So to add some clarity and answer some of the questions:
In my state, you must have completed PGY-2 to become licensed, and you're not required to have a license in residency. We receive a medical permit after completing PGY-1 and can use that for the rest of residency, just can't moonlight.
What I have that wasn't present before: a notarized letter from the state medical board through the office of the attorney general stating that I'm in a training program and that I am an unlicensed physician, as well as a copy of my contract that states that I'm in a temporary training program with an end date in 2024.
Couple of quick notes:
- the IWRP is supposed to be reviewed each year, but mine hasn't been reviewed since 2017.
- I requested a phone discussion with my counselor on this topic, but she never replied - I only got a letter in the mail about 2 weeks later of a denial.
- She never completed a job analysis, and listed below it states the requirements of the VRC are to utilize the OOH (below) and essentially check directly with employers if they're not sure of the requirements - the OOH states the residency is required for licensure and certification. The M28R states that those requirements must met and must include any required certifications and/or licenses for employment.
- On that note, the M28R also states that salary and earnings should also be matched to what's expected (also below). Resident's aren't salaried, we receive a stipend to offset costs during training since it's full time. Salary is paid for either hours, work, or production, or a combo often based on a set minimum if not paid hourly. For us, it doesnt matter how much or little we do, it's the same, and we have no control. And if fired or need a leave and don't have a spot reserved, we're SOL. And a W-2 doesn't mean employment either. It just means what we receive is taxable, and stiwpdents can still be taxable in other fields/ways too. Therefore, resident stipends are not equivocal for the expected pay of the field.
- Their sole reasons for denying me are based on me being "permanently employed" and because I've been in the program for more than the allotted time (designed with SEH). Being I have SEH, that time is irrelevant. And I don't need to explain to any of you that residency is temporary training lol.
- Lastly, the M28R directly refers to the 38 CFR. I quoted the 38 CFR at the bottom. It literally specifies that residency is recognized as an institution course so long as it is accredited by an appropriate body, which it further lays out as including ACGME, AOA, and a couple for Pod and Dental I think.
All in all, each denial was copy and pasted from the previous, and none touch on my statements or any of this information I provided. The veteran law judge
should understand this language and hopefully not be as ignorant to the case. I've never spoken to my 'current' VRC on the phone, zoom, in person, anything. Only by email. And no phone calls despite multiple requests at various points. She was my VRC for about 7-9 months before school ended as my old one was promoted and then eventually left VRE.
________
- M28R, Part V, Section A, Chapter 2 (Program Assistance):
- 2.06 (Adjusting the Rehabilitation Plan)
- (d): Review of the Individual Written Rehabilitation Plan (IWRP)
- The VRC and the Veteran will periodically review and evaluate the IWRP. A comprehensive review will be conducted at least once every 12 months (38 CFR 21.96) and will be annotated on the IWRP. Review may result in no change to the plan, an amendment, or redevelopment of the plan.
_______
- M28R, Part VI, Section A, Chapter 4: Job Readiness, Development, And Placement Services:
- 4.03 Job Readiness:
- (b): Requirements:
- “It is the Vocational Rehabilitation Counselor’s (VRC) responsibility to make a determination for declaring a Veteran job ready before he/she is provided employment services. The determination must include the following verifications:“
- 1. Documentation such as a diploma, certification from a training facility or transcript of records that demonstrate the Veteran has completed the education or other training outlined in his/her Individualized Written Rehabilitation Plan (IWRP).
- 2. Completion of any required certification or license.
- 3. No barriers, such as disability conditions, family situations, etc., exist that may prevent the Veteran from obtaining or maintaining suitable employment.
- 4. Possession of job-seeking skills.
- (d): Documentation for Job Ready Declaration
- “It is the VRC’s responsibility to assess the Veteran’s job readiness and make a formal declaration of job readiness upon completion of the IWRP. The VRC must accurately and clearly justify and document the declaration of the Veteran’s job readiness on VAF 28-1905d, Special Report of Training (See Appendix O. VA Forms), or CWINRS Notes. The narrative must clearly explain that there are no impediments in the Veteran’s ability to obtain or maintain suitable employment. This documentation must be filed in the middle flap of the Counseling/Evaluation/Rehabilitation (CER) folder.”
- (g): Veteran Determined Not Job Ready
- “If a case manager determines that the Veteran is not currently job ready, the case manager must work with the Veteran to determine the services he/she needs to become ready to obtain or maintain suitable employment. Once the services are identified, the case manager must modify the Veteran’s IWRP to include the additional services to be provided.
- 4.04 Job Placement:
- (a): Direct Placement Service
- “This requires the case manager’s active involvement and personal intervention with employer on behalf of the Veteran. Direct job placement occurs within a network that involves employers, employees and service providers.”
- “Direct placement entails the following activities: Matching the Veteran’s needs, abilities and aspirations to the demands, salary and other characteristics of a specific employment objective”
- 4.05 Job Analysis:
- (a): General Information
- “Job analysis is an essential aspect of direct placement. It is a process used to identify and determine the particular job duties and requirements, and the relative importance of these duties for a given job. An important concept is that the analysis is conducted on the specifics of the job, not the person performing the duties of the job. Job analysis is particularly useful when dealing with small businesses, as many of the jobs in this setting have a variety of ancillary duties.”
- (b): Methodology
- “A case manager may need to conduct an on-site analysis of a prospective job when precise information about job task requirements and the work environment are not known. A job analysis should identify the following factors of a job:”
- “8. Education, experience, license and/or certification requirements.”
- (c): Job Profile
- “A case manager may utilize the Dictionary of Occupational Titles (DOT) and the Occupational Outlook Handbook (OOH) to identify several aspects of an occupation, to include:”
- “Training and education requirements"
- “Earnings”
_____________
Per the OOH directly from the BLS.GOV website, regarding the occupation of
“Physicians and Surgeons:”
- Education
- “In addition to requiring a bachelor’s degree, physicians and surgeons typically need either a Medical Doctor (M.D.) or a Doctor of Osteopathic Medicine (D.O.) degree. No specific undergraduate degree is required to enter an M.D. or D.O. program, but applicants to medical school usually have studied subjects such as biology, physical science, or healthcare and related fields.”
- Training:
- “After medical school, almost all graduates enter a residency program in their specialty of interest. A residency usually takes place in a hospital or clinic and varies in duration, typically lasting from 3 to 9 years, depending on the specialty. Subspecialization, such as infectious diseases or hand surgery, includes additional training in a fellowship of 1 to 3 years.”
- Licensure, Certifications, and Registrations:
- “All states require physicians and surgeons to be licensed; requirements vary by state. To qualify for a license, candidates must graduate from an accredited medical school and complete residency training in their specialty.”
“Licensure requirements include passing standardized national exams. M.D.s take the U.S. Medical Licensing Examination (USMLE). D.O.s take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). For specific state information about licensing, contact your state’s medical board.”
________
- M28R, Part V, Section A, Chapter 2 (Program Assistance):
- 2.04 (Course and Program Length):
- “Full and part-time training for Veterans in the Chapter 31 program is measured under 38 CFR 21.310 (also see 38 CFR 21.4270 through 21.4275); unless a physician determines that the Veteran’s disabilities reduce his/her ability to pursue a program (see 38 CFR 21.312).”
38 CFR subsections directly referred to by the M28R above:
“§ 21.4270 Measurement of courses:” … “(c) Undergraduate, graduate,
professional, and on-the-job training courses. Collegiate graduate,
professional and on-the-job
training courses shall be measured as stated in this table. This shall be used for measurement of collegiate undergraduate courses subject to all the measurement criteria of § 21.4272. Clock hours and sessions mentioned in this table mean clock hours and class sessions per week.”
Ҥ 21.4275 Practical training courses; measurement: (a) Medical and dental residencies and osteopathic internships and residencies.
VA will measure medical and dental residencies, and osteopathic internships and residencies as provided in
§ 21.4270(c) of this part
if they are accredited and approved in accordance with § 21.4265(a) of this part.”
“§ 21.4265(a) as referenced in 38 CFR § 21.4275:
“Practical training approved as institutional training or on-job training:”
- Medical-dental internships and residencies.
- (1) Medical residencies (other than residencies in podiatric medicine), dental residencies, and osteopathic internships and residencies may be approved and recognized as institutional coursesonly when an appropriate accrediting agency accredits and approves them as leading to certification for a recognized professional objective.
- (2) The appropriate accrediting agencies are:
- (i) The Accreditation Council for Graduate Medical Education, or where the Accreditation Council for Graduate Medical Education has delegated accrediting authority, the appropriate Residency Review Committee,
- (ii) The American Osteopathic Association, and
- (iii) The Commission on Dental Accreditation of the American Dental Association.
- (3) These residency programs—
- (i) Must lead to certification by an appropriate Specialty or Subspecialty Board, the American Osteopathic Association, or the American Dental Association; and
- (ii) Will not be approved to include a period of practice following completion of the education requirements even though the accrediting agency requires the practice.
- (4) Except as provided in paragraph (a)(5) of this section, no other medical or dental residency or osteopathic internship or residency will be approved or recognized as institutional training.
- (5) A residency in podiatric medicine may be approved and recognized as institutional training only when it has been approved by the Council on Podiatry Education of the American Podiatry Association.”
. I know my old VRC did this for things like my MCAT. It doesn't take long to fill out, however. Good catch making sure folks are using this form.
