Internal Medicine after Pathology

[DIce3]

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I am an internist with an interesting problem. After 16 years, my wife wants to change over and join me. She is an AMG with six years of pathology residency/fellowship at a solid university. She is triple board certified and is now in her tenth year as a private practice pathologist.

I have a crazy busy solo general internal medicine practice and could easily keep her full from the first day. The problem we are having is getting an internal medicine residency to even warm up to the idea of letting her do a categorical IM residency. We tried to interview/match this last cycle without success. She has no red flags except for the amount of time from medical school and that we are in our early 40s. Thank you for your consideration.

 

[jdh71]

I am an internist with an interesting problem. After 16 years, my wife wants to change over and join me. She is an AMG with six years of pathology residency/fellowship at a solid university. She is triple board certified and is now in her tenth year as a private practice pathologist.

I have a crazy busy solo general internal medicine practice and could easily keep her full from the first day. The problem we are having is getting an internal medicine residency to even warm up to the idea of letting her do a categorical IM residency. We tried to interview/match this last cycle without success. She has no red flags except for the amount of time from medical school and that we are in our early 40s. Thank you for your consideration.

Apply broadly? Situation addressed in the personal statement?

 

[DubVille]

Doesnt medicare only pay for one completed residency per student? If she is an amg and did her path residency here then I dont think the hospital will be reimbursed for this 2nd round.

 

[LukeWhite]

Do you have any geographic limitations?

 

[DIce3]

I think at this point, we would be willing to relocate to any state for three years.

 

[NotAProgDirector]

It's not a huge surprise that residency programs are not excited. She's an AMG which will be in her favor, but that's it. Her time since medical school is a problem. The fact that she trained in path and essentially hasn't seen a live patient in years will be a major weakness. And then there is the fact that her second residency is reimbursed less than her first.

But, there is a possible solution. It's kinda crazy.

She is a licensed physician.

Her license let's her practice any type of medicine she wants, not limited to path.

She could join you in your office. You could teach her the basics of outpatient internal medicine. She wouldn't get any ICU experience, or ED experience, or inpatient experience, but if all she will be doing is outpatient clinic, perhaps that doesn't matter. No one in their right mind would do this, but perhaps you would... and your patients (who hopefully love you) would know she was your wife, and would be happy to play along.

She would never be ABIM certified. You might need to "supervise" her for her entire career -- i.e. review charts at the end of the day or something. It's not totally clear that she would be able to get medmal insurance, but if you're "supervising" her perhaps your medmal insurance would cover you.

Would she be any good? I don't know. She could certainly learn the basics quickly. HTN, diabetes, cholesterol, ostoporosis, obesity, insomnia, etc are all not that complicated. Would she be able to recognize when something more rare walks in the door? Maybe. If she actually can diagnose the patient with a new presentation of GCA, that would be fantastic. If she simply recognizes that she doesn't know what it is and is worried about it and gets you involved, that would be good enough.

 

[Scottish Chap]

I am an internist with an interesting problem. After 16 years, my wife wants to change over and join me. She is an AMG with six years of pathology residency/fellowship at a solid university. She is triple board certified and is now in her tenth year as a private practice pathologist.

I have a crazy busy solo general internal medicine practice and could easily keep her full from the first day. The problem we are having is getting an internal medicine residency to even warm up to the idea of letting her do a categorical IM residency. We tried to interview/match this last cycle without success. She has no red flags except for the amount of time from medical school and that we are in our early 40s. Thank you for your consideration.

I worked with one guy that did this - clinical pathology trained with sub-specialty in hematopathology, then went back for an IM residency and then a hematology fellowship. Ultimately, he ended back in a faculty position doing mostly research, with a little clinical work. Quite possible. PM me if you have specific questions you are not comfortable posting openly.

Also, to echo what aProgDirector said above: I know another guy in the city where I work with a massive, private, general practice (almost boutique medicine, actually). The guy was an FMG who did a clinical pathology residency. Now he's in general practice after apparently learning on the job (and I'm sure mostly fee-for service). That's the nice thing about that NBME certification.

 

[DIce3]

Our current plan is to try one more time next season. The crazy idea may turn out to be the most feasible. While there are serious logistical problems to work out, I too have seen it work. We have a general surgeon, now general practitioner in town. Thank you for your thoughtful responses.

 

[earmuff]

Our current plan is to try one more time next season. The crazy idea may turn out to be the most feasible. While there are serious logistical problems to work out, I too have seen it work. We have a general surgeon, now general practitioner in town. Thank you for your thoughtful responses.

What about working in an urgent care setting, without any further training?