June, one takes the written boards in July. Only after successfully passing this exam can you schedule and take the oral portion (offered 2x year). You are BC after passing both parts. Most folks work as a BE anesthesiologist while in the exam process. Of note, this is the majority of providers claiming BE

3. You've taken the boards, but failed and either are reattemping or choosing not to pursue BC

Mick

 

[deleted87716]

Board Eligible (BE) can mean a few things

According to the ABMS:

There could be a variety of meanings and you should contact the specialty board directly to verify their status. Most of the boards have not used this term for twenty years because of the variety of interpretations and the tendency of some individuals to call themselves "board eligible" indefinitely.

In the case of the ABFM:

The American Board of Family Medicine does not recognize or use the term "board eligible," and does not issue statements concerning "board eligibility." The Board informs an applicant of admissibility to an examination to be given on a specified date after a formal application has been reviewed and approved.

The term still gets used though, primarily by recent residency graduates who haven't yet taken the exam. The expectation is that they will take the exam and become BC within a short time (usually one year) after graduation. Anyone who continues to use the term "BE" several years after finishing residency is suspect, IMO.

 

[NavyDMO]

You certainly can practice after only a transitional internship. In the Navy it is a common My first tour was at a clinic serving as a family practice doctor. My second is more acute care but I do run the acute care when I am the only Doctor on call. Therefore, I have corpsman, nurses and PA's working under my license.

YES. I can be sued.

No, I would not reccomended this to anyone! A PGY-1 year is just not enough. Med school and boards are one thing, but unsupervised patient care is a whole different ball game. Patients are not board questions and they do not present that way. I don't feel after 1 year we have the clinical experince or had the opporunity to make "resident errors" to do the best for patients.