Practicing without board certification?

[relapse]

I recently heard about a lot of physicians in the U.S. (private practitioners mostly) practicing medicine without being board certified. I understand that there are "fake" boards that give certification that are completely legal and that there is variation among which specialties are more stringent but I wanted to know if this is:

a)Legal
b)Possible with the exclusion of hospital practice due to insurance companies lack of reimbursement
c)Common

There was another post here a while ago regarding a Radiologist that was stationed at Wash U. that did his medical school training in India, his Post-graduate training (residency) in chandigarh (India) and then did a fellowship in the U.S. for two years. He was then able to go to Wash U. and is now practicing. How is it possible for someone who didn't do their residency in the U.S. to be practicing radiology @ Wash U.?

Confused

---

Members don't see this ad.

 

[Winged Scapula]

I recently heard about a lot of physicians in the U.S. (private practitioners mostly) practicing medicine without being board certified. I understand that there are "fake" boards that give certification that are completely legal and that there is variation among which specialties are more stringent but I wanted to know if this is:

a)Legal
b)Possible with the exclusion of hospital practice due to insurance companies lack of reimbursement
c)Common

You are not required to be board certified (BC) to practice in the US. Most insurance companies and hospitals will require you to be Board Eligible (BE) to be a provider. Some may require BC after a certain length of time, but currently there is no requirement.

As for the "fake" boards, these are legal and it is up to the hospital and insurance company, if they require BC, whether or not they accept these boards. Given that I see non-plastic surgeons BC by the American Board of Cosmetic Surgery and other boards, I suspect that it is not a huge issue, except for those in the know.

There was another post here a while ago regarding a Radiologist that was stationed at Wash U. that did his medical school training in India, his Post-graduate training (residency) in chandigarh (India) and then did a fellowship in the U.S. for two years. He was then able to go to Wash U. and is now practicing. How is it possible for someone who didn't do their residency in the U.S. to be practicing radiology @ Wash U.?

Confused

Again, you can practice in the US without being BC and some places might not require BE. However, radiology is different. If you do a fellowship in the US, you may be eligible to become BC if your residency training is considered up to snuff. Not all specialities allow this (ie, surgery does not). Most of the time you will see these practitioners in university settings because it is easier to get on insurance plans and hospital credentialed when you are an employee rather than in private practice. Also patients assume some sort of quality in academic medicine so you probably don't get the BC question often (although i've only had it twice in the last 2 years).

 

[lowbudget]

Again, you can practice in the US without being BC and some places might not require BE. However, radiology is different. If you do a fellowship in the US, you may be eligible to become BC if your residency training is considered up to snuff. Not all specialities allow this (ie, surgery does not).

FM does not recognize "board-eligible". You are either board certified or you are not. Our board exam is 1 written test whereas our surgical or subspeciality colleagues will have 1 written and 1 oral, with the orals usually testing cases the examinee have accumulated over time. Since it takes time to get these exams done and cases accumulated, some boards will label some doctors "board-eligible" in that interim period. In FM, you are eligible to sit for the board right after residency, so anyone calling themselves board-eligible in family medicine is known as simply "not board certified" in FM. Since this is known to everyone, people who are not board certified in FM either have restricted hospital privileges or have to provide documentation of equivalence to get full hospital privileges (more for grandfathered FP's via GP route). Insurance companies usually want board certification in order for them to put you on their list of providers. I guess you can get by with not getting BC'ed if you don't do hospital work and don't take insurance. But if you get sued, you will be judged against community standards and they will get fellow FP's as expert witnesses. If you are not BC'ed, it's a vulnerability.

In order to sit for the ABFM boards, you must graduate from LCME, AOA, or Canadian accredited med school, 5th pathway, or have ECFMG. You must complete residency at an ACGME accredited residency. If you went to an osteopathic FM residency, you have to follow the AOBFP rules.

If you did a 2 year residency in Canada and wish to sit for the ABFM boards, you must finish a 3rd year in an ACGME approved FM residency program with proof that all requirements are otherwise met.

If you are already board certified FM in Canada, GP in New Zealand, GP in Australia, GP in Great Britain by their standards, you may be eligible to sit & take the ABFM boards. We have a reciprocity agreement with Canada, New Zealand, and Australia. We no longer have it with Great Britain (i.e. they can use this route to come to the US, but US can not use this route to go Great Britain).

Anyways, to make a short story long and make Wing Scap's point, it differs depending on the specialty & the Board.

 

[Good Solutions]

Focusing on board certification of Physicians when there are less trained individuals practicing autonomously is like worrying about the size of your life rafts motor after the titanic sunk when there are people hanging onto debris.

 

[maceo]

Focusing on board certification of Physicians when there are less trained individuals practicing autonomously is like worrying about the size of your life rafts motor after the titanic sunk when there are people hanging onto debris.

point well taken. I agree.. But everyone is soo worried about being better than someone else that they dont see the real problems. a non boarded anesthesiologist is still someone who finished 3 years of residency and a year of internship.. there are crnas who barely got through nursing school practicing autonomously and in some states pain management.

 

[Winged Scapula]

Thank you for the clarification for FM, lowbudget.

It does indeed vary by specialty. Because of the requirements of the surgical and Ob-Gyn boards, the classification BE does exist. I know it does not necessarily for other specialties.

 

[relapse]

Thank you for the clarification for FM, lowbudget.

It does indeed vary by specialty. Because of the requirements of the surgical and Ob-Gyn boards, the classification BE does exist. I know it does not necessarily for other specialties.

I understand now the difference of BE and BC but is it possible to be BE/BC withOUT completing a residency in the U.S.?

I also understand that some specialties as mentioned above like radiology can accept individuals that have done their residency outside the U.S. Who oversees this and based on what criteria are these people judging based on? The radiologist did his residency in India, unless which he physically went and observed, would be no better at guessing his competency than a cat.

Aside from the legal implications of practicing without doing a residency in the U.S. how is it that I continue to see individuals practicing both in the academic and private practice sectors?

 

[docB]

FM does not recognize "board-eligible". You are either board certified or you are not.

It's the same way with ABEM but it's kind of silly. Even though the boards don't "recognize" BE as a status all employers and hospital credentialing committees do. There just has to be a way to designate the cohort of "docs who have completed residency but have not yet taken their boards but who will." If we didn't acknowledge that status we'd have to force all new grads to wait until they'd passed their boards before we hire them.

 

[Giemsa]

That's very interesting. I had no idea that this was how it worked in the US.

In Canada you must (in general) be board certified before the provincial College of Physicians and Surgeons will give you licence to practice.

We get around the problem of 5th year residents starting work prior to having their exams by having primary certification exams e.g. rads, OBGYN, gen surg etc. etc. in the spring (April or May). Family med also sits in the spring, as far as I know.

For subspecialists (e.g. the IM subspecialties), their exams are in the fall of the year they graduated. But they will have already completed primary certification in internal medicine (done in their third year in the spring as above) so that they are board-certified in IM before going out to work.

You can certainly find a job as a fifth year resident on the strength of the assumption that you'll pass, but you can't actually start treating patients (with the exception of moonlighting) until you have passed the Royal College exams.

 

[Winged Scapula]

Ok, let's clarify things.

In the US licensing is handled by individual states. They can set requirements on amount of GME required, cost, etc. The relevant specialty College plays no part in licensing.

Board certification is a function of the relevant Board. The board is different than the college and different than state licensing. As noted above, some specialties (like Gen Surg and Ob-Gyn) recognize the term Board Eligible, and some do not.

You can be licensed and not be Board Certified, but you cannot be BC without holding an active license (at least when you apply). Board certification lasts a specific length of time, then you have to recertify. It is 10 years in general surgery.

You must have a license to practice medicine in the US, you do not have to be Board Eligible or Board Certified.

In response to relapse: different specialties decide on what they will accept for training. While you are correct in that the ABR does not have detailed knowledge of the training in India, you are assuming that the quality of education is the same at all residency programs in the US. The licensing exams and then the relevant Board exams are supposed to measure quality. We all know it doesn't, but its the best we've currently got.

Therefore, the ABR reviews the Indian (or whichever foreign country we are talking about) residency, the US fellowship and decides whether or not this applicant meets the criteria to take the ABR examination(s).

There are no legal implications to practicing in the US without doing a US residency. If you can get licensed, you can practice medicine in the US. Licensing does not require completion of a US residency; there are some states which require only graduation from medical school and 1 year of training. Actually practicing without finishing residency, is another story that has been well and thoroughly discussed elsewhere here.

It has been popular in the past for physicians trained outside of the US to come here, do a fellowship and stay to practice. This is how many of the FMGs are working here. The ability to do so depends on the specialty and the hospital credentialing process.

I suspect you are interested in training abroad and then coming to the US to work. Given that the doors are closing to FMGs, it would not be advisable to assume that the above pathway will continue to exist, at least not in its current form.

Bottom line: you must have a license to work in the US. A license requires graduation from medical school. It does not require, in some states, completion of residency. You do not have to be Board Certified to work in the US. Some Boards will allow foreigners admission to the exams based on their prior training - this is highly variable.

 

[relapse]

phew WS, that was a heck of a post. thanks for clarifying, was really confused.

I am not planning to do residency here as it doesn't not adequately prepare you for practicing in the US but out of curiosity,what states allow you to practice autonomously without doing residency in US?

 

[Winged Scapula]

phew WS, that was a heck of a post. thanks for clarifying, was really confused.

I could tell.

I am not planning to do residency here as it doesn't not adequately prepare you for practicing in the US...

Why so obsessed then with these guys who have trained elsewhere but work here in the US?

... but out of curiosity,what states allow you to practice autonomously without doing residency in US?

Here is a list of initial licensing requirements :http://www.fsmb.org/usmle_eliinitial.html

All require at least 1 year internship, but the requirements for FMGs/IMGs are more stringent in most states.

 

[relapse]

Why so obsessed then with these guys who have trained elsewhere but work here in the US?

Not obsessed, just curious as to how they did it as one of my friends here asked me the question.

*sighs* got a long way to go before residency anyways...

 

[relapse]

That's very interesting. I had no idea that this was how it worked in the US.

In Canada you must (in general) be board certified before the provincial College of Physicians and Surgeons will give you licence to practice.

We get around the problem of 5th year residents starting work prior to having their exams by having primary certification exams e.g. rads, OBGYN, gen surg etc. etc. in the spring (April or May). Family med also sits in the spring, as far as I know.

For subspecialists (e.g. the IM subspecialties), their exams are in the fall of the year they graduated. But they will have already completed primary certification in internal medicine (done in their third year in the spring as above) so that they are board-certified in IM before going out to work.

You can certainly find a job as a fifth year resident on the strength of the assumption that you'll pass, but you can't actually start treating patients (with the exception of moonlighting) until you have passed the Royal College exams.

I have a friend that is from canada doing his medical school in India. Is he eligible to practice/ enter residency in Canada?

 

[docB]

Ok, let's clarify things...

What she said. And we make things even more confusing in the US by referring to licensing exams (eg. USMLE) as "the boards." We would confuse fewer people if we quit that and always called them licensing exams.

 

[Giemsa]

I have a friend that is from canada doing his medical school in India. Is he eligible to practice/ enter residency in Canada?

He may be eligible to apply to residency. See eligibility & more eligibility
To try to gain licensure, start here and here

 

[relapse]

Do canadian medical schools/american medical schools have reciprocity with each other?

 

[medicinesux]

Ok, getting back to the OP's question.

Ante up! This is what I call education creep. Just as a college degree really meant something 30 years ago, it is now expected and the PhD has become the new bachelors. In a similar fashion, these "certification exams" will soon become mandatory for all in the near horizon. If you can't pass them you will be as useless to the healthcare field as a med school drop out. Hospitals will never credential you and insurance agencies will refuse to reimburse you. I also predict that since these exams are ruinously expensive, we will start having to recertify every year or two just like we do for ACLS. Quality control agencies will demand this to "protect the public".

 

[Winged Scapula]

Do canadian medical schools/american medical schools have reciprocity with each other?

Yes, as long as they are LCME accredited.

 

[pgg]

Focusing on board certification of Physicians when there are less trained individuals practicing autonomously is like worrying about the size of your life rafts motor after the titanic sunk when there are people hanging onto debris.

On the contrary, drawing attention to our voluntary maintenance of the higher standard of board certification is exactly what can help hold off further encroachment from midlevels.

We're probably going to lose the war because they're cheaper than we are, but it's still a battle worth fighting.

 

[deleted87716]

On the contrary, drawing attention to our voluntary maintenance of the higher standard of board certification is exactly what can help hold off further encroachment from midlevels.

We're probably going to lose the war because they're cheaper than we are, but it's still a battle worth fighting.

Not to change the subject, but why do you think it would be cheaper to see an independently-practicing mid-level instead of a physician?

Because they'll charge less? Not likely, since an independently-practicing mid-level would incur overhead and practice expenses similar to a physician, and would have to charge accordingly.

Because they'll get reimbursed less from insurance companies? Not likely, since most payers already reimburse independently-practicing mid-levels at the same rates as physicians. Sure, they could come up with some kind of tiered payment system and try to force patients to see mid-levels rather than physicians, but that would likely elicit a strong protest from patients as well as the medical (and medico-legal) community.

Because they'll order fewer tests or refer to specialists less often? Not likely. In fact, it's usually the other way around.

 

[docB]

Not to change the subject, but why do you think it would be cheaper to see an independently-practicing mid-level instead of a physician?

Because they'll charge less? Not likely, since an independently-practicing mid-level would incur overhead and practice expenses similar to a physician, and would have to charge accordingly.

Because they'll get reimbursed less from insurance companies? Not likely, since most payers already reimburse independently-practicing mid-levels at the same rates as physicians. Sure, they could come up with some kind of tiered payment system and try to force patients to see mid-levels rather than physicians, but that would likely elicit a strong protest from patients as well as the medical (and medico-legal) community.

Because they'll order fewer tests or refer to specialists less often? Not likely. In fact, it's usually the other way around.

That's an interesting point. I've always assumed that they would get reimbursed less. But you're saying that's not true? Interesting. If that's the case they really wouldn't be cheaper.

In EM a midlevel visit bills about 80% of what a physician visit bills. That's for a setting where a PA sees people and then the supervising doc signs the charts every so often. In my practice we are required by hospital bylaws to see all of the patients in real time (ie. while they're in the ED for that visit), discuss the case with the patient and sign the chart and prescriptions before they leave. Because of that we bill a physician level visit. So in that scenario we as the physicians are using the midlevels as extenders and they work for us rather than a situation where they are being used by a hospital or other entity to cut costs.

 

[deleted87716]

In EM a midlevel visit bills about 80% of what a physician visit bills.

It's 85%, actually...that's known as "incident-to" billing in CMS parlance, and is used when mid-levels have physician supervison. In states where mid-levels (NPs, to be more precise) have independent practice rights, they are reimbursed at 100% of physician rates.

More info here: http://www.physiciansnews.com/law/307rodriguez.html

 

[core0]

It's 85%, actually...that's known as "incident-to" billing in CMS parlance, and is used when mid-levels have physician supervison. In states where mid-levels (NPs, to be more precise) have independent practice rights, they are reimbursed at 100% of physician rates.

More info here: http://www.physiciansnews.com/law/307rodriguez.html

Actually its the other way around. Incident to requires the physician to see the patient and develop the plan of care first. Then for follow up care for that problem the must be provided my either the physician or a qualified non-physician provider. The follow care provided must happen under the direct supervision of the physician (interpreted by Medicare as the physician being present in the same suite of offices). If you do all that you can bill Medicare 100% of the E/M encounter for a qualified NPP. If you don't you can bill under the NPPs NPI at 85% of the physician E/M rate.

As far as practice expenses NPs in theory can run a practice less expensively than a physician. The 85% rate was theoretically developed under the concept that it costs 15% less for a non-physician practitioner to operate than a physician. The primary increased costs for a physician identified in 1986 were student loans and malpractice. While the gap in student loans has narrowed somewhat, malpractice remains significantly cheaper for NPPs (with the exception of CNM's).

Finally non-medicare plans reimburse NPPs at a variable rate (65%-100%). NPPs working without physicians have difficultly negotiating with these plans. On the other hand NPPs working for physicians typically are reimbursed at 100% of the physician rate.

More on incident to:
NPP opens an "independent practice" with no onsite physician. Medicare will reimburse 85%.

NPP sees the patient in the office for a new problem with the physician present. Medicare reimburses 85%.

NPP sees the patient in the office for a problem first evaluated by the physician. However, the physician has to leave the office to deal with an emergency at the hospital. Medicare reimbures 85%.

NPP sees the patient for a problem first evaluated by the physician. However, during the encounter a new problem is discussed. Options: 1. The NPP deals with the new problem and the E/M is billed at 85%. Or 2. The physician stops what they are doing. Does the entirety of the E/M on the patient and then bills for the E/M at 100%. The NPP can then follow both problems under incident to.

NPP sees the patient for a problem first evaluated by the physician with the physician present in the office suite. Billed under the physicians NPI as incident to at 100%.

As you can see its very difficult to make this work. Neither consults or new patient encounters can be billed under incident to.

For a more readable version of incident to see:
http://www.aafp.org/fpm/20011100/23thei.html

David Carpenter, PA-C

 

[deleted87716]

For a more readable version of incident to see:
http://www.aafp.org/fpm/20011100/23thei.html

Thanks...that's a much better explanation. I don't work with mid-levels, so I'm no expert on this stuff.

 

[Good Solutions]

On the contrary, drawing attention to our voluntary maintenance of the higher standard of board certification is exactly what can help hold off further encroachment from midlevels.

We're probably going to lose the war because they're cheaper than we are, but it's still a battle worth fighting.

We will only win if the patient is paying for their medical care. If insurance, employers, or the government is indirectly paying for it we will lose. We will continue to hear people say how they're only establishing with you because their new insurance has you on their list of 'providers.'

Support high deductible plans with Health Savings Accounts.

 

[relapse]

Thanks...that's a much better explanation. I don't work with mid-levels, so I'm no expert on this stuff.

for those that don't know, what exactly does a mid level refer to?

 

[docB]

for those that don't know, what exactly does a mid level refer to?

PAs and Nurse Practitioners.

 

[lowbudget]

You do not have to be Board Certified to work in the US.

But, you have to be careful with how and what you call yourself and not misrepresent yourself. Every state has its own set of laws with variations, but they all have the common theme.


Follow the Law When You Advertise Board Certification
Keywords: Practice_Marketing
(http://www.texmed.org/Template.aspx?id=2449)


When you advertise your practice in any media, be sure to follow Texas Medical Board (TMB) rules for promoting your specialization.

-You may use “board certified” or something similar only if the certifying organization meets strict criteria set by the board.
-Don’t stretch the use of “board certified” or similar terms: Don’t use “board certified” in an ad if the certification has expired and you have not renewed it by the time the ad runs. Also, don’t use misleading terms such as “board eligible” and “board qualified.”
-You are allowed to advertise a specialty as a “field of interest.” However, each listing of a field of interest must include the phrase “Not certified by an organization recognized by the Texas Medical Board.” This statement must be separate from other statements and be “displayed conspicuously with no abbreviations, changes, or additions in the quoted language so as to be easily seen or understood by an ordinary consumer.”

For example, an ad cannot state, “Certified by American Academy of Family Practice,” because this organization does not meet TMB criteria for certifying organizations. The ad could say: “Member of the American Academy of Family Practice. Not certified by an organization recognized by the Texas Medical Board.”

If you violate TMB rules on advertising board certification, the board may take legal action to remove the offending ad, levy a fine, and publicly document your misdeed. The board may even report it to the National Practitioner Data Bank.

Content reviewed: 4/05/2007

TMA Practice E-tips main page

Last Published: 8/18/2009

 

[ShyFly]

Focusing on board certification of Physicians when there are less trained individuals practicing autonomously is like worrying about the size of your life rafts motor after the titanic sunk when there are people hanging onto debris.

Excellent post! To clarify BC is not required to practice (hence the moonlighting opportunities) however many insurance companies require it to become a provider, most hospitals require it for priviledges, and malpractice coverage may pose an issue.

 

[Knicks]

Didn't read through the long posts in this thread (don't have time), but I did manage to read just enough from the first 2 posts to gather that one can practice/be licensed without being board certified?

How?

I thought that in order to get residency/practice, one had to first pass the boards (USMLE). Also, I thought becoming board-certified IS 'getting licensed'.

Obviously, I'm confused.

Can someone clarify?

Thanks.

 

[Winged Scapula]

Didn't read through the long posts in this thread (don't have time), but I did manage to read just enough from the first 2 posts to gather that one can practice/be licensed without being board certified?

How?

I thought that in order to get residency/practice, one had to first pass the boards (USMLE). Also, I thought becoming board-certified IS 'getting licensed'.

Obviously, I'm confused.

Can someone clarify?

Thanks.

You are erroneously assuming that when we speak of "the boards" we are talking about the US Medical Licensing Exams. The USMLEs are licensing exams and as such, they have little to do with being Board Certified except that you are required to have a medical license to take your BC exam(s). People call them the boards, and they are administered by the National Board of Medical Examiners, but they are not THE boards.

To get into residency, you must have taken at least Step1 and usually Step 2.

To get a full and unrestricted medical license, you must pass Step 3 (or the corresponding osteopathic exams for DOs).

To be Board Certified, you must fulfill the requirements of your particular specialty's board (ie, for surgery its the American Board of Surgery), hold a license and take whatever the required exams are.

Thus, to become BC you must have an active license, but having a license is NOT the same thing as being BC.

 

[gutonc]

Didn't read through the long posts in this thread (don't have time), but I did manage to read just enough from the first 2 posts to gather that one can practice/be licensed without being board certified?

How?

I thought that in order to get residency/practice, one had to first pass the boards (USMLE). Also, I thought becoming board-certified IS 'getting licensed'.

Obviously, I'm confused.

Can someone clarify?

Thanks.

We're talking about different boards. "Board Certified" refers to certification in a specialty by a particular professional board (ABIM/ABMS for medicine and subspecialties, ABS for Surgery, ABPN for psych and neuro, etc.). You can only be BC after completing whatever training your specialty board requires.

You're talking about passing the USMLE exams (colloquially, but inaccurately referred to as "The Boards"). Once you pass those, you may (depending on the state you practice in and their training requirements) be eligible for a state license to practice medicine.

You do not need to be BC/BE to get a license (I've had mine for 2+ years and have not yet sat for my specialty boards). Likewise, you do not need to have a license to be BC (I know several people who took their IM boards before getting their state license).

 

[Winged Scapula]

Likewise, you do not need to have a license to be BC (I know several people who took their IM boards before getting their state license).

Really? Thanks for the clarification. The ABS requires a full and unrestricted license, good for at least 6 months after testing dates, to sit for the exams and be BC,

 

[gutonc]

Really? Thanks for the clarification. The ABS requires a full and unrestricted license, good for at least 6 months after testing dates, to sit for the exams and be BC,

I should have stated that it depends on specialty. But now I've looked at the current ABIM requirements, a license is required at the time of registration (but not for any specific time period they note).

Thanks for reminding me that "things change" on a pretty regular basis. Also...never trust anything you read on the intertron.

 

[Winged Scapula]

I should have stated that it depends on specialty. But now I've looked at the current ABIM requirements, a license is required at the time of registration (but not for any specific time period they note).

Thanks for reminding me that "things change" on a pretty regular basis. Also...never trust anything you read on the intertron.

 

[Knicks]

Thanks for the clarification, guys.

So, an IM intern is licensed (since he/she passed the USMLEs), but not necessarily certified, right?

 

[Winged Scapula]

Thanks for the clarification, guys.

So, an IM intern is licensed (since he/she passed the USMLEs), but not necessarily certified, right?

No and no.

Most interns have not taken Step 3 by the start of internship (FMGs are often the exception). Interns may have a training license (in states that require it) but Step 3 is required for a full and unrestricted license to practice medicine.

In addition, all states require at least a year of GME before granting a full and unrestricted license (regardless of whether or not you have taken Step 3). Here is the link for requirements for Initial Licensure: http://www.fsmb.org/usmle_eliinitial.html You can see that all states require at least 1 year training, many require more especially for IMGs/FMGs.

Internship is not sufficient training to be Board Certified so interns are never Board Certified in the specialty in which they are currently training.

 

[dragonfly99]

You cannot be board certified without having finished your residency. For example, to be board certified in IM you have to first finish your 3 years of IM residency and then take the ABIM specialty exam (usually done in August, Sept or October after finishing IM residency). For anesthesiology, you have to finish 4 years of your residency and then take 2 tests, first a written exam and then if you pass that you have to take an oral board exam a few months later. Each particular subspecialty determines what it takes to be board certified, but as far as I know it pretty much always require that you finish your residency in a particular field and then take some sort of test(s).

Medical licensing is totally a separate thing and is controlled by each particular state, but it always require that someone passes the US medical licensing exam step 1, 2 and 3 and have completed a certain number of years of residency (usually it's 1 or 2, but sometimes they require more, particularly if the person is from a foreign medical school), and turn in some sort of application, and generally have the backing of his/her residency program and maybe even some letters of recommendation from doctors.

 

[forbes270]

In lieu of the above thread, winder if guys heard of the anesthesia pilot program which the ASA has on it's site for FMG They can be eligible fir fellowships without residency in the US and then be eligible for anesthesia boards. But I doubt whether it has been started or people have any experiences in this.

 

[kickazzz2000]

What about this one:

You finish your residency, thus are board eligible.

You either don't take, or don't pass your boards during your subspecialty fellowship.

You try to get a job in that subspecialty.

You are board eligible in your primary specialty, but not board eligible in the subspecialty.

How does an insurance company handle that?

 

[docB]

What about this one:

You finish your residency, thus are board eligible.

You either don't take, or don't pass your boards during your subspecialty fellowship.

You try to get a job in that subspecialty.

You are board eligible in your primary specialty, but not board eligible in the subspecialty.

How does an insurance company handle that?

They will cover you to practice within your boarded specialty but not your subspecialty.

From a hospital credentials standpoint we frequently have docs who's DOPs (Deliniation of Priveledges) allows them to practice within thier main specialty but not their subspecialty.

 

[maxheadroom]

Really? Thanks for the clarification. The ABS requires a full and unrestricted license, good for at least 6 months after testing dates, to sit for the exams and be BC,

Same for Plastics.

 

[maxheadroom]

They will cover you to practice within your boarded specialty but not your subspecialty.

From a hospital credentials standpoint we frequently have docs who's DOPs (Deliniation of Priveledges) allows them to practice within thier main specialty but not their subspecialty.

Not sure that this is always the case. In Plastics it takes at least 18 months (if everything stays on schedule) after you finish training to become Board Certified. As a non-Boarded Plastics guy, in a Hand fellowship, I will have NO board certifications at all (and cannot refer to myself as "Board Eligible" per American Board of Plastic Surgery rules), but I'm pretty sure that most hospitals will give me privileges for both Plastics and Hand.

 

[docB]

Not sure that this is always the case. In Plastics it takes at least 18 months (if everything stays on schedule) after you finish training to become Board Certified. As a non-Boarded Plastics guy, in a Hand fellowship, I will have NO board certifications at all (and cannot refer to myself as "Board Eligible" per American Board of Plastic Surgery rules), but I'm pretty sure that most hospitals will give me privileges for both Plastics and Hand.

That's true. But that's because you're board eligible. The fact that ABMS or ABPS don't recognize the term doesn't mean everyone else in medicine doesn't either. As credentials committees, insurers, etc. we have to have a mechanism to deal with the docs who are fresh out and just haven't taken the test yet.

The situations I'm talking about are usually more along the lines of you are a fellowship trained ortho hand surgeon. You are boarded in ortho but not in hand because you failed the test or lost your certification. No hand for you.