MD3:16

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Sadly we often read in many of the residency forums, medical residents who are terminated or forced to resign for a myriad of reasons. Sadly enough we know without completing a residency your MD degree is practically worthless. That being said, what is the practicality of these individuals who may not be able to return to residency to consider other alternative career paths related to health care in some way, like pursuing a career in pharmacy, or being a nurse practionaire, or physician assistant. And knowing that some are going to say who wants to go back to school when they have invested so much time or are already in debt? however, pursuing the later options seems more reasonable than sitting on the couch for the next 3-4 years in the time you could of obtained the above certification. moreover, working at sears or jcpenny want be adequate to take care of the accumulating debt, as the later options provide a more viable alternative. i welcome any thoughts or consideration on the matter.
 

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Thoughts?

Do a search. We've discussed this many many times.

In most cases, your MD will not get you advanced standing, as the training is totally different. If you are prepared to start all over in a different career, these are viable alternative paths to a different type of practice but remember none of these are free. You will have additional debt load.
 
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turquoiseblue

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i wish someone could step up to the plate and change all that.

maybe some licensed, board certified MD's could hire MD's (who haven't completed residency) under them and under their insurance so that they can act as PA's, at least until they can get residency or even permanently. I think that is possible but im not exactly sure.
 

JackADeli

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...maybe some licensed, board certified MD's could hire MD's (who haven't completed residency) under them and under their insurance so that they can act as PA's, at least until they can get residency or even permanently. I think that is possible but im not exactly sure.
Not really. If you haven't completed adequate residency to obtain an unrestricted/full license, then you would need at the least a trainee license within a ~trainee environment. If you have not completed adequate residency for a significant reason, I don't know any physicians that would assume the liability of hiring in some sort of charitable fashion so that you could work as an untrained PA. While the theory and idea may seem reasonable, the reality suggested by your comment is not. Liability/malpractice aside, a physician has and his/her patients have far too much at risk to hire an untrained physician outside of a structured teaching environment. From a practice standpoint, you are better off and your patients are better off if you hire a fully trained mid-level to do a mid-level's job as opposed to hiring an untrained MD to do a mid-level's job.
 

Samoa

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To the OP: if you are willing to start over, pharm would probably be the most realistic career path. Your medical knowledge will help you, and the MD degree won't hurt you (as it would in trying to be an NP or PA)
You might actually get credit for a few of your classes, too. All told, you might be able to shorten the degree by a half-year or so. That would make it three and a half years instead of four (not counting the pre-pharm years, which your pre-med classes would cover). But there's talk of making it a 7-year program, which would mean up to five more years of education.

And now you need a one-year residency if you want to work anywhere besides a prescription mill. And there aren't anywhere near enough residencies to go around. Also, the supply of new pharmacists has finally caught up to demand in most cities, so you can't afford to turn down a job anymore.

On the flip side, you generally don't have to send out hundreds of resumes to get an interview. And most interviews do still result in a job offer. But don't expect to be hired (or admitted to pharmacy school) if it's just something to do until you find a physician residency.
 
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I would not go the NP route as you would need to get a nursing degree first and become a RN and then apply to NP school. In theory that would take you around 4 years (2 for RN (as a second degree student) and 2 for NP), however by the time you are done with your RN the DNP requirement may come into force (2015) and then NP will take 4 years instead of 2. Also studying for RN could be difficult for you as you would go from giving orders to fulfilling them. PA would be the most viable and fast option as you should have all the prerequisites (from pre-med) to get into a PA school. PharmD would also work as you would have most necessary prerequisites fro pre-med to get into pharmacy school. It would take longer to complete than PA though.

If I were you I would try finding a residency before considering any other options. If it is completely impossible then PA or PharmD. PA would be closest to MD in terms of what you will do after you graduate. PharmD would earn you more money.
 

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i wish someone could step up to the plate and change all that.

maybe some licensed, board certified MD's could hire MD's (who haven't completed residency) under them and under their insurance so that they can act as PA's, at least until they can get residency or even permanently. I think that is possible but im not exactly sure.
Doubtful. Too much liability if that MD who hasn't completed residency (1) doesn't even have a temporary training license, or (2) doesn't have their own malpractice coverage.
 

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Doubtful. Too much liability if that MD who hasn't completed residency (1) doesn't even have a temporary training license, or (2) doesn't have their own malpractice coverage.

i believe OK allows docs with 1 year intern done to work in acute care clinics.
 

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i believe OK allows docs with 1 year intern done to work in acute care clinics.

There are MANY states who will allow someone with 1 year of post-grad training to be eligible for a license. In most states, FMGs/IMGs are required to have more training before they are eligible for an unrestricted license.

That is not the issue - TB was suggesting that someone could work in a PP office to get the clinical training they need. This is not feasible because once you have a medical degree, you are held to the practice standards of a physician, even without a license. She would also have to have malpractice insurance, which most in PP would not be willing to pay for.I highly doubt any physician would be willing to allow such a person to do any clinical work given the liability; since she has not completed a full year of training, she is not eligible for a medical license.
 

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A better option might be to ensure that as many residents as possible know how to avoid having problems completing their residency. The impression I get from this forum, which probably has more of the clued-up residents on it in any case, is that -

1) Very few residents seem to bother to read and understand the residency contract they sign, in particular the procedures for dealing with performance issues. (It's not just that they don't do this when they sign, they don't even seem to do it after the procedures have kicked in, which is extraordinary.)

2) Very few residents who start to get into trouble recognise that they are in trouble before it is too late. How come such intelligent people can't read the signals being sent to them? It's worse than watching live lobsters in cold water with the burner on beneath them.

3) A significant proportion of residents who get into trouble are unwilling to take responsibility for it and accept that either all or part of the problem comes from things they have done and ways they have behaved. (Yes, I know, malignant programs and all that, but why are they picking on you and not all the others? You are more vulnerable to being picked on if you are not male, white, able-bodied, heterosexual and a citizen, but even so not everyone not in those categories is getting picked on, even in the most malignant programs.)

4) None of those residents in trouble seem to understand that in order to get out of trouble they will probably need to change two things: a) what they do and b) how they are perceived. (Yes, I know, malignant programs, again, but you are the person with the most invested in your career as a doctor, and you are the person who has to do most to solve the problem in a way that lets you stay in your residency.)

5) No resident seems to know where to go to for help.
 

OBandWifey

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Not really. If you haven't completed adequate residency to obtain an unrestricted/full license, then you would need at the least a trainee license within a ~trainee environment. If you have not completed adequate residency for a significant reason, I don't know any physicians that would assume the liability of hiring in some sort of charitable fashion so that you could work as an untrained PA. While the theory and idea may seem reasonable, the reality suggested by your comment is not. Liability/malpractice aside, a physician has and his/her patients have far too much at risk to hire an untrained physician outside of a structured teaching environment. From a practice standpoint, you are better off and your patients are better off if you hire a fully trained mid-level to do a mid-level's job as opposed to hiring an untrained MD to do a mid-level's job.
But isn't this was a PA is? I mean they complete school and then go into a clinic or hospital and work. It seems that we as physicians have more clinical experience than a PA straight out of medical school so what's wrong with hiring one to do a mid-level's job? Physicians are hiring them why not hire a DO/MD straight out of medical school? I'm not in this boat but it just seems that by hiring a PA straight out of school over a DO/MD straight out of school you're saying their education and training is better...you know? I don't know...that's just want it appears to be to me. PA student's don't specialize while in school...they just pick what speciality they like and hunt for a job. It's the physician's job to train them to perform the duties in their office. So it's not like PA's are graduating as Peds PAs, Ortho PAs, OB PAs, etc. It's more like on the job training...so why not do this with a medical school graduate?
I would have no problem with a DO/MD graduate doing a mid-level's job in my office. I would treat them the same as a PA or NP really. They would be responsible for working up my easier patients and mainly do office work while being supervised. *shrug* Unless I'm missing something.
 
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I would have no problem with a DO/MD graduate doing a mid-level's job in my office. I would treat them the same as a PA or NP really. They would be responsible for working up my easier patients and mainly do office work while being supervised. *shrug* Unless I'm missing something.
I would also agree with you personally. but my understanding is that the problem is not from an individual practitioner's perspective. The problem is that once someone has finished Medical School, then they are held to the standards of conduct expected of a Physician and not NP/PA. Hence malpractice becomes an issue.

If this were not so, under-performing AMGs and many FMGs/IMGs could use this route to get official hands-on clinical experience in the US healthcare system and also keep their skills intact. However it is a catch-22 system-unless you are licensed/ECFMG certified, etc., you are not employable, and even then as a "trainee" in an ACGME accredited program only, but regardless, you will be held to the standards of a Physician.

I wonder who set this up, and whether mid-levels, who benefit from this the most, had a hand in such regulations.

As always, I am willing to learn especially if I am wrong, but from previous discussions on a related topic, this is what my understanding has been.
 

Winged Scapula

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...Unless I'm missing something.
What you are missing is that with the medical degree in hand, even without a license, you are held to the standard of a physician.

Your malpractice rates are higher, the expectations are higher. Therefore, hiring a physician, even a non-residency trained unlicensed one, means that the malpractice rates quoted will be higher for him/her than for a PA or RN. Simply because he or she is a physician.

It will not be an excuse if something went wrong that you were "only" a PA or other mid-level sans the training. The argument will be, as a physician, you should have known more.
 

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This idea of a MD being a PA or RN is absurd. Most MD's only need one year to be licensed. Once licensed, you can open your own clinic. Many people do not care if you are fully trained or not. They pick their doctors because the doctors take care of their concerns and they feeling good that they came to seek your help. You can accept medicaid. It don't pay much but you can still earn six figures. Most BC MDs won't even take medicaid.

But there are other benefits. You'd be surprised how many grannies on medicaid know how to cook and bring their creations to cheer the office. Some of the recipes will die with these women as today's women may not have the same interest in learning the oldest path to a man's heart.

Sure you cannot get privileges or pursue academic medical practice. But you can still pursue academic research. The pay sucks but the lifestyle can be good. It's still very competitive though. You may still face prejudice from other MDs who have finished training.

The thought of even becoming a PA or RN suggests that you do not have a license or that you have drank the cool-aid. The desire to be accepted by one's peers can interfere with what you have already achieved. You are doctor. If you want to practice as a doctor, then just do it if you are licensed. General practice is not really that different from IM, FP, or PC.

As for insurance, you pay the premium based on what you do not your education level. An OB-GYN who restricts his practice to just primary care will pay what an internist pays. You might get a slight discount for being BC. If the insurance co. still won't cover, find another that does. You might have to move to a state where a provider will cover you such as a poor state.

If you do get sued you will be held to the same reasonable physician standard just as everyone else is. Contrary to myth, it is very hard to lose a malpractice suit. Mechanisms are in place such that if you lose, you definitely did wrong. Law affords medicine much deference. It's not like residency where the remote possibility of something going wrong can bring about a charge of incompetency. In law you actually have to prove negligence and actual damages. So spend a hundred bucks on used MKSAPs and spend time memorizing stuff in there. If you passed all three USMLEs, the MKSAPs should not present a problem.
 

Winged Scapula

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This idea of a MD being a PA or RN is absurd. Most MD's only need one year to be licensed. Once licensed, you can open your own clinic. Many people do not care if you are fully trained or not. They pick their doctors because the doctors take care of their concerns and they feeling good that they came to seek your help. You can accept medicaid. It don't pay much but you can still earn six figures. Most BC MDs won't even take medicaid.

But there are other benefits. You'd be surprised how many grannies on medicaid know how to cook and bring their creations to cheer the office. Some of the recipes will die with these women as today's women may not have the same interest in learning the oldest path to a man's heart.

Sure you cannot get privileges or pursue academic medical practice. But you can still pursue academic research. The pay sucks but the lifestyle can be good. It's still very competitive though. You may still face prejudice from other MDs who have finished training.

The thought of even becoming a PA or RN suggests that you do not have a license or that you have drank the cool-aid. The desire to be accepted by one's peers can interfere with what you have already achieved. You are doctor. If you want to practice as a doctor, then just do it if you are licensed. General practice is not really that different from IM, FP, or PC.

As for insurance, you pay the premium based on what you do not your education level. An OB-GYN who restricts his practice to just primary care will pay what an internist pays. You might get a slight discount for being BC. If the insurance co. still won't cover, find another that does. You might have to move to a state where a provider will cover you such as a poor state.

If you do get sued you will be held to the same reasonable physician standard just as everyone else is. Contrary to myth, it is very hard to lose a malpractice suit. Mechanisms are in place such that if you lose, you definitely did wrong. Law affords medicine much deference. It's not like residency where the remote possibility of something going wrong can bring about a charge of incompetency. In law you actually have to prove negligence and actual damages. So spend a hundred bucks on used MKSAPs and spend time memorizing stuff in there. If you passed all three USMLEs, the MKSAPs should not present a problem.
:thumbup:
 

JackADeli

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This idea of a MD being a PA or RN is absurd. Most MD's only need one year to be licensed. Once licensed, you can open your own clinic. Many people do not care if you are fully trained or not. They pick their doctors because the doctors take care of their concerns and they feeling good that they came to seek your help. You can accept medicaid. It don't pay much but you can still earn six figures. Most BC MDs won't even take medicaid...
I generally concur with much of what you originally posted. However, I think individuals need realistic ideas in the practice of medicine.

First, I have not look at the exact numbers of what states accept only 1 year of post graduate training to obtain a full and unrestricted license. If you know that number to be >26 great. In general, I have seen some states moving towards a 24 month requirement. Taking step 3 generally is a state by state governance in accordance with their individual medical/licensing boards. Some states require application for full licensure as a component to applying to sit for step 3.

Second, I am not certain one can say most people/patients do not care if you are fully trained. It is probably true to say that in a pinch, many people just want the pain to stop and will not check your credentials. Many people will accept a general practitioner that has not completed a residency because of the quality of care they feel they receive. However, again, more anecdote, the patients I have seen all either do internet searches or ask if I have completed a residency and if I am board certified.

Finally, if one has completed adequate post-grad training (aka residency) and completed all USMLE steps and obtained a full unrestricted license, he or she can try to open a practice somewhere. There are numerous problems but it is possible. One problem is that insurance carriers may be unwilling to reimburse for such a persons care. This pushes the person into a direct pay situation which may or may not be feasible where they are licensed. Patients in general seem to be less then thrilled with paying a co-pay. I doubt they will be happier paying the full bill. Another problem is the malpractice coverage. Yes, rates are related to scope of practice. However, these are actuaries we are talking about and they do consider what kind of "risk" you represent. They absolutely will consider how much training you completed for the scope of practice you intend. Some may be unwilling to cover you without completion of a training program. Others may be willing to cover you at a significant cost. The OP and others will just have to investigate their options.
 

JackADeli

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Just some reference from USMLE & FSMB web
USMLE said:
...Step 3
To be eligible for Step 3, prior to submitting your application, you must:
...meet the Step 3 requirements set by the medical licensing authority to which you are applying...

...Note: The USMLE program recommends that for Step 3 eligibility, licensing authorities require the completion, or near completion, of at least one postgraduate training year in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA. You should contact the FSMB for state-specific eligibility requirements for Step 3...
FSMB said:
 

Carboxide

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You might actually get credit for a few of your classes, too. All told, you might be able to shorten the degree by a half-year or so. That would make it three and a half years instead of four (not counting the pre-pharm years, which your pre-med classes would cover). But there's talk of making it a 7-year program, which would mean up to five more years of education.

And now you need a one-year residency if you want to work anywhere besides a prescription mill. And there aren't anywhere near enough residencies to go around. Also, the supply of new pharmacists has finally caught up to demand in most cities, so you can't afford to turn down a job anymore.

On the flip side, you generally don't have to send out hundreds of resumes to get an interview. And most interviews do still result in a job offer. But don't expect to be hired (or admitted to pharmacy school) if it's just something to do until you find a physician residency.
From a pharmer's perspective...

Your MD experience MIGHT be useful in pharmacy, but the overlap in careers really isn't large. You'd definitely have to start from square one, and because pharmacy school (like, I assume, med school) has a very set schedule, you would not be able to skip a semester. I haven't heard anything about going to a 7 year program (unless you mean a 3+4). Most good schools essentially require a bachelor's now.

The above poster is correct about pharm residencies and the job market. Be aware that in the last pharm match, 50% did not match. You may end up pushing pills at CVS.
 

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The idea that US medical school graduates are "not qualified" or "not trained" to work as PAs is absolutely absurd. You can cite all the stupid logistical malpractice red tape hurdles you want, but at the end of the day a US grad MD is just as well qualified to be a PA as a PA grad is.

I know some of the PAs like to spout BS on here about how PA training "prepares you for supervision" whereas MD schools "prepare" you for independent practice but its all smoke and mirrors.

The logistical and regulatory barriers to this should be removed ASAP.
 

bigDinLV

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In Oklahoma... You get your license after your intern year. It's your license, do what you want with it basically.

I'm working in a few community ERs. At one hospital they even have me admit, round and discharge patients.

A few people have even been caught up by the money. They find a moonlighting job making $90-120 per hour and end up leaving residency to make that a career. Bad decision IMO, they will only be able to have a license here (or in a similar state) and never be boarded. I can see how the immediate gratification of $250k per year would be tempting though.
 

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Doubtful. Too much liability if that MD who hasn't completed residency (1) doesn't even have a temporary training license, or (2) doesn't have their own malpractice coverage.
i've seen it out there. a supervising licensed physician with unlicensed MD's working under them, and the supervising physician signs off charts. Much like a residency program, but all they get to do is make house calls or work in a clinic. it is a possibility. Why don't we give MD's the credit they deserve. I mean we are highly trained, much better than a PA or RN, so why can't we do what they do? More should come of this idea, in my opnion. It would finally allow MD's to get the credit they deserve and not be pushed down by a PA or NP.
 

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...Why don't we give MD's the credit they deserve. I mean we are highly trained, much better than a PA or RN, so why can't we do what they do? ...It would finally allow MD's to get the credit they deserve and not be pushed down by a PA or NP.
A trained physician is given the credit they deserve and is not pushed down by mid-levels. You want to be a physician, get the respect, and status of a physician, you complete med-school and at least a minimum amount of residency to be adequately trained to obtained appropriate licensure. That is the deal. There is no short cut. Med-school is NOT mid-level school.

You don't cut it as a full physician, mid-level is NOT the fall back. An untrained MD without licensure is LESS then a licensed mid-level. They are at least trained & licensed. That is life. That is reality. And, that is not a secret. Pre-meds and med-students, as adults and professionals, should all be aware of it. An MD degree by itself without adequate residency training and licensure does NOT entitle you to any clinical practice...PERIOD!
 

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i've seen it out there. a supervising licensed physician with unlicensed MD's working under them, and the supervising physician signs off charts. Much like a residency program, but all they get to do is make house calls or work in a clinic. it is a possibility.
If its out there then why aren't you doing it?
 

altap

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A PA school grad who passed the PANCE or nursing school grad who passed the NCLEX can work as a physician extender but a medical school graduate who passed the hardest exams of them all cannot work as a midlevel is just mind boggling.

Correct me if I'm wrong, but I think the medical profession is the only profession that won't allow its graduates to practice their craft even after passing its licensing or licensure exams (USMLEs). Because of this and bec. of the scarcity of residency slots, the gov't should incentivize those who passed these exams by letting them work as midlevels. IMHO, if a med school grad passed the Steps 1 and 2 CK and CS then he is at least ready to be a midlevel.
 
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JackADeli

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... MD's ...are highly trained, much better than a PA or RN...
...a medical school graduate who passed the hardest exams of them all cannot work as a midlevel is just mind boggling...
Because you didn't train to be a mid-level and you are not a mid-level. Frankly, I never want to hire a ~MD in the position of mid-level that is so hung up on themselves, believing they are more then a mid-level, i.e. "much better than...". I am amazed at all the MD degree holders lacking adequate if not full residency training declaring they are worth more then fully trained physicians believe. I am reading about the respect you may think you deserve... What about actual fully trained and experienced physicians/attendings, I guess your MD degree without complete training gives you vision and understanding beyond ours. Yes, I will always ask the trainee what are they worth...to me:confused: Your value as an untrained but MD holding degree seems largely centered in your mind.
...Correct me if I'm wrong, but I think the medical profession ...won't allow its graduates to practice their craft even after passing its licensing or licensure exams (USMLEs)...
You are wrong. You complete ALL USMLE and obtain a license, you can practice.
...the gov't should incentivize those who passed these exams by letting them work as midlevels. IMHO, if a med school grad passed the Steps 1 and 2 CK and CS then he is at least ready to be a midlevel.
No, the government should not incentivize dropping out. And, your honest opinion is IMHO naive and self serving.... If you want to be a mid-level, there is an easier way, go to mid-level school and train to be a mid-level. Do not go the route of MD/DO school and then cry a river that you are now eligible to be a mid-level. A great deal of time, money and effort is put into training a MD into a functional physician. To incentive otherwise is stupid.
i've seen it ...unlicensed MD's working ...make house calls or work in a clinic. it is a possibility...
I would be very surprised. This is practicing medicine without a license. I know of no states in the USA that would allow this legally.
 
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Makati2008

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I totally agree with Jack on these issues. If there was an incentive for docs to quit practicing medicine that would be a bad thing in my opinion(worsening primary care shortage...). Also Altap is very self serving(he/she is an IMG that has been unable to match from what I gather. I really do want him to get a spot because being in medical school debt would definitely be a very bad predicament to be in.) and since he has not been able to practice as a doc in the USA/doesn't know how a PA would function then he should have no say in this argument.

I would have no problem with an AMG going the PA route in only extreme circumstances that would have to be dictated by the AMA/AOA/AAPA. I would also hope this door was shut from IMG/FMG's. This is not to discourage them from coming to the USA but we at least know the level of an AMG's training based on the standards that our medical schools must meet and the same cannot be said for their training.

My question is the reverse-If a PA could pass all three of the steps should they be allowed to be given a shot a residency and unrestricted licensure being the end result minus medical school?

Originally Posted by turquoiseblue
i've seen it ...unlicensed MD's working ...make house calls or work in a clinic. it is a possibility...
I would be very surprised. This is practicing medicine without a license. I know of no states in the USA that would allow this legally.-I have seen this as well Jackadeli More than you can imagine in clinics and they are referred to as Dr. X - they are "docs" but IMG/AMG that couldn't pass all the steps/ complete residency.


sorry if any typos are present.
 

emedpa

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when I was a student one of the hospitals I rotated at had a pool of unlicensed fmg surgical assistants( who they called dr xyz) but they used them interchangeably with the surgical pa's and paid them the same(which at the time was something like 50k/yr). when they were able to hire enough pa's they fired all the fmg's because the pa's could round in the hospital, write admission h+p's, d/c summaries, staff the surgical clinic, do er consults, write scripts, etc and the fmg's could only first assist with a doc across the table from them..
 

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i've seen it out there. a supervising licensed physician with unlicensed MD's working under them, and the supervising physician signs off charts. Much like a residency program, but all they get to do is make house calls or work in a clinic. it is a possibility.
Not so sure about that. Residents are allowed to "practice" under the guises of their residency program, GME and their temporary training permit. You have to renew said license every year (and then eventually you'll get a full license once it's mandated by your residency/fellowship program, when you moonlight, or when you get into practice).

Correct me if I'm wrong, but I think the medical profession is the only profession that won't allow its graduates to practice their craft even after passing its licensing or licensure exams (USMLEs).
Technically, once you've passed all the Steps, and have obtained your full medical license in any given state, you can practice independently in that state. That's what all moonlighting residents do. Of course, going out into solo practice to "hang your shingle" as a GP would be a lot harder (especially in bigger cities) since most places (employers, hospitals, insurance companies) may require you be BC/BE.
 

JackADeli

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i've seen it ...unlicensed MD's working ...make house calls or work in a clinic. it is a possibility...
...This is practicing medicine without a license. I know of no states in the USA that would allow this legally.
...I have seen this as well Jackadeli More than you can imagine in clinics and they are referred to as Dr. X - they are "docs" but IMG/AMG that couldn't pass all the steps/ complete residency...
when I was a student one of the hospitals I rotated at had a pool of unlicensed fmg surgical assistants ...but they used them interchangeably with the surgical pa's and paid them the same...
To Makati and others, I would suggest that you are/were probably unaware of the finer points of these individuals employment. I have been at numerous hospitals in which IMG/FMG (even US grads with certain issues) worked in a clinical capacity without a formal "physician license". However, they were NOT unlicensed. To say such an individual is practicing or even performing house calls without a license, I again suggest you lack the full story.

The individuals that lack the ~normal license for whatever reasons and still clinically function (legitimately) are authorized, i.e. licensed by the state board. These individuals have their records reviewed by the state boards. Their "scope of intended practice" is submitted with an accompanying licensed and vouching party. The board/s then authorize, aka license these individuals to act within this limited scope under set criteria.
 

michaelrack

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To Makati and others, I would suggest that you are/were probably unaware of the finer points of these individuals employment. I have been at numerous hospitals in which IMG/FMG (even US grads with certain issues) worked in a clinical capacity without a formal "physician license".
The individuals that lack the ~normal license for whatever reasons and still clinically function (legitimately) are authorized, i.e. licensed by the state board. These individuals have their records reviewed by the state boards. Their "scope of intended practice" is submitted with an accompanying licensed and vouching party. The board/s then authorize, aka license these individuals to act within this limited scope under set criteria.
Agree with JackADeli, although I wouldn't doubt that there are some individuals out there illegally practicing medicine without a licence/medical board authorization
 

emedpa

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my example of the unlicensed fmg first assists was from almost 20 yrs ago. I know for a fact that these guys were not licensed by the medical board at the time. they were working totally under the radar at an inner city hospital. I had a friend working at the same facility who filled me in on the details. most of these guys were still studying to take usmle step 2...and most of them failed. they were hired as "surgical assistants" and competing with folks with an associates degree in surgical assisting and to a lesser extent , surgical pa's who were just coming on the scene at that institution at the time. my friend was the first surgical pa hired there. he was the first to replace one of these unlicensed fmg's.
even earlier than this( 80's) when I was an er tech I remember facilities hiring fmg's as er techs even though they were not emt's.
back in the day (before the joint commission, etc) many jobs were filled based on prior experience, not certification. if you could prove you had done a similar job before elsewhere(even overseas) you could get hired.
 

altap

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To Jack and Makti: There is a shortage of physicians and physician extenders in this country primarily in rural America. This country has a number of unmatched highly educated and skilled FMGs who are ECFMG certified who are working odd jobs or worse don't have jobs. All I'm saying is that why can't this country tap into this wealth/resource. This is a win-win situation: the shortage is addressed and midlevel jobs are given to these FMGs. I'm not naive I understand the pocketbook issue, law of supply and demand, they will just add to the competition etc, but as Blue dog said there are too many pts. to go around. There is a shortage now how much more in 2015 when a deluge of new pts with health insurance come into play. The question is what is being done to address this issue? Is the preparation enough to adequately address the issue? I hope that med orgs and the gov't. look at the FMGs who don't match as one of the answers to this nagging problem of physician and midlevel shortage.
 

Makati2008

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To Jack and Makti: There is a shortage of physicians and physician extenders in this country primarily in rural America. This country has a number of unmatched highly educated and skilled FMGs who are ECFMG certified who are working odd jobs or worse don't have jobs. All I'm saying is that why can't this country tap into this wealth/resource. This is a win-win situation: the shortage is addressed and midlevel jobs are given to these FMGs. I'm not naive I understand the pocketbook issue, law of supply and demand, they will just add to the competition etc, but as Blue dog said there are too many pts. to go around. There is a shortage now how much more in 2015 when a deluge of new pts with health insurance come into play. The question is what is being done to address this issue? Is the preparation enough to adequately address the issue? I hope that med orgs and the gov't. look at the FMGs who don't match as one of the answers to this nagging problem of physician and midlevel shortage.

1.)I disagree with you. Agian we know the quality of the AMG grad but not the FMG and this could lead to some dangers in clinical practice I would think in the question of FMG's(residency would prevent this). Again AMGs I see in a different light.
2.)If this was done(which I hope it isn't) I would hope the AMA/AOA/AAPA would form a hybrid version of PA school that would satisfy the requirements of a PA and then let them practice
3.)I know a few IMG's that go back to PA school and compete against the rest of the applicant pool. I think this is the best method.

For someone interested in "patient safety" it seems like your looking for a shortcut yourself is that not more dangerous than the current midlevel model?
 

JackADeli

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...There is a shortage of physicians and physician extenders in this country primarily in rural America. This country has a number of unmatched highly educated and skilled FMGs who are ECFMG certified who are working odd jobs or worse don't have jobs. All I'm saying is that why can't this country tap into this wealth/resource...
This is nice in a perfect world, sunny day, flowery field. If someone has successfully completed a reasonable medical school with reasonable caliber credentials, he/she can at the very least obtain and complete 12-24 months of accredited residency/prelim-ship, etc..., be granted a full license and go to these rural communities to help the underserved. The issue comes to actually ascertaining these individuals are "highly educated and skilled" in order to practice safely.

Also, we heard these same arguments about mid-levels. They were supposed to be the solution to inadequate healthcare access in rural America. I don't think we can say that is really panning out.

No, I do not think someone that has completed medical school but can not for whatever reason complete 1-2 years accredited residency to obtain license should just be deemed adequate for the role of a mid-level. And, yes, sometimes "something" can be worse then "nothing"! Just because some rural communities have limited access to qualified health professionals does not mean we subject them to whatever happens to be floating around.
 

WorkaholicsAnon

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sigh...:rolleyes: Such limited ideas...

Here are some ideas off the top of my head -- consulting, business, pharma (not pharmD but pharmaceutical companies), health policy, public health, epidemiology, etc etc etc!!!!

A couple of my med school classmates actually CHOSE not to do residency and went into consulting instead.

c'mon people!! LOTS of possibilities out there if you choose to see them!


(p.s. LOL @ Roofie's post! :thumbup::thumbup:)
 

IMdocT

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i never really understood what it meant to be a consultant? what do people consult you on?
 

altap

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To makati, I'm still an "advocate" for patient safety. Why? I still believe that when it comes to practicing medicine independently, med education and training are a must and midlevels should only practice under the supervision of a MD/DO. I also believe that when it comes to gen. medical knowledge and clinical acumen a med school grad (FMG or AMG) who passed the USMLE Steps 1 and 2 CK and CS is > than most PAs or NPs (not to put down any profession).

To jack, I respect your opinion but I disagree. I believe that when it comes to gen medical knowledge and clinical acumen a med school grad (FMG or AMG) who passed the USMLE Steps 1 and 2 CK and CS is > than most PAs or NPs.
 
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Makati2008

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To makati, I'm still an "advocate" for patient safety. I still believe that when it comes to practicing medicine independently, med education and training are a must and midlevels should only practice under the supervision of a MD/DO. I also believe that when it comes to gen. medical knowledge and clinical acumen a med school grad (FMG or AMG) who passed the USMLE Steps 1 and 2 CK and CS is > than most PAs or NPs (not to put down any profession).

To jack, I respect your opinion but I disagree. I believe that when it comes to gen medical knowledge and clinical acumen a med school grad (FMG or AMG) who passed the USMLE Steps 1 and 2 CK and CS is > than most PAs or NPs.
No offense Altap. I feel as though the AMG would be better suited in this position(I wouldn't like it per se) but again as a whole I feel that IMG training is not as well known in many circumstances as an AMG. Also are you telling me if I studied and took the steps and passed both I could drop out of medical school and do residency? That is how I see your statement(again only FMG not AMG). Also there are reasons why people that pass the USMLE's/COMLEX don't match with passing scores in my opinion. I personally think that us just giving a unmatched MD/DO a license to practice as a PA without some sort of formal mechanism in place to see if they could function in that capacity is dangerous because some of these people would still want to be called doc and probably function outside of his/her scope.

When I become a doc I will be a part of the group against a change in the status quo(unmathced DO/MD becoming "PAs" without something in place to have patient safety in mind.

In class so if typos present sorry.