As the title says, I completed my residency in the US, became board certified, and have been practicing for a bit. I am well trained and well-rounded - not just in terms of my field. Now, I am looking to retrain in another field for personal reasons. Has anyone else been in this position and/or know what my options are? Can I even apply through the NRMP match? Is there any possibility of getting any credit for my initial residency rotations? I realize that it is a huge decision and it is not one that I have taken lightly. But, this is what I need to do in order to have professional satisfaction in the long-term.
Any other board certified physicians complete a US residency, practice, then do a second residency?
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FM 2014, interested in IM.
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If you are near an IM program, it might be worth trying to talk to the PD there or at the same place you did FM to see what your chances might be. I would wait until after match to do that as they are insanely busy right now.
Wouldn't it be better to talk to them before they fill up all their spots? I'm also trying to figure out if the funding piece could be any kind of wrench.
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So many things wrong here, but let's stick with the money. You've burned all your FULL Medicare funding years. Anyone taking you for training would receive 50% of your cost in DME and 100% of your IME monies. It's not impossible to find a hospital willing to do that, but it's a big problem.
It's interesting to learn about the financial part of it. Your post was helpful in directing me towards digging into it more, thanks. Would programs be more receptive if I offered to fund the "discounted" 50% DME myself or is that not allowed?
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Not allowed by the ACGME.
Overall, doing a second residency is not impossible and people have done it before, but you better have a compelling reason. You'd be better off just doing a fellowship or finding a job in an underserved area that lets you do more of what you want out of IM. There do still exist hospitals where there are FM hospitalists and such.
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piggybacking off of this, it might be helpful to know what you would gain out of switching to IM from FM - if you want to work in a hospital, another possibility to consider is a hospitalist fellowship - there are 12 FM hospitalist fellowships
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There are no rules against it -- it is completely legal to complete a second residency.
As IMPD stated, there is a potential funding issue. At a program that is over it's GME cap, this might not be a problem. In that case they get zero dollars for some of their residents, so it might not matter at all. And any program with fellowships already gets decreased reimbursements for them, and may not care about one more. But my institution is becoming increasingly focused on reducing costs, so it could be a big problem.
Theoretically, you can get 1 year of ABIM credit for your 3 year FM residency. But the question is whether you're ready to be a PGY-2. Are you ready to supervise a PGY-1 admitting / managing patients on an inpatient service? Whether you get any credit or not is completely up to the PD. If you match into a PGY-1 position, you should be prepared to complete the full 3 years.
As IMPD stated, there is a potential funding issue. At a program that is over it's GME cap, this might not be a problem. In that case they get zero dollars for some of their residents, so it might not matter at all. And any program with fellowships already gets decreased reimbursements for them, and may not care about one more. But my institution is becoming increasingly focused on reducing costs, so it could be a big problem.
Theoretically, you can get 1 year of ABIM credit for your 3 year FM residency. But the question is whether you're ready to be a PGY-2. Are you ready to supervise a PGY-1 admitting / managing patients on an inpatient service? Whether you get any credit or not is completely up to the PD. If you match into a PGY-1 position, you should be prepared to complete the full 3 years.
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I know someone who completed IM after finishing FM so that they could specialize. They were allowed to skip intern year but had to complete the other 2 years of IM. They did a pulm fellowship. He was a poster on here. We lost touch when he moved for fellowship so I don't know what kind of issues he ran into with his fellowship since he had done 5 years of residency.
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This use to be more common in past years. I have friend who did a three year psyche residency at UTSW after being a board certified general surgeon for many years. He paid for his second residency. Another doctor I know went from an FM residency into general surgery, he paid for his second residency-- board certified in both specialties. He's a valuable member of our medical staff, and leads medical missions to rural areas of the Western US states and Northern Mexico.
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Interesting, how much does it cost if you pay for a second residency? Do you still get a resident's salary? I don't have any intention of doing this but just curious how it works.
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ACGME rules do not allow this now...
That's interesting - I was not aware that programs go over their GME cap. How do they sustain themselves? Is it just that they have very generous benefactors?
To be frank, where I trained, the FM service was the one everyone dreaded because we had such a high census (no cap) with a significant proportion of very complex patients. As FM residents, we LOVED rotating through the IM services because they were like vacation months: almost all of their patients spoke English, far fewer of them were as complex as our patients, and they simply had fewer patients. Each IM team had more residents and each team was capped at 20 patients total, with additional patients automatically being punted to the hospitalists. It was a pretty sweet setup. FM also admitted 24/7, while each IM team admitted only one to two days/week. Of course, to be reasonable, I don't expect to be able to jump straight into supervising PGY-1 IM residents in a new place. But, I suspect it would only take me a month or two to get my bearings in a new hospital system and get up to date with the main issues. At the end of the day, if my only option is to do the full training, I'm at peace with that and it is something I would still pursue.
Thanks for the insight, everyone!
Hopefully your desire to switch from FM to IM is not spuriously fostered by your notion of how the two specialty's inpatient teams were run at your specific hospital.
In case it was, do understand that every place is different and each hospital has its own way of managing how it runs inpatient. If your concern is feeling that you will be lambasted with problem patients and unchecked censuses, then your energies may be better focused on finding a position that offers what you look for.
In terms of the inpatient/hospitalist field, there is a lot of overlap in the two specialties and it's hard to imagine one being unable to find a position to one's liking regardless of the field you are coming from.
However if your desire to switch is solely to subspecialize, it might be worth some further insight into seeing what you believe the subspecialty field can offer you and why you believe you cannot find it in your current FM specialty or any of FM's various fellowships.
In case it was, do understand that every place is different and each hospital has its own way of managing how it runs inpatient. If your concern is feeling that you will be lambasted with problem patients and unchecked censuses, then your energies may be better focused on finding a position that offers what you look for.
In terms of the inpatient/hospitalist field, there is a lot of overlap in the two specialties and it's hard to imagine one being unable to find a position to one's liking regardless of the field you are coming from.
However if your desire to switch is solely to subspecialize, it might be worth some further insight into seeing what you believe the subspecialty field can offer you and why you believe you cannot find it in your current FM specialty or any of FM's various fellowships.
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I've never really understood why the 0.5 DME thing is a huge problem given that so many of the academic hospitals are over their caps to begin with (since the spots were set back in the 90s)...so most likely you're taking an unfunded spot to begin with. I can see it maybe making a difference in a smaller hospital with smaller programs but DME is still typically not that much in the overall hospital scheme...
It has nothing to do with a specific institution, hospital, or service. I was trying to avoid details, but I'm not a US citizen or green card holder. I now live and practice in a country that prides itself on having a world-class healthcare system (if you keep reading, you'll see why I mention this). Here, the fields of FM and IM are very different. Quite simply, as a GP (general practitioner), I cannot practice the medicine to the level I was trained and remain financially viable. I say "GP" with gritted teeth because the system here clumps me into that category - FM does not exist here as a specialty like it does in the US. Traditionally, GPs are MDs that finished medical school and then completed a single year of random rotating internships without any formalized/structured FM training. What this means is that most of my colleagues are clueless or woefully behind (including those who are training the next generation of physicians) when it comes to practicing evidence-based medicine. Don't get me wrong - many of them have such vast experience and knowledge that it blows me away and some of them are fantastic physicians. But, the majority are not, and unfortunately, the system is set up to reward only quantity of care. As an example of this, I routinely see patients from other GPs who have been prescribed narcotics for years to treat their migraines. Most patients on opiates that I have encountered also do not realize that they are on an opiate/narcotic.
Quite simply, I am supposed to be a glorified doorman who is supposed to simply triage and refer people on to a specialist because the five- to six-minute appointments I'm supposed to strive towards seeing people in are not sufficient for digging into a problem, working it up, and treating it. I do spend the extra time to practice proper medicine, but it means that I need to look for other sources of income to remain financially viable. Sadly, I also see many of my peers who trained in the US falling into the habit of not practicing proper medicine (like prescribing medications and ordering tests in lieu of doing a proper history and exam) in order to earn more. Am I being judgmental? Definitely. But, there are some things I refuse to cut corners on and quality of care is one of those things.
I realize working in the US as FM is an option (for most locations, it would be much more money for less work), though tricky because I would require a visa. As of late, I have been considering it seriously, but worry that I would not be able to adapt back to the US system with all its nuances - documentation, CYA, insurance, ICD10, and so forth.
To answer your other question, I may also be interested in subspecializing.
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OP,
You are the poster child for Americans who oppose giving away any residency slots to foreign physicians while there are Americans either SOAPING or not matching at all. You have already trained in the US at a cost of approximately $400,000 to the US taxpayers, gone home and found your job boring and now you want to soak up another US residency slot. I have two suggestions for you. Either get used to the job you have or come to the US and practice as a family physician here. Please stop mooching off us.
You are the poster child for Americans who oppose giving away any residency slots to foreign physicians while there are Americans either SOAPING or not matching at all. You have already trained in the US at a cost of approximately $400,000 to the US taxpayers, gone home and found your job boring and now you want to soak up another US residency slot. I have two suggestions for you. Either get used to the job you have or come to the US and practice as a family physician here. Please stop mooching off us.
Is it not a bit hypocritical for you to first complain about me, then go on to say you want me to practice in the US? To carry the torch, one might then go on to complain about you in that by encouraging me to move to the US, you were taking work away from American physicians by encouraging me to practice in the US.
On a more serious note, I would accept your post as a fair point of criticism IF I had lied on my applications or during my interviews. However, I did not. All of the programs at which I interviewed were fully aware of my background, my citizenship, and my training. Ironically, I was very open to practicing in the US up until I was in my residency and discovered the unfortunate medicolegal climate. So, I'll allow you to remain on your soapbox and stay upset at something that I had no control over - that is, that a program decided to offer me a spot over an American. If you're in primary care, it would be akin to complaining to your diabetic smokers that they should quit smoking because you're getting dinged because they refuse to quit smoking...
ETA: I know that personal responsibility isn't a big thing for medical students, but even where I practice, I've noticed that there isn't a whole lot of it with the local grads. My point is that many AMGs (and it's like this in many other countries, too) are overly confident and choose to rank only a couple specific programs, then act shocked when they don't match. THAT is what plays a big role in them not matching. It's not simply that some crazy non-American is applying for the spot. Even if the program ranked the AMG, they won't match the applicant if the applicant didn't rank them. Personal responsibility is important. Relevant username, btw.
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The fact that program directors were aware of your plans in the past is quite irrelevant. Circumstances in this country have changed. For all I know your program director ranked you to stifle competition down the road because he or she didn't want to train people who would compete for patients in that area.
I am not hypocritical in the least. Every year of residency training costs the US taxpayers approximately $130,000. I don't want to see that money get wasted again. You used American resources to train as a physician and then you moved back to practice in your home country. Now, you want to pull the same stunt all over again. We don't have money to waste on people like you. We need physicians to practice in rural America. Americans subsidize the world by pouring approximately $50,000,000,000 into basic medical research every year and we pick up the tab for the cost of clinical trials and applied research for drugs. We don't need to add to that burden by carrying people like you on our backs.
I am not hypocritical in the least. Every year of residency training costs the US taxpayers approximately $130,000. I don't want to see that money get wasted again. You used American resources to train as a physician and then you moved back to practice in your home country. Now, you want to pull the same stunt all over again. We don't have money to waste on people like you. We need physicians to practice in rural America. Americans subsidize the world by pouring approximately $50,000,000,000 into basic medical research every year and we pick up the tab for the cost of clinical trials and applied research for drugs. We don't need to add to that burden by carrying people like you on our backs.