Board certification in different specialties?

[NDESTRUKT]

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I've heard that nowadays if you are board certified in one specialty, you can't go back to residency for another specialty.

But I know of a few doctors who did ER or IM and then after practicing for a few years went back and did anesthesia. An R2 in anesthesia right now in fact was an ER doc for 16 years.

So what's the latest on this? Are we allowed to go back to residency and get another specialty if we want?

 

[Winged Scapula]

Your experience shows its possible. I saw the same thing with a practicing surgeon going back to do a rads residency, then an IR fellowship.

Board Certification has NOTHING to do with it (doing another residency), so take that out of the equation. You can be BC in as many fields as you like, as long as you complete the requisite training.

It is possible, although HCFA (Medicare) funding can be a problem.

 

[f_w]

Yes and No.

While there is nobody keeping you from going back, the goverment who funds residency education frowns on this. Their way of dealing with it is to slash the 'DGME' component of the funding for the second residency by 50% (this typically means about 20k per year less). As a result, it is less attractive for the hospital to train a resident for a second residency and it can be difficult to find a position based on that fact.

You can get board certified in as many specialties as you can afford. With the maintenance of certification requirements it might be difficult to maintain the required CMEs though.

 

[path15]

Not sure this is true but I heard that if you initially match into a 4 year program, then you are guaranteed 4 years of government funding. So if you start in a 4 year residency but then finished in 3 years, you would be eligible for one more year of full funding (if say, you then went and did another residency).
I am actually thinking of doing 2 residencies - but may not because of the funding issue.

 

[docB]

Not sure this is true but I heard that if you initially match into a 4 year program, then you are guaranteed 4 years of government funding. So if you start in a 4 year residency but then finished in 3 years, you would be eligible for one more year of full funding (if say, you then went and did another residency).
I am actually thinking of doing 2 residencies - but may not because of the funding issue.

I have heard this as well. I had a friend who matched in a 6 year gen surg residency. Did 3 years then bailed and did 3 years of Gas. They gave him 1 year credit for the 3 pgys in surg. He was told he couldn't have done that if he had originally matched into a program of less than 6 years.

 

[Apollyon]

There is a list of how much time Medicare will pay for, and it's "flat rate" - for example, 3 years for IM, peds, FM, and EM, and 5 years for general surgery. Whatever you start with, that's what you get (things not leading to board certification - transitional and prelim programs - don't start the clock). So, if someone starts with GSx, they get 5 years, even if they drop out and do, say, IM. EM gets 3 years, so any 4-year programs have to eat the 4th year (for the 2-4 programs, this doesn't count - all 3 years are funded).

At the same time, no one works for free. As f_w points out, the disincentive is to cut the money in half, but, still, the hospital gets paid. More at the same time, if they want you, they'll come up with the money.

 

[doctor2wannabe1]

curious, this is ONLY residences or do they dislike doing 2 fellowships?
like 4 yr anesthesia ,than one fellowship in critical care and another in say pain management

 

[NotAProgDirector]

All fellowships, since they follow residencies, are already paid at 50%. So it doesn't matter at that point. This again points out that if a program really wants a candidate, they can easily live with the 50% payment -- they already do so for all their fellows.

 

[core0]

All fellowships, since they follow residencies, are already paid at 50%. So it doesn't matter at that point. This again points out that if a program really wants a candidate, they can easily live with the 50% payment -- they already do so for all their fellows.

Off topic question, but can programs bill for fellows? I know they can't for residents, but one of our docs thought that the program billed for him during fellowship.

David Carpenter, PA-C

 

[f_w]

Off topic question, but can programs bill for fellows? I know they can't for residents, but one of our docs thought that the program billed for him during fellowship.

In non-ACME fellowships it is common to credential the fellows with limited attending priviledges and to obtain medicare #s for them.

That way, not every patient seen by the fellow in the ER has to be seen by an attending in follow-up and the fellows work can actually be billed.

ACGME accredited and medicare funded positions can't bill.

 

[parmiss]

Do you know any one who did neurology after IM? is it duable ?

 

[Wednesday]

We have an attending (ob/gyn) who did internal medicine residency then a cards fellowship, then went back and did an ob/gyn residency and an MFM fellowship. Thats 13 years of postgraduate training!!! Obviously she's an amazing resource for all of us who get to work with her.

 

[Hurricane]

Well there are quite a few double-board (and even triple-board) residency programs, so I don't see how it wouldn't be possible to get board certified in more than one specialty.

But I have heard - although I don't know it it's true - that you can't bill as both a specialist and a PCP. That's one of the arguments I've heard against family/psych double-board programs.

But I'm just an intern so I know squat about outpatient billing at this point...