IMG ABIM pilot

[dozitgetchahi]

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.

The noncompete argument isn’t done yet. That will get appealed. If the Supreme Court knocks it down, legislation will be an option to get that fixed.

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

No kidding. But you can band together to 1) pressure them to do or not do things (witness the backlash against ABIM MOC, and how things changed when enough doctors pushed back against it) and 2) convince other institutions to not use the ABIM as the certification board.

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[DrMetal]

The noncompete argument isn’t done yet. That will get appealed. If the Supreme Court knocks it down, legislation will be an option to get that fixed.



No kidding. But you can band together to 1) pressure them to do or not do things (witness the backlash against ABIM MOC, and how things changed when enough doctors pushed back against it) and 2) convince other institutions to not use the ABIM as the certification board.

I'm telling ya', you're preaching to the choir of NBPAS.

You should all look into it (yes it requires initial ABIM, yes it's another 'board'): but it's a good alternative. If it picks up some traction (and it seems like it is), it could be what we're looking for . . .

 

[randomhemoncpd]

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

Not our hem/onc fellowship, and I hope (but can't assume) that PD's are savvy enough that of all the red flags, not doing a U.S. IM residency is the reddest.

 

[IM_to_ortho_hopeful]

Not our hem/onc fellowship, and I hope (but can't assume) that PD's are savvy enough that of all the red flags, not doing a U.S. IM residency is the reddest.

subspecialty fellowships seem safe. Even if IMG --> nephro (skip IM) --> heme onc were possible, there are still the same number of BE/BC oncologists being produced every year, so virtually no effect on job market. Hospitalist/PCP on the other hand is ****ed

 

[dozitgetchahi]

subspecialty fellowships seem safe. Even if IMG --> nephro (skip IM) --> heme onc were possible, there are still the same number of BE/BC oncologists being produced every year, so virtually no effect on job market. Hospitalist/PCP on the other hand is ****ed

Completely agree.

What this will do initially is make competitive AMGs want the competitive fellowships even more. Which will make competition there more brutal than it already is.

 

[chessknt]

subspecialty fellowships seem safe. Even if IMG --> nephro (skip IM) --> heme onc were possible, there are still the same number of BE/BC oncologists being produced every year, so virtually no effect on job market. Hospitalist/PCP on the other hand is ****ed

I think that is short-sighted. What would stop the ABIM from then extending exceptional certification to foreign oncologists/gastroenterologists/cardiologists who can just skip fellowship training and go immediately in to practice? After all they already have the procedures under their belts.

 

[gutonc]

I think that is short-sighted. What would stop the ABIM from then extending exceptional certification to foreign oncologists/gastroenterologists/cardiologists who can just skip fellowship training and go immediately in to practice? After all they already have the procedures under their belts.

State licensing requirements are the current guardrail to this being an issue. But who knows how long that will hold up.

 

[Imtocardio]

I think that is short-sighted. What would stop the ABIM from then extending exceptional certification to foreign oncologists/gastroenterologists/cardiologists who can just skip fellowship training and go immediately in to practice? After all they already have the procedures under their belts.

This is exactly what's going to happen next. They'll make them do a year of peer to peer supervised practice and let them become board eligible to "fill" specialist shortage.

 

[Imtocardio]

State licensing requirements are the current guardrail to this being an issue. But who knows how long that will hold up.

State licensing won't be an issue for board certified candidates

 

[gutonc]

State licensing won't be an issue for board certified candidates

ATM, most state licensing laws require a certain number of years of post-grad training, not BC, for licensing. I agree that things may change, but at least for now, that's the case.

 

[CCM-MD]

I think that is short-sighted. What would stop the ABIM from then extending exceptional certification to foreign oncologists/gastroenterologists/cardiologists who can just skip fellowship training and go immediately in to practice? After all they already have the procedures under their belts.

Do 2 years of IM and we’ll let you skip fellowship and take both IM and subspecialty boards. This bypasses the state licensing GME requirements. All kinds of future possibilities.

 

[Ubba]

The bottom line is that anything that can occur in our worst nightmares it already a glint in the eyes of admins/the government.

It's sad that I already feel that I can't, in good conscience, recommend med school to any of my kids. Let's at least try to save our careers here.

Don't give them an inch!

 

[dozitgetchahi]

ATM, most state licensing laws require a certain number of years of post-grad training, not BC, for licensing. I agree that things may change, but at least for now, that's the case.

The biggest thing we need to do is lobby state governments…and the federal government, for that matter.

 

[LoudBark]

Ok, did everyone fill out the ABIM survey and let the corrupt machine there get a piece of our mind? Please, please do if you have not done it yet.

 

[IM_to_ortho_hopeful]

I think that is short-sighted. What would stop the ABIM from then extending exceptional certification to foreign oncologists/gastroenterologists/cardiologists who can just skip fellowship training and go immediately in to practice? After all they already have the procedures under their belts.

I just need 5.75 more years of this to hit my coastfire numbers, so as long as the US government restrains immigration until then I feel relatively safe but lets see how the politics play out

 

[Imtocardio]

Do 2 years of IM and we’ll let you skip fellowship and take both IM and subspecialty boards. This bypasses the state licensing GME requirements. All kinds of future possibilities.

That seems to be the plan in the long run

 

[NewYorkDoctors]

if the goal is to recruit foreign doctors (I am not Caucasian FYI) to help out with underserved rural areas then that's fine. but comon let's be real now. most foreign doctors from other countries usually want to be somewhat near an urban center by their own culture. This plan may not lead to the pipeline of doctors going to underserved areas persay.

It will just further wreck hospitalist medicine in the urban areas. Then eventually salaries will be so low the hospital administrators (parasites) will hire NPs to be hospitalists in the future. Panconsults for all!

All the more reason why anyone who does Internal Medicine should get some subspecialty. You can always be a hospitalist as a subspecialist. You cannot do subspecialty without a fellowship. If opportunity cost is an issue precluding too much training , then should have done another specialty that is not subject to encroachment. Heck even FM might have more security since FM gets some additional PCP training such as some OBGYN, some peds, some psych, some dermpath, some sports medicine injections, a mishmash of this and that that most IM PCPs do not get. Anyway just my two cents. Hope I'm wrong.

 

[MD46]

I would say if they want to hire foriegn doctors via this pathway, it needs to be modified.

Always keep the license restricted to assistant physician license that requires supervision by Board Certified MD and allow practice in rural/under served areas only. No path to any other fellowship like CC, Cards, HO etc

They will likely do a better job than a mid level in that capacity.

I have a friend who works with an assistant physian (not Physician assistant) in Missouri. The AP, does a real good job and makes like 150k a year.

 

[Ubba]

if the goal is to recruit foreign doctors (I am not Caucasian FYI) to help out with underserved rural areas then that's fine. but comon let's be real now. most foreign doctors from other countries usually want to be somewhat near an urban center by their own culture. This plan may not lead to the pipeline of doctors going to underserved areas persay.

It will just further wreck hospitalist medicine in the urban areas. Then eventually salaries will be so low the hospital administrators (parasites) will hire NPs to be hospitalists in the future. Panconsults for all!

All the more reason why anyone who does Internal Medicine should get some subspecialty. You can always be a hospitalist as a subspecialist. You cannot do subspecialty without a fellowship. If opportunity cost is an issue precluding too much training , then should have done another specialty that is not subject to encroachment. Heck even FM might have more security since FM gets some additional PCP training such as some OBGYN, some peds, some psych, some dermpath, some sports medicine injections, a mishmash of this and that that most IM PCPs do not get. Anyway just my two cents. Hope I'm wrong.

There is no way the ramifications are limited to LA and NYC hospitalists. It would tank the entire physician market, every specialty.

 

[NewYorkDoctors]

There is no way the ramifications are limited to LA and NYC hospitalists. It would tank the entire physician market, every specialty.

right though it'll probably start there first of course where the supply is already fairly high and physician salaries are already somewhat low compared to the rest of the country

still subspecialists with skillsets that cannot be easily procured or access to certain procedures will still be in demand.

any physicians who have the ability to go independent of the hospital system should do so.

 

[dozitgetchahi]

right though it'll probably start there first of course where the supply is already fairly high and physician salaries are already somewhat low compared to the rest of the country

still subspecialists with skillsets that cannot be easily procured or access to certain procedures will still be in demand.

any physicians who have the ability to go independent of the hospital system should do so.

Never been happier to be in PP and not rounding at the hospital. But even that is not going to protect against a massive influx of new doctors in the market.

 

[NewYorkDoctors]

here in new york city, anyone (US citizen, legal immigrant or illegal border crossers) get FREE MANAGED MEDICAID if theyr income is low enough (through a company Healthfirst or metroplus - local insurances). I see a lot of these patients. OMFG this insurance is like cadillac insurance. virtually everything is covered (barring some name brands). zero copay zero deductible zero limits on visits. it's basically free government paid for concierge service.

people from other countries with severe asthma - Fasenra nucala tezpisre no issues no barriers easy prior auth FREE
people with pulmonary fibrosis - ofev - FREE
patients with post TB bronchiectasis - everything i do DME and med wise - FREE
patients with CF - the CFTR modulators - FREE

while I benefit from this and get paid nicely, I know this is unsustainable and the golden goose is going to croak sooner than later. this is also why I don't run for political office as I would be a massive hypocrite.

hence NYC and LA gonna bankrupt first


addendum: the only thing comparable I can think of is this Aetna Open Choice POS II plan I have. I pay quite a high premium a year. But after reaching the deductible of $3200 and out of pocket max of merely $6400, everything becomes "free" after that. only difference is these managed medicaids are zero out of pocket costs and zero deductibles.

 

[NewYorkDoctors]

in New York State anyone with straight Medicaid or managed Medicaid follows this formulary

Medicaid Member Portal

member.emedny.org

prior auths are dirty easy and always instant approval for the most part.

if you played around you'll see so many things are covered no questions asked and no copay for these patients

 

[dozitgetchahi]

here in new york city, anyone (US citizen, legal immigrant or illegal border crossers) get FREE MANAGED MEDICAID if theyr income is low enough (through a company Healthfirst or metroplus - local insurances). I see a lot of these patients. OMFG this insurance is like cadillac insurance. virtually everything is covered (barring some name brands). zero copay zero deductible zero limits on visits. it's basically free government paid for concierge service.

people from other countries with severe asthma - Fasenra nucala tezpisre no issues no barriers easy prior auth FREE
people with pulmonary fibrosis - ofev - FREE
patients with post TB bronchiectasis - everything i do DME and med wise - FREE
patients with CF - the CFTR modulators - FREE

while I benefit from this and get paid nicely, I know this is unsustainable and the golden goose is going to croak sooner than later. this is also why I don't run for political office as I would be a massive hypocrite.

hence NYC and LA gonna bankrupt first


addendum: the only thing comparable I can think of is this Aetna Open Choice POS II plan I have. I pay quite a high premium a year. But after reaching the deductible of $3200 and out of pocket max of merely $6400, everything becomes "free" after that. only difference is these managed medicaids are zero out of pocket costs and zero deductibles.

Meanwhile, when I worked in Alabama…

Medicaid patients were limited to a grand total of 18 doctor visits per year…not just for one doctor, for ALL doctors seeing the patient. Sick patients who saw a number of doctors would run out of available visits halfway through the year, and just stop coming to doctors after that. They were also limited to no more than 5 total prescriptions per month. Coverage for biologics? Lmao.

As compared to what you’re describing, my current healthcare coverage (and my coverage as a fellow) was/is 100% free if you get care within the system. As a fellow, this was great as it was within a huge academic health system, and you didn’t have to get healthcare from your colleagues etc…however, now my family has to get healthcare in a large multispecialty private practice of about 100 providers, which has been…interesting at times. We actually have a DPC that we use for the vast majority of our healthcare, mostly because we don’t want to have all of our health history broadly known among coworkers and colleagues…

 

[NewYorkDoctors]

Meanwhile, when I worked in Alabama…

Medicaid patients were limited to a grand total of 18 doctor visits per year…not just for one doctor, for ALL doctors seeing the patient. Sick patients who saw a number of doctors would run out of available visits halfway through the year, and just stop coming to doctors after that. They were also limited to no more than 5 total prescriptions per month. Coverage for biologics? Lmao.

As compared to what you’re describing, my current healthcare coverage (and my coverage as a fellow) was/is 100% free if you get care within the system. As a fellow, this was great as it was within a huge academic health system, and you didn’t have to get healthcare from your colleagues etc…however, now my family has to get healthcare in a large multispecialty private practice of about 100 providers, which has been…interesting at times. We actually have a DPC that we use for the vast majority of our healthcare, mostly because we don’t want to have all of our health history broadly known among coworkers and colleagues…

meh I just manage my own health. yes you're technically not suppose to do this. but that conflict arises for two reasons

1) nonchalance and not following every lead for yourself or your family and missing diagnoses
2) for difficult cases with diagnostic dilemmas and no clear management protocol, this might become more difficult and lead to choices based on emotion and not logic

my counter
1) pursue everything within reason for myself. i'll pursue everything reasonable and not over-irradiate onself. but I'm not doing stupid things like using "tumor markers" for lungs screening that have weak or no evidence for. my thought is well I need to stay alive as long as possible to keep squeezing this golden goose. hence im big on fitness. I love RFK Jr's MAHA movement now.

2) I am just doing routine primary care for myself and family who are healthy. what diagnostic dilemma is there? hmm shall I order a differential with this CBC or skip? hmm the father in law with well controlled DM has been eating more carbs than usual should I add on a fructosamine to check 3 week status? hmmm oh the dilemmas and moral quandries! in a prior era in which not everything was as protocolized as it is now, I can see how it was best now to manage yourself or your family. but with so many EBM protocols, it's jsut following a cookbook for common issues. want a yummy cake? follow the recipe to every single step diligently

anyway straight Medicaid and managed medicaid was fairly restrictive in NYS as well (same limitations applied as you cite about) from 2016 to 2020.... then 2020 onward.... omfg.... you know why they are doing it..


anyway I treat all my patients US citizens, green card permanent resident, illegal immigrants / non-documented / migrants the same way with the best medical care and dignity and respect. I go all out for them and them what they need to get their disease better. I just do not think this "socialist utopia" is going to work long term

now if it were like Star Trek with the unlimited energy production of those dilithium crystals, more planets to inhabit, a United Federation of Planets ,etc.... then a socialist utopia could work and would be quite cool and I would be in favor. But that requires A) a far higher resource load than that is currently on planet Earth and B) outside hostile alien forces like the Klingons, the Romulans, the Dominion, the Borg etc... to unite the human population. so yeah... the realm of science fiction....

 

[dozitgetchahi]

meh I just manage my own health. yes you're technically not suppose to do this. but that conflict arises for two reasons

1) nonchalance and not following every lead for yourself or your family and missing diagnoses
2) for difficult cases with diagnostic dilemmas and no clear management protocol, this might become more difficult and lead to choices based on emotion and not logic

my counter
1) pursue everything within reason for myself. i'll pursue everything reasonable and not over-irradiate onself. but I'm not doing stupid things like using "tumor markers" for lungs screening that have weak or no evidence for. my thought is well I need to stay alive as long as possible to keep squeezing this golden goose. hence im big on fitness. I love RFK Jr's MAHA movement now.

2) I am just doing routine primary care for myself and family who are healthy. what diagnostic dilemma is there? hmm shall I order a differential with this CBC or skip? hmm the father in law with well controlled DM has been eating more carbs than usual should I add on a fructosamine to check 3 week status? hmmm oh the dilemmas and moral quandries! in a prior era in which not everything was as protocolized as it is now, I can see how it was best now to manage yourself or your family. but with so many EBM protocols, it's jsut following a cookbook for common issues. want a yummy cake? follow the recipe to every single step diligently

anyway straight Medicaid and managed medicaid was fairly restrictive in NYS as well (same limitations applied as you cite about) from 2016 to 2020.... then 2020 onward.... omfg.... you know why they are doing it..


anyway I treat all my patients US citizens, green card permanent resident, illegal immigrants / non-documented / migrants the same way with the best medical care and dignity and respect. I go all out for them and them what they need to get their disease better. I just do not think this "socialist utopia" is going to work long term

now if it were like Star Trek with the unlimited energy production of those dilithium crystals, more planets to inhabit, a United Federation of Planets ,etc.... then a socialist utopia could work and would be quite cool and I would be in favor. But that requires A) a far higher resource load than that is currently on planet Earth and B) outside hostile alien forces like the Klingons, the Romulans, the Dominion, the Borg etc... to unite the human population. so yeah... the realm of science fiction....

Oh I totally agree that what NY and Cali are doing is unsustainable.

 

[AlbinoHawk DO]

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.

Take the osteopathic AOBIM exam. It's open to both MD and DO graduates now. It works essentially the same for purposes of employment and reimbursement. It's seriously better than worrying about taking ABIM over and over again