Graduates with no residency

[RyanR634]

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I met a guy who quit his surgical residency halfway through his intern year a few years ago and now he is working as a "midlevel" provider. I was just curious why more international grads who are (for one reason or another) not able to get a residency aren't doing this type of thing??? It seems like a pretty sweet deal until they find a residency spot or decide which kind of specialty they want. Is it because they don't know of this option? I'm not sure of the logistics but they should be able to do it without taking all the USMLE steps since frickin real midlevels practice with far less training and testing.

 

[cheruka]

I don't know how your friend did it but I would imagine you still have to take more classes, do some other type fof rotations and pass some other types of boards (PA/NP etc). While there is a three time limit to take USMLE boards in most U.S med schools, ironically the IMGs do not have the same rules so I am guessing they keep taking the boards until a desired score is achieved. Not a fun way to live your life but as you know, in medicine once you get into it, it is too late to turn back.

 

[link2swim06]

I met a guy who quit his surgical residency halfway through his intern year a few years ago and now he is working as a "midlevel" provider. I was just curious why more international grads who are (for one reason or another) not able to get a residency aren't doing this type of thing??? It seems like a pretty sweet deal until they find a residency spot or decide which kind of specialty they want. Is it because they don't know of this option? I'm not sure of the logistics but they should be able to do it without taking all the USMLE steps since frickin real midlevels practice with far less training and testing.

The issues is when you are trained as a physician you are expected to give "physician level of care." Regardless if you function as a midlevel, from a legal standpoint you are suppose to be working at the level you were trained.

Furthermore, if you haven't passed all of USMLEs then you dont have a license and are not more qualified than midlevel (regardless if you 'know' more).

I suspect this is a unique arrangement and is not normally done. If he would have completed step 3 and intern year then at least he could have gotten a license (w/o board certification). This would open up some opportunities in rural areas without many doctors.

 

[Law2Doc]

The issues is when you are trained as a physician you are expected to give "physician level of care." Regardless if you function as a midlevel, from a legal standpoint you are suppose to be working at the level you were trained...

This. You open the hospital up to much greater liability than a midlevel by virtue of having an MD, so if a hospital has the option to hire a midlevel over you, they generally will. Plus you technically cannot be either an NP or PA without additional graduate education and certification, so reimbursement and billing will be impacted. You have no billing status so your tasks can only be accounted for the same as a non licensed nurse, and you need direct supervision for everything, even those things an NP or PA would traditionally do on their own. So no, it not actually an option. If you actually know someone who did this it likely he had connections who created such a job despite the hurdles. It cannot be replicated.

 

[Law2Doc]

...While there is a three time limit to take USMLE boards in most U.S med schools, ironically the IMGs do not have the same rules so I am guessing they keep taking the boards until a desired score is achieved....

Each state sets it's requirements. There is no IMG exception that gives them more bites at the apple.

 

[Winged Scapula]

Each state sets it's requirements. There is no IMG exception that gives them more bites at the apple.

Also not to mention that you cannot simply keep retaking the steps until you get the score you desire. Once you reach a passing score, you can't retake the exam. That's the rules for both AMGs and IMGs.

 

[cheruka]

Yes, I understand that the rules are set by the states. But, there are some states (down south) that do allow multiple attempts. To my knowledge, most US med school have a three strike policy.

 

[DrAwsome]

Yes, I understand that the rules are set by the states. But, there are some states (down south) that do allow multiple attempts. To my knowledge, most US med school have a three strike policy.

You can only take the steps until you pass them. Once you pass them, you cannot take them again. I don't think any differences apply to IMGs.

The only exception is if you fall outside of the state requirements for licensing, and you can retake a step even if you passed it before in order to fall within a certain time frame.

 

[dragonfly99]

I think cheruka is talking about the fact that at many (? most) US med schools, if a student fails one of the steps 3 times, he/she will not be allowed to graduate. A IMG at many schools could retake USMLE as many times as he/she needed in order to pass...but I personally would think that an IMG with one or more failed USMLE step attempts would have a hard time getting a residency (any residency) in this day and age.

 

[Law2Doc]

I think cheruka is talking about the fact that at many (? most) US med schools, if a student fails one of the steps 3 times, he/she will not be allowed to graduate. A IMG at many schools could retake USMLE as many times as he/she needed in order to pass...but I personally would think that an IMG with one or more failed USMLE step attempts would have a hard time getting a residency (any residency) in this day and age.

I believe many med schools draw the line the same as the state they are in -- you can only take each part X number of times to get licensed, and once you can't get licensed in the state based on Step 1, you wouldn't be getting a degree either. But at most places i believe you can't advance to rotations until you pass step 1, so there is really a second internal hurdle anyhow. I supposed an IMG might have slightly more options if there was another state that had a more generous retake policy (doubtful). But lots of luck finding a residency with so many attempts at Step 1. I'd say IMGs start out in a worse position in terms of US opportunities, and don't really ever end up with advantageous treatment even with this strained reading. I sure wouldn't be lamenting that I'm not an IMG or be jealous of all their extra bites at the apple.

 

[Raryn]

I believe many med schools draw the line the same as the state they are in -- you can only take each part X number of times to get licensed, and once you can't get licensed in the state based on Step 1, you wouldn't be getting a degree either. But at most places i believe you can't advance to rotations until you pass step 1, so there is really a second internal hurdle anyhow. I supposed an IMG might have slightly more options if there was another state that had a more generous retake policy (doubtful). But lots of luck finding a residency with so many attempts at Step 1. I'd say IMGs start out in a worse position in terms of US opportunities, and don't really ever end up with advantageous treatment even with this strained reading. I sure wouldn't be lamenting that I'm not an IMG or be jealous of all their extra bites at the apple.

Not sure how true the bold is. Of the double handful of schools I'm aware of, it's true of half at most. At my institution you cannot advance to M4 year until you pass step 1 (not m3 year), giving some extra time for those few that need to retake. At a few schools I have friends at, you don't even have to have a passing step 1 score to technically graduate. (Just need to have taken it at least once... Of course, you won't match or get licensed without a passing score).

 

[DrAwsome]

Not sure how true the bold is. Of the double handful of schools I'm aware of, it's true of half at most. At my institution you cannot advance to M4 year until you pass step 1 (not m3 year), giving some extra time for those few that need to retake. At a few schools I have friends at, you don't even have to have a passing step 1 score to technically graduate. (Just need to have taken it at least once... Of course, you won't match or get licensed without a passing score).

That's crazy, most schools even require step 2CS and CK to graduate these days. Most of the schools I know require you to take and pass step 1 to go onto/continue in 3rd year clerkships.

 

[Law2Doc]

That's crazy, most schools even require step 2CS and CK to graduate these days. Most of the schools I know require you to take and pass step 1 to go onto/continue in 3rd year clerkships.

This was my experience as well.

 

[mordounhas]

If you didn't pass Step 1 at my school, you were pulled from clinical rotations at least until you had re-taken it. Step 2 CS and CK had to be taken before the end of December as a MS4 so you had time to re-take if you failed. In my residency I have to pass Step 3 to advance to PGY-2.

Frankly, I think these are largely reasonable requirements. You don't want people going on to higher levels until they've at least proven something- in this case that they have enough base knowledge to pass a standardized test.

 

[QuacksterVu]

If you didn't pass Step 1 at my school, you were pulled from clinical rotations at least until you had re-taken it. Step 2 CS and CK had to be taken before the end of December as a MS4 so you had time to re-take if you failed. In my residency I have to pass Step 3 to advance to PGY-2.

Frankly, I think these are largely reasonable requirements. You don't want people going on to higher levels until they've at least proven something- in this case that they have enough base knowledge to pass a standardized test.

^This is what my medical school does as well. We had a few people that were pulled out of their current rotations once Step 1 scores had come back.

 

[cabinbuilder]

If he would have completed step 3 and intern year then at least he could have gotten a license (w/o board certification). This would open up some opportunities in rural areas without many doctors.

Don't count on this. Most rural areas require board certification because many times YOU ARE THE ONLY PROVIDER and the facility hiring you wants someone who is well trained not some residency dropout.