IMG ABIM pilot

[Gastrapathy]

https://blog.abim.org/call-for-public-comment-pilot-model-pathway-to-board-eligibility-for-exceptionally-qualified-international-medical-graduates/

So I guess Nephrology fellowship will survive after all. Do a fellowship, get your IM cert, and be a hospitalist. I kinda suspect this isn't about the graduates but to keep the sweatshop fellowships full.

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[chessknt]

I left a comment that I am sure will be ignored telling them what I thought about this amazing plan. Hospitals won the noncompete argument and apparently purchased the ABIM to also work for them. Might as well go work at McDonalds at this point.

 

[Señor S]

If I'm understanding correctly "exceptionally qualified" means their fellowship program vouches for them? Seems a bit recursive.

Overall I think it's good for increasing the supply of physicians and bad for people in these specialties, as well as in primary care and hospitalist medicine. Certainly better than the other foreign-grad licensing schemes that are gaining traction.

 

[CCM-MD]

Pick up an unfilled geriatrics spot, get your IM boards and become a hospitalist. Genius. IMGs are going to flock to this. This, in combination with the massive number of NPs is going to be a big win for hospital corporations.

 

[dozitgetchahi]

I figured it wouldn’t take long for the ABIM to sell out on this. I left scathingly negative feedback about it at their site mentioned in the email. We will see if they listen to us.

 

[Prehealth1011]

Curious to see if it'll apply to cardio, GI, onc and pulm crit.

 

[Señor S]

Curious to see if it'll apply to cardio, GI, onc and pulm crit.

Think it applies to all ABIM fellowships? Moot point though; how often do you see non-US trained IMGs matching into those specialties?

 

[gutonc]

Curious to see if it'll apply to cardio, GI, onc and pulm crit.

From the FAQ:
"This pilot program will be available in all ABIM subspecialty disciplines where accredited training is required, regardless of training length. Pilot participants will be subject to all other initial certification eligibility requirements, e.g., licensure requirements and ABIM Board Certification in Internal Medicine prior to application for to the ABIM Subspecialty Certification Examination."

 

[gutonc]

Think it applies to all ABIM fellowships? Moot point though; how often do you see non-US trained IMGs matching into those specialties?

Non-US IMGs who have completed US residency programs? All the time.

 

[Señor S]

Non-US IMGs who have completed US residency programs? All the time.

The non-US trained part I meant meant to refer to those who didn't complete US residencies.

 

[CCM-MD]

Curious to see if it'll apply to cardio, GI, onc and pulm crit.

It will apply to all specialties in policy but not in reality. Because it’s going to be very rare for someone without a US IM residency to match into one of the competitive fields.

 

[Imtocardio]

Curious to see if it'll apply to cardio, GI, onc and pulm crit.

This is just the beginning. Ofc it will in the future. First, get into a one year geriatric or pain/palliative or whatever unfilled 'fellowship' spot that exists. Next get your IM board done. After that I don't see why they wouldn't be able to apply for competitive fellowships in the US. This way they're skipping on the entire residency match process in the US and becoming IM boarded, working as a hospitalist while building up some research and connections to get into competitive fellowships. Win win for IMGs.

Also I think ABIM may make it possible for 'exceptionally qualified' specialists from other countries also eligible to take their specialist boards and work as specialists. GI is not competitive in a lot of countries. Imagine if a GI specialist comes for a 1 year subspecialty (non accredited) fellowship here, gives both IM and GI boards and lo presto, can apply for GI jobs on par with everyone who has suffered here to match into both IM and GI in the first place?

This is only going to get worse. Corporations have bought out ABIM. I wouldn't mind if these guys increased residency or fellowship spots. This exceptional candidate pathway is just nonsense. In a lot countries all you need to get into a residency or fellowship is sit and pass a theory exam. Absolutely NO RESEARCH or LORs needed. Any resident who matched into a competitive specialty here in the US knows the pains they went to get a solid research profile on their CV to match into a competitive specialty. This pathway will just open doors to everyone, non competitive specialties first followed by competitive specialties eventually. Please leave a negative feedback at ABIM website to stop this nonsense

 

[DrMetal]

Can we just get rid of ABIM and all Board Certification then? It's obvious nobody give a **** any more.

 

[Imtocardio]

It will apply to all specialties in policy but not in reality. Because it’s going to be very rare for someone without a US IM residency to match into one of the competitive fields.

They will not match into competitive specialties directly. Let me give an example. Do a one year pain palliative fellowship, give IM boards and apply for hem onc fellowship which will gladly take that candidate over a candidate applying directly after IM residency here

 

[DrMetal]

Riddle me this: was it not once touted that the purpose of ABMS(ABIM) and board certification---which you can only obtain if you completed American training---was to protect us from foreign and mid-level encroachment? Now we have both.

Collectively, we are the dumbest profession. We love to kill each other off.

 

[Ubba]

"ACGME has also created specific criteria to be identified as an “exceptionally qualified candidate.” (See ACGME Common Program Requirements (Fellowship), III.A.1.c). Some of these criteria are named below:

• Evaluation by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty.
  • Graduate Medical Education Committee (GMEC) review and approval of candidates’ exceptional qualifications.
  • Educational Council on Foreign Medical Graduates (ECFMG) certification documentation.
  • Evaluation of performance {in the core competencies} by the Clinical Competency Committee within 12 weeks of matriculation. {Any gaps in competence should be addressed.}

In brief, exceptionally qualified candidates have their international training evaluated by their prospective fellowship program, complete ECFMG credentialing processes and are evaluated early in their fellowship training to determine whether they are on track to achieve the necessary competencies for their discipline, in addition to being formally evaluated on readiness for safe, independent practice and on the six general ACGME competencies."

_________________________________


Unless i'm missing something, it seems like the ABIM defines "exceptionally qualified" as someone who clears the impressive hurdle of... being a mediocre physician.

What the hell?

 

[DrMetal]

"ACGME has also created specific criteria to be identified as an “exceptionally qualified candidate.” (See ACGME Common Program Requirements (Fellowship), III.A.1.c). Some of these criteria are named below:

• Evaluation by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty.
  • Graduate Medical Education Committee (GMEC) review and approval of candidates’ exceptional qualifications.
  • Educational Council on Foreign Medical Graduates (ECFMG) certification documentation.
  • Evaluation of performance {in the core competencies} by the Clinical Competency Committee within 12 weeks of matriculation. {Any gaps in competence should be addressed.}

In brief, exceptionally qualified candidates have their international training evaluated by their prospective fellowship program, complete ECFMG credentialing processes and are evaluated early in their fellowship training to determine whether they are on track to achieve the necessary competencies for their discipline, in addition to being formally evaluated on readiness for safe, independent practice and on the six general ACGME competencies."

_________________________________


Unless i'm missing something, it seems like the ABIM defines "exceptionally qualified" as someone who clears the impressive hurdle of... being a mediocre physician.

What the hell?

My local Country Club has the same criteria for exceptionality. That's why I haven't joined. (that and the the $100K initiation fee, and my > 20 handicap).

 

[bronx43]

Get yours while there's still some gravy in the bowl... we've said this many years, but everyone should have a 5 year plan. None of this will get any better, it'll only get worse.

 

[dozitgetchahi]

Can we just get rid of ABIM and all Board Certification then? It's obvious nobody give a **** any more.

This is probably the best answer. ABIM already screwed the pooch with some of their exams last year (cardiology) to the extent that at least one alternative cardiology specialty board is forming. Probably the best move is to encourage the formation of some other board to replace them.

 

[DrMetal]

Probably the best move is to encourage the formation of some other board to replace them.

Say no more, join NBPAS!:
NBPAS - Providing a Pathway for Continuous Certification

The National Board of Physicians and Surgeons​

Established in 2015, the National Board of Physicians and Surgeons (NBPAS) is a non-profit, physician-led organization which provides a pathway for continuous certification in all of the broadly recognized areas of specialty medical practice. Access the list of specialties NBPAS certifies.

NBPAS is led by a board of unpaid physicians, thought leaders in clinical and academic medicine, and is the only continuing certification board that strictly prohibits the discriminatory practice of time-unlimited "grandfathering".

NBPAS is dedicated to its mission to:

• Support continuous and rigorous lifelong learning, clinical excellence, professionalism, and patient care through evidence-based CME.
• Provide a continuous board certification pathway that is evidence based, specialty specific, and clinically relevant.
• Require learning that is streamlined, less burdensome, and aligned with other requirements to reduce burnout and help keep physicians practicing medicine.
• Provide competition and choice in continuing certification.
• Elevate the practice of medicine over the business of medicine by eliminating obstacles, distractions, and interference, allowing more time for physicians to equitably care for patients.
• Welcome and support qualified physicians through our dedicated team of NBPAS professionals who are here to support you.

Holding specialty and subspecialty certification with NBPAS indicates a physician’s ongoing commitment to continuous learning through a physician-led pathway that is clinically rigorous, evidence-based, less burdensome, and nationally recognized.

The National Board of Physicians and Surgeons meets national accreditation standards for health plans and hospitals including National Committee on Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Det Norske Veritas (DNV), Center for Improvement in Healthcare Quality (CIHQ), Accreditation Commission for Health Care (ACHC) and was named as a “Designated Equivalent Source Agency” by The Joint Commission (TJC).

NBPAS proudly represents physicians in all 50 states, at over 200 hospitals, health systems, telemedicine and insurers.

NBPAS is an independent organization and is NOT affiliated with the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

 

[dozitgetchahi]

Say no more, join NBPAS!:
NBPAS - Providing a Pathway for Continuous Certification

The National Board of Physicians and Surgeons​

Established in 2015, the National Board of Physicians and Surgeons (NBPAS) is a non-profit, physician-led organization which provides a pathway for continuous certification in all of the broadly recognized areas of specialty medical practice. Access the list of specialties NBPAS certifies.

NBPAS is led by a board of unpaid physicians, thought leaders in clinical and academic medicine, and is the only continuing certification board that strictly prohibits the discriminatory practice of time-unlimited "grandfathering".

NBPAS is dedicated to its mission to:

• Support continuous and rigorous lifelong learning, clinical excellence, professionalism, and patient care through evidence-based CME.
• Provide a continuous board certification pathway that is evidence based, specialty specific, and clinically relevant.
• Require learning that is streamlined, less burdensome, and aligned with other requirements to reduce burnout and help keep physicians practicing medicine.
• Provide competition and choice in continuing certification.
• Elevate the practice of medicine over the business of medicine by eliminating obstacles, distractions, and interference, allowing more time for physicians to equitably care for patients.
• Welcome and support qualified physicians through our dedicated team of NBPAS professionals who are here to support you.

Holding specialty and subspecialty certification with NBPAS indicates a physician’s ongoing commitment to continuous learning through a physician-led pathway that is clinically rigorous, evidence-based, less burdensome, and nationally recognized.

The National Board of Physicians and Surgeons meets national accreditation standards for health plans and hospitals including National Committee on Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Det Norske Veritas (DNV), Center for Improvement in Healthcare Quality (CIHQ), Accreditation Commission for Health Care (ACHC) and was named as a “Designated Equivalent Source Agency” by The Joint Commission (TJC).

NBPAS proudly represents physicians in all 50 states, at over 200 hospitals, health systems, telemedicine and insurers.

NBPAS is an independent organization and is NOT affiliated with the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

The problem with them is that they still don’t do initial certification, right? IIRC you have to take the ABIM exam and do all the other ABIM BS first and then you can recertify with these people?

We need an alternative institution that is willing to do the whole process top to bottom…after all, that’s where the ABIM FMG issue lies, as they’re planning to allow these foreign doctors to do an “end run” around the rest of the process. These foreign trained docs would be initially certified by ABIM and then probably would be able to get NBPAS certified too. At least the alternative cardiology boards plan to issue their own exams etc.

Other big alternative: we kill individual state licensure and move to a federal medical license, and then lobby so that the federal license requires US GME training. No “end runs” anymore. Whether you hate or love Trump (I don’t exactly love him), he was at least talking about trying to establish federal medical licensing during the pandemic.

 

[NewYorkDoctors]

The problem with them is that they still don’t do initial certification, right? IIRC you have to take the ABIM exam and do all the other ABIM BS first and then you can recertify with these people?

We need an alternative institution that is willing to do the whole process top to bottom…after all, that’s where the ABIM FMG issue lies, as they’re planning to allow these foreign doctors to do an “end run” around the rest of the process. These foreign trained docs would be initially certified by ABIM and then probably would be able to get NBPAS certified too. At least the alternative cardiology boards plan to issue their own exams etc.

Other big alternative: we kill individual state licensure and move to a federal medical license, and then lobby so that the federal license requires US GME training. No “end runs” anymore. Whether you hate or love Trump (I don’t exactly love him), he was at least talking about trying to establish federal medical licensing during the pandemic.

is it too off topic to say I love Trump as a media personality? He has that the bombastic nature, the **** talker, the hole in one golfer, the WWE hall of famer, the Apprentice "you're fired!" He's a great entertainer! Everyone in the "establishment" loved him before 2015.

do I love MAGA? heck no. i'm not white, not a populist, don't exactly like to see what will happen to the environment after fracking and drilling, atheist (please no jehovah, allah, or satan), serve the underserved immigrant population (both legal and currently illegal) in a poor part of NY, serve many in the LGBTQ crowd... you would think someone like me votes Blue. but the far left communist movement is to ruin this country. but being in NYC where I see all kinds of brain dead single issue far leftist voters ruining this city, I am inclined to say Trump is the "normal moderate pick" especially if RFK endorses him later today

okay politics aside not to get derailed.... I do see how this can help Nephrology a lot lol. now all those unfilled nephrology slots will seem very appealing. Make Nephrology Great Again by ... outsourcing! lol.

The issue with this is if these "Exceptional" physicians can only be allowed to work in the subspecialty they trained in then this would be a lot more palatable. No "backdoor" into IM from Nephrology or Geriatrics then doing cardiology or GI later. usually the older age and "time constraints" of these "exceptional" physicians may preclude trying to do so much training though

 

[DrMetal]

The problem with them is that they still don’t do initial certification, right? IIRC you have to take the ABIM exam and do all the other ABIM BS first and then you can recertify with these people?

Correct. Yes, you have still have to do iBC (initial BC) with ABMS. But at least you'll be done with it, only do MOC via NBPAS. NBPAS is grass roots, getting more recognition and gaining more acceptance. I'd highly advise everyone to look into and consider it.

We need an alternative institution that is willing to do the whole process top to bottom…

Fundamentally I agree with you. I propose getting rid of 'Board Certification' altogether. It's a fictious credential that we physicians made up, b/c we weren't happy with just finishing a residency/fellowship.

And if you argue back to me that we need a 'test' to confirm you learned something in training, I'd argue that said test should be run by the ACGME and a part of the actual training period (you pass, your graduate, don't pass, need to remediate). IF you pass and graduate, that's it, you're done, go practice.

At heart, 'board certification' is meaningless (as evidenced by the discussion here, since we seem to be finding ways around it).

 

[Imtocardio]

is it too off topic to say I love Trump as a media personality? He has that the bombastic nature, the **** talker, the hole in one golfer, the WWE hall of famer, the Apprentice "you're fired!" He's a great entertainer! Everyone in the "establishment" loved him before 2015.

do I love MAGA? heck no. i'm not white, not a populist, don't exactly like to see what will happen to the environment after fracking and drilling, atheist (please no jehovah, allah, or satan), serve the underserved immigrant population (both legal and currently illegal) in a poor part of NY, serve many in the LGBTQ crowd... you would think someone like me votes Blue. but the far left communist movement is to ruin this country. but being in NYC where I see all kinds of brain dead single issue far leftist voters ruining this city, I am inclined to say Trump is the "normal moderate pick" especially if RFK endorses him later today

okay politics aside not to get derailed.... I do see how this can help Nephrology a lot lol. now all those unfilled nephrology slots will seem very appealing. Make Nephrology Great Again by ... outsourcing! lol.

The issue with this is if these "Exceptional" physicians can only be allowed to work in the subspecialty they trained in then this would be a lot more palatable. No "backdoor" into IM from Nephrology or Geriatrics then doing cardiology or GI later. usually the older age and "time constraints" of these "exceptional" physicians may preclude trying to do so much training though

Age isn't an issue for these exceptional physicians. Remember, IMGs in many countries go to med school directly out of high school. The average age of an IM graduate in India is 26-27, they can easily backdoor into a competitive specialty after sacrificing a year or two in a mediocre fellowship here instead of having to repeat IM residency here all over again.

 

[NewYorkDoctors]

Age isn't an issue for these exceptional physicians. Remember, IMGs in many countries go to med school directly out of high school. The average age of an IM graduate in India is 26-27, they can easily backdoor into a competitive specialty after sacrificing a year or two in a mediocre fellowship here instead of having to repeat IM residency here all over again.

though how "exceptional" can any physician AMG or IMG be at age 26-27?

yes I know these criteria for "exceptional" seem to be bare bones. but a truly exceptional (shall we say aspirational) physiican is someone who has a done a lot of real research, has had at least a decade of clinical experience... then those doctors are proabbly nearing 40 and may not want to do all that training again.... but that's just my view on things. I understand these criteria proposed seem to be bare bones and designed to drive up the physician supply and allow hospital employers to negotiate lower salaries.

this is the impetus for the economic migrant situation after all . more corporate greed.

my advice join a physician IPA if the opportunity arises. you might not need to do full outpatient private practice. but there is power in numbers as they say

 

[Señor S]

I don't think this will function as a big back door into specialties like cardiology. The IMGs who take these unfilled spots in ID etc are the ones who couldn't match into residency in the US; a year or two in some uncompetitive fellowship program followed by a few years as a hospitalist aren't going to magically make up for whatever defects prevented them from getting an IM slot in the first place.

 

[dozitgetchahi]

though how "exceptional" can any physician AMG or IMG be at age 26-27?

yes I know these criteria for "exceptional" seem to be bare bones. but a truly exceptional (shall we say aspirational) physiican is someone who has a done a lot of real research, has had at least a decade of clinical experience... then those doctors are proabbly nearing 40 and may not want to do all that training again.... but that's just my view on things. I understand these criteria proposed seem to be bare bones and designed to drive up the physician supply and allow hospital employers to negotiate lower salaries.

this is the impetus for the economic migrant situation after all . more corporate greed.

my advice join a physician IPA if the opportunity arises. you might not need to do full outpatient private practice. but there is power in numbers as they say

Yeah exactly.

“Exceptional physician” should be reserved for international experts with a solid research pedigree and a good reputation within a certain niche of medicine. That was the original purpose of that “shortcut”. Not just any random doctor trying to get in the back door to American medicine.

 

[dozitgetchahi]

I don't think this will function as a big back door into specialties like cardiology. The IMGs who take these unfilled spots in ID etc are the ones who couldn't match into residency in the US; a year or two in some uncompetitive fellowship program followed by a few years as a hospitalist aren't going to magically make up for whatever defects prevented them from getting an IM slot in the first place.

I agree.

What this will do, however, is saturate the market for hospitalists and PCPs etc. (Which is maybe what the original intent was.)

 

[NewYorkDoctors]

I agree.

What this will do, however, is saturate the market for hospitalists and PCPs etc. (Which is maybe what the original intent was.)

I can see hospitalist salaries going further down for sure. that might be the intent of many of these greedy hospital corporations.

outpatient primary care is already getting encroachment by midlevels... though perhaps an expanding pool of IMG / FMG PCPS in rural areas can "take back" those jobs from the midlevels. shrugs.

 

[Imtocardio]

I don't think this will function as a big back door into specialties like cardiology. The IMGs who take these unfilled spots in ID etc are the ones who couldn't match into residency in the US; a year or two in some uncompetitive fellowship program followed by a few years as a hospitalist aren't going to magically make up for whatever defects prevented them from getting an IM slot in the first place.

They should be able to build connections during their fellowship and match into competitive specialties. Connections are a big deal in competitive fellowships.

 

[NewYorkDoctors]

They should be able to build connections during their fellowship and match into competitive specialties. Connections are a big deal in competitive fellowships.

right an ambitious enough doctor who has no student debt, nothing to lose and everything to gain can indeed go trhough this path and become a Nephrologist => Cardiac Imaging 1 year fellowship or CHF 1 year (do those still exist as one year standalone? citing love for aquapheresis and wanting to do some cardionephrology research then eventually wind up in Cards fellowship then go all out for for IC or EP.

usually what stops AMGs from doing this much training (usually) is student debt and desire to settle down and have a family. '

but if no student debt and if one alreayd has a family with older kids, then why not go for broke?

 

[dozitgetchahi]

They should be able to build connections during their fellowship and match into competitive specialties. Connections are a big deal in competitive fellowships.

Not that big a deal.

I don’t see how this is going to be much of a threat for the competitive fellowships. Those fellowships generally want to select residents with good pedigrees, good research, yadda yadda. There may be a few of these FMGs who match because of these back door connections etc, but not enough to move the needle on the current match dynamics.

 

[NewYorkDoctors]

well at the very least Nephrology is no longer dead lol. even if the goal was to become a hospitalist, if someone had to choose between 2 years of renal or 1 year of palliative/geriatrics or 2 years of ID it is possible some might choose Nephrology because it is "more involved with other organ systems" or something.

Too be Renal Prometheus is no longer with us.... under that username anyway...

 

[kaycee18]

Is it possible to create an organization to hire lawyers and sue the ABIM? Most physicians do not seem worried but this is a terrible slippy slope. I have not even made enough money to survive and now, my livelihood is at risk. Would doing endocrinology help to protect one against what is coming?

 

[dozitgetchahi]

Is it possible to create an organization to hire lawyers and sue the ABIM? Most physicians do not seem worried but this is a terrible slippy slope. I have not even made enough money to survive and now, my livelihood is at risk. Would doing endocrinology help to protect one against what is coming?

Certainly, one could try.

I would support any collective effort from American physicians to try to change the direction of where things are going and push back against this ABIM BS, midlevels, admin encroachment, etc etc. Take our profession and dignity back. Hell, I’d even lead it.

 

[Mehena]

Is it possible to create an organization to hire lawyers and sue the ABIM? Most physicians do not seem worried but this is a terrible slippy slope. I have not even made enough money to survive and now, my livelihood is at risk. Would doing endocrinology help to protect one against what is coming?

I am very much against these types of schemes. Last year, the ABIM for oncology and hematology started rolling out similar initiatives, and I was furious. I'm not xenophobic, and I couldn't be, as I too am a first-generation immigrant from very humble beginnings. However, my entire undergraduate and graduate medical training took place in the USA (achieving the American dream through blood and sweat). Now, that dream feels threatened.

The only crumbs of comfort we have as internal medicine doctors are the immigration bottlenecks. Regardless of ABIM's actions, the American immigration process is so bureaucratic that it would take several years before such measures significantly affect us (Talent is scarce. Yet many countries spurn it). However, I feel sorry for future medical students. So, make hay while the sun shines.

I don't think the American Surgical Society or any other specialty society would throw such garbage at their members. They appear to be more vocal, and a higher percentage of their members are AMGs.

 

[voxveritatisetlucis]

Physicians who propose these stupid rules are nothing more than sell outs

Started with allowing FMGs without residency to practice in states like Florida and Virginia. How the next step is board cert. lol at people who thought that their specialty boards would “protect” them lmao

 

[kaycee18]

Certainly, one could try.

I would support any collective effort from American physicians to try to change the direction of where things are going and push back against this ABIM BS, midlevels, admin encroachment, etc etc. Take our profession and dignity back. Hell, I’d even lead it.

I think midlevels could actually help us in this fight seeing as this would affect them too. Maybe one fight at a time. Any suggestions on how we can initiate some defense against this? I still have a lot of student loans and I cannot afford to start training for a new career.

 

[CCM-MD]

A few people I talked to are delusional and think this is great, “rather have docs than midlevels”. Pretty sure the public comment period is a formality and this is here to stay.

 

[voxveritatisetlucis]

I think midlevels could actually help us in this fight seeing as this would affect them too. Maybe one fight at a time. Any suggestions on how we can initiate some defense against this? I still have a lot of student loans and I cannot afford to start training for a new career.

Maybe if enough people negatively comment they’ll not do it. Post on med school residency medicine subreddits. I can’t I’m banned

A few people I talked to are delusional and think this is great, “rather have docs than midlevels”. Pretty sure the public comment period is a formality and this is here to stay.

They probably have trust funds and don’t worry about salary

 

[Imtocardio]

A few people I talked to are delusional and think this is great, “rather have docs than midlevels”. Pretty sure the public comment period is a formality and this is here to stay.

Doctors rather than mid-levels? Yes I'm all for it too. Doctors who actually came in through the residency route, not someone who backdoored into IM through a non competitive specialty.

The problem with this thought process is this. An IMG from a third world country usually doesn't have much of student loans and graduates much earlier from residency as compared to a US graduate (or a US IMG from a Caribbean school). They wouldn't mind going through this route to gain access to the US job market. And a board certified physician will be considered equal to an AMG for all hiring purposes (anyone from a country other than India or China can easily get a green card within a year or two of working here on an H1B work visa, so the argument of visa status doesn't stand here). If a hiring manager has an AMG who is demanding $300k as a hospitalist vs an IMG who is willing to work for $150k (and is also board certified), who will the hiring manager hire? Mid-levels may have infiltrated the profession but they're not a direct threat to a PHYSICIAN's job as much as another equally qualified physician who is willing to work for half your salary.

 

[Ubba]

I'd bet that this is the scheme:

1. Powerful interests, likely governmental ones looking for easy targets to trim to give more slack to burgeoning debt, have sighted doctors and have us in the crosshairs. They know MDs don't have the temperaments, by and large, to do much but grumble and take it. ABIM has received the message loud and clear.

2. Influx of thousands of doctors from around the world who would live better lives in the US if they were making 90k/year. These doctors drive down the market value of all physicians in these specialties. This serves as an excuse for the government/insurance companies to drive down the "value" of all the other specialties across medicine, from Ortho to FM to Derm, to bring compensation "in line."

3. Not only do smart US students begin to avoid medicine like the plague, but those of us who are in the relative beginnings or middles of our careers will see precipitous decline in the ratio of pay:work.

4. Complete addiction to perpetual importation of healthcare providers from second- and third-world countries. See NHS.

5. "Outsourcing" complete. Field of medicine ruined for the sharpest American students for generations.

This is really serious. Must be nipped in the bud immediately.

 

[voxveritatisetlucis]

I'd bet that this is the scheme:

1. Powerful interests, likely governmental ones looking for easy targets to trim to give more slack to burgeoning debt, have sighted doctors and have us in the crosshairs. They know MDs don't have the temperaments, by and large, to do much but grumble and take it. ABIM has received the message loud and clear.

2. Influx of thousands of doctors from around the world who would live better lives in the US if they were making 90k/year. These doctors drive down the market value of all physicians in these specialties. This serves as an excuse for the government/insurance companies to drive down the "value" of all the other specialties across medicine, from Ortho to FM to Derm, to bring compensation "in line."

3. Not only do smart US students begin to avoid medicine like the plague, but those of us who are in the relative beginnings or middles of our careers will see precipitous decline in the ratio of pay:work.

4. Complete addiction to perpetual importation of healthcare providers from second- and third-world countries. See NHS.

5. "Outsourcing" complete. Field of medicine ruined for the sharpest American students for generations.

This is really serious. Must be nipped in the bud immediately.

Exactly. Anybody who willingly goes into 500k debt for medical school these days must be clinically insane. At least older students residents attending didn’t know about these crazy proposals when they started

 

[Imtocardio]

I'd bet that this is the scheme:

1. Powerful interests, likely governmental ones looking for easy targets to trim to give more slack to burgeoning debt, have sighted doctors and have us in the crosshairs. They know MDs don't have the temperaments, by and large, to do much but grumble and take it. ABIM has received the message loud and clear.

2. Influx of thousands of doctors from around the world who would live better lives in the US if they were making 90k/year. These doctors drive down the market value of all physicians in these specialties. This serves as an excuse for the government/insurance companies to drive down the "value" of all the other specialties across medicine, from Ortho to FM to Derm, to bring compensation "in line."

3. Not only do smart US students begin to avoid medicine like the plague, but those of us who are in the relative beginnings or middles of our careers will see precipitous decline in the ratio of pay:work.

4. Complete addiction to perpetual importation of healthcare providers from second- and third-world countries. See NHS.

5. "Outsourcing" complete. Field of medicine ruined for the sharpest American students for generations.

This is really serious. Must be nipped in the bud immediately.

I agree with all of this. This is the biggest fear. A similar outsourcing happened in IT and look at how the job market is for Americans graduating in that field these days. A lot of IT jobs are outsourced to third-world countries where people are happy to work for 1/4th of the salary [as the dollar goes a long way in those countries due to geographical arbitage] and forums are filled with stories about how Americans have had to train their replacements shortly after demanding a pay increase.

The NHS made the same mistake by importing physicians across the globe [instead of training medical students themselves] and have not benefited as much as they thought they would. The reason behind having an IMG train in the US in residency is to expose them to the pattern of thinking and culture here [which is crucial as many third world countries do not have different ethnicities whom they treat during their residency training] in addition to commonly used protocols in IM [and no passing an IM boards doesn't cut it]. Fellowship training for a year or two will simply not cut it. If ABIM is hell-bent on passing this rule, they can do it provided these graduates are restricted to practicing only in the fellowship discipline they came to train in. Not to backdoor into a hospitalist job or apply into a competitive specialty [and abandon the specialty they used to backdoor in the first place]. Using this as a backdoor to IM or another competitive specialty completely defeats the purpose of bringing an IMG to fill a fellowship spot in the first place. If an IMG is allowed to bypass US residency training or observerships to come train in nephrology, they better stay and work in nephrology, not backdoor into IM or card/PCCM/GI after a couple of years and ruin the job market for other IMGs who have gone through two matches [residency and fellowship] to gain an opportunity to train in that competitive specialty in the first place. AMGs will also be equally hit when the job market starts to worsen with this influx of physicians. We underestimate the number of physicians countries across the globe produce on a yearly basis and to what extent people would go to come to the US [mostly for the physician salary>>training, which is evident as the US is the No. 1 destination for IMGs still].

If ABIM has multiple specialties [nephro/ID/palliative/geriatrics] that remain unfilled, then they probably don't need all those spots in the first place! They should shut down those programs [PDs of those programs can go find jobs elsewhere] and decrease supply for a few years till demand increases. This will drive up the salaries of these specialties and gradually more candidates would be willing to apply to them in the years to come. Bringing in IMGs to fill these sweatshop spots is simply not the answer. When the Tennessee bill to allow IMGs to bypass the residency match [if they worked as hospitalists for 2 years under "supervision"] came out, a lot of people argued that they would not be allowed to sit for ABIM boards [despite getting an unrestricted license]. Look at how swiftly ABIM has opened a pilot pathway to enable people to sit for boards without residency training! Currently, almost 10 states have approved laws similar to Tennessee. And this is not restricted to primary specialties as everyone thinks. Lucrative specialties will also take a hit soon. We have to join together to convey our opposition to ABIM regarding this pathway.

 

[voxveritatisetlucis]

bought out by HCA. Stock at all time highs for a reason!

Don’t be surprised when many of these Abim leaders get board positions and stock compensation

I guess an alternative would be to vote for new leadership but I doubt most members are active

 

[dozitgetchahi]

I agree with all of this. This is the biggest fear. A similar outsourcing happened in IT and look at how the job market is for Americans graduating in that field these days. A lot of IT jobs are outsourced to third-world countries where people are happy to work for 1/4th of the salary [as the dollar goes a long way in those countries due to geographical arbitage] and forums are filled with stories about how Americans have had to train their replacements shortly after demanding a pay increase.

The NHS made the same mistake by importing physicians across the globe [instead of training medical students themselves] and have not benefited as much as they thought they would. The reason behind having an IMG train in the US in residency is to expose them to the pattern of thinking and culture here [which is crucial as many third world countries do not have different ethnicities whom they treat during their residency training] in addition to commonly used protocols in IM [and no passing an IM boards doesn't cut it]. Fellowship training for a year or two will simply not cut it. If ABIM is hell-bent on passing this rule, they can do it provided these graduates are restricted to practicing only in the fellowship discipline they came to train in. Not to backdoor into a hospitalist job or apply into a competitive specialty [and abandon the specialty they used to backdoor in the first place]. Using this as a backdoor to IM or another competitive specialty completely defeats the purpose of bringing an IMG to fill a fellowship spot in the first place. If an IMG is allowed to bypass US residency training or observerships to come train in nephrology, they better stay and work in nephrology, not backdoor into IM or card/PCCM/GI after a couple of years and ruin the job market for other IMGs who have gone through two matches [residency and fellowship] to gain an opportunity to train in that competitive specialty in the first place. AMGs will also be equally hit when the job market starts to worsen with this influx of physicians. We underestimate the number of physicians countries across the globe produce on a yearly basis and to what extent people would go to come to the US [mostly for the physician salary>>training, which is evident as the US is the No. 1 destination for IMGs still].

If ABIM has multiple specialties [nephro/ID/palliative/geriatrics] that remain unfilled, then they probably don't need all those spots in the first place! They should shut down those programs [PDs of those programs can go find jobs elsewhere] and decrease supply for a few years till demand increases. This will drive up the salaries of these specialties and gradually more candidates would be willing to apply to them in the years to come. Bringing in IMGs to fill these sweatshop spots is simply not the answer. When the Tennessee bill to allow IMGs to bypass the residency match [if they worked as hospitalists for 2 years under "supervision"] came out, a lot of people argued that they would not be allowed to sit for ABIM boards [despite getting an unrestricted license]. Look at how swiftly ABIM has opened a pilot pathway to enable people to sit for boards without residency training! Currently, almost 10 states have approved laws similar to Tennessee. And this is not restricted to primary specialties as everyone thinks. Lucrative specialties will also take a hit soon. We have to join together to convey our opposition to ABIM regarding this pathway.

First step is for anyone reading this to check their email and leave the same negative feedback to ABIM that they’re leaving here.

From there, next step is to figure out how to band together and 1) defend the profession and 2) figure out an alternative to ABIM.

ABIM was already a very questionable institution, but they have truly jumped the shark on this one. ABIM needs to go.

 

[voxveritatisetlucis]

First step is for anyone reading this to check their email and leave the same negative feedback to ABIM that they’re leaving here.

From there, next step is to figure out how to band together and 1) defend the profession and 2) figure out an alternative to ABIM.

ABIM was already a very questionable institution, but they have truly jumped the shark on this one. ABIM needs to go.

Need to post on Reddit. I tried to make an alt account on Reddit but the moderators of r/residency don’t seem to allow any discussion of FMGs anymore. I wonder if they’re even doctors. Granted might be the fact that my account was previously banned on there

Also
r/hospitalist
r/familymedicine
r/medicalschool
r/medicine

Might be good

 

[dozitgetchahi]

Need to post on Reddit. I tried to make an alt account on Reddit but the kuck moderators of r/residency don’t seem to allow any discussion of FMGs anymore. I wonder if they’re even doctors. Granted might be the fact that my account was previously banned on there

Also
r/hospitalist
r/familymedicine
r/medicalschool
r/medicine

Might be good

FB Physician Community also. I used to be a member but my FB account got hacked and locked out a couple years ago and I had to start over with a new FB page. The physician community admin doesn’t seem to believe that my new account really is me.

 

[Gastrapathy]

There is no "voting" for ABIM leadership. This is a private organization for which there is no accountability or oversight.

 

[PhoenixRS]

I failed my initial ABIM certification exam these past two years. Each time I scored barely below the passing cutoff. I am going to leave clinical medicine before my board eligibility expires. I am sick of these tests telling me I am not good enough despite never having failed a licensing exam.

Test is offered once a year. Can’t keep putting my life on hold until I pass this exam. Can’t make any big life decisions until I know I will have a job for 10 years (until the recertification).

Thanks ABIM for adding to my mental stress/depression and forcing me out of clinical medicine.

Good luck with the PAs, NPs, non-US trained doctors working and seeing patients.