Tennessee is now allowing FMG's to practice without a US residency, any chance outsourcing becomes a legit concerning for radiology now?

[Student189045]

Here is the bill summary. My theory would be that the large telerads companies will lobby for it allowing them to rapidly expand their service availability and price out typical private practices

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Members don't see this ad.

 

[maxxor]

Yeah this is bad. Not so much Tennessee law in and of itself, but that this was done by Republicans. If the Trans-healthcare bills have taught me anything, they are not above copy pasting to every legislature they control.

I’m 100% certain this was a gift to HCA.

 

[guytakingboards]

Maybe I'm just getting mixed up here but I'm failing to see how this increases the number of board certified rads. The rate limiting step is the board cert, not the licensure.

Under the previous model, an IMG with no stateside training had to either redo internship/residency or do the ABR alternate pathway which was a minimum of 4 years at a department with a training program (with a mininum of 1 year being a trainee). If they did the alternate pathway, they could have a training license for that 1 year of fellowship and then get a provisional full license and serve as an attending for the next 3 years... or do all 4 years as a trainee fellow.

Under this paradigm, they can get their full license after 2 years.... but they're still not board eligible. They still have to do 4 years at a training institution (and pass the core after the 3rd year) to become board eligible.

Am I missing something here?

 

[maxxor]

Maybe I'm just getting mixed up here but I'm failing to see how this increases the number of board certified rads. The rate limiting step is the board cert, not the licensure.

Under the previous model, an IMG with no stateside training had to either redo internship/residency or do the ABR alternate pathway which was a minimum of 4 years at a department with a training program (with a mininum of 1 year being a trainee). If they did the alternate pathway, they could have a training license for that 1 year of fellowship and then get a provisional full license and serve as an attending for the next 3 years... or do all 4 years as a trainee fellow.

Under this paradigm, they can get their full license after 2 years.... but they're still not board eligible. They still have to do 4 years at a training institution (and pass the core after the 3rd year) to become board eligible.

Am I missing something here?

Vanderbilt, HCA, et al, anyplace with a residency, could hire these people as faculty. Forget the fellowships requirement.

The ABR alternative pathway has 4(5) years of fellowships or you do 2 and then remain on staff for the total of 4 years.

Well. Now they can hire attendings and pay them fellow wages. There’s also no “cap” like there is on number of fellows.

Good luck having them pay fair market for a rad in TN again.

The big problem is HCA.


This line from the ABR website is the line where this can get bad.

“The Alternate Pathway may be completed with four years as a resident; as a fellow (in an ACGME-accredited or a non-accredited fellowship); as a faculty member; or as any combination of residency, fellowship, or faculty service in a single institution with an ACGME- or RCPSC (Canadian)-accredited residency program. Research may be credited for a maximum of 12 months if it is part of a pre-approved four-year plan.”

 

[colbgw02]

Maybe I'm just getting mixed up here but I'm failing to see how this increases the number of board certified rads. The rate limiting step is the board cert, not the licensure.

Under the previous model, an IMG with no stateside training had to either redo internship/residency or do the ABR alternate pathway which was a minimum of 4 years at a department with a training program (with a mininum of 1 year being a trainee). If they did the alternate pathway, they could have a training license for that 1 year of fellowship and then get a provisional full license and serve as an attending for the next 3 years... or do all 4 years as a trainee fellow.

Under this paradigm, they can get their full license after 2 years.... but they're still not board eligible. They still have to do 4 years at a training institution (and pass the core after the 3rd year) to become board eligible.

Am I missing something here?

I don't think you're missing anything. I don't see any reason why this affects radiology more so than any other specialty.

The problem with "outsourcing" radiology, which I will take to mean "offshoring" in this context, was never licensure or even certification. It's compensation. If CMS ever decides to change its rules, then I'll start paying attention and/or worrying.

 

[maxxor]

Unfortunately, we have a built in back door for these people to get board certified. Not all boards do.

 

[guytakingboards]

Vanderbilt, HCA, et al, anyplace with a residency, could hire these people as faculty. Forget the fellowships requirement.

The ABR alternative pathway has 4(5) years of fellowships or you do 2 and then remain on staff for the total of 4 years.

Well. Now they can hire attendings and pay them fellow wages. There’s also no “cap” like there is on number of fellows.

Good luck having them pay fair market for a rad in TN again.

The big problem is HCA.

Yea, but again the limiting step is the IMG's still have to spend 4 years to become ABR board eligible. This doesn't really impact the broader board-certified rad market, but it does give Vanderbilt/UT/etc... some more faculty options.

I know people see HCA as the boogeyman, particularly in TN, but as far as I can tell none of the 4 residency programs in TN are affiliated with HCA.

 

[maxxor]

HCA will open one. They have been opening DR residencies in other states.

 

[guytakingboards]

HCA will open one. They have been opening DR residencies in other states.

Not saying they wouldn't do it, but that's a heck of a lot of effort to just get a few extra years worth of non-board certified rads.

HCA has a total of 2 DR programs.

 

[GwBXtRTrVktW9E]

Not saying they wouldn't do it, but that's a heck of a lot of effort to just get a few extra years worth of non-board certified rads.

HCA has a total of 2 DR programs.

They have at least three

 

[guytakingboards]

They have at least three

Ah, touche. I looked under "Diagnostic Radiology" on the HCA GME website and it lists 2 programs. But it lists another 4 under just "radiology". My b.

 

[Student189045]

As an update: Copycat bills are spreading, already passed in Florida and very soon to pass in MA, Illinois, Georgia. Definitely not just conservative states.

My question is: How did the alternative pathway work prior to these bills, international physicians could get board certified but not have state licensure? How did they practice?