Is doing a fellowship practically mandatory thesedays?

[Monkeymaniac]

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I think I've read somewhere that you can't become radiology board-certified until a year after you finish your residency, so pretty much all the people do fellowship to fill the time in between. I tried to google about it, but I couldn't find when and which entity established the requirement or the resonable justification for it. Can anyone please shine a light on these issues? Thank you.

 

[bulletproof]

I think I've read somewhere that you can't become radiology board-certified until a year after you finish your residency, so pretty much all the people do fellowship to fill the time in between. I tried to google about it, but I couldn't find when and which entity established the requirement or the resonable justification for it. Can anyone please shine a light on these issues? Thank you.

This is true.

You are no longer eligible to become ABR Board certified until 16 months after the completion of a Diagnostic Radiology residency. This virtually ensures that 100% of individuals will pursue fellowship training so as to remain gainfully employed during this period in addition to making themselves more marketable.

 

[meister]

Something like 90% of graduates pursue a fellowship, this number is likely to only increase. Most fellowships are one year.

 

[topsurgeon2010]

This is true.

You are no longer eligible to become ABR Board certified until 16 months after the completion of a Diagnostic Radiology residency. This virtually ensures that 100% of individuals will pursue fellowship training so as to remain gainfully employed during this period in addition to making themselves more marketable.

what was the rationale behind ABR implementing this?

 

[colbgw02]

what was the rationale behind ABR implementing this?

The cynic's view(s)?

That the ABR is run largely by a bunch of ivory tower academics who were tired of seeing R4s disappear for their last six months for board prep. Senior residents on call keep the attending's home phone from ringing at 2am, after all.

Or...that the oral exam is costly and complex to organize and administer. By going to a computerized exam, the ABR saves money. But what do you want to bet the board fees don't go down proportionately? Who gets to pocket the difference? The ABR.

Or...people wanted change for the sake of change.

 

[shark2000]

The cynic's view(s)?

That the ABR is run largely by a bunch of ivory tower academics who were tired of seeing R4s disappear for their last six months for board prep. Senior residents on call keep the attending's home phone from ringing at 2am, after all.

Or...that the oral exam is costly and complex to organize and administer. By going to a computerized exam, the ABR saves money. But what do you want to bet the board fees don't go down proportionately? Who gets to pocket the difference? The ABR.

Or...people wanted change for the sake of change.

I am happy that I did the old system.

In the new system, after 3 months of starting your first job, you have to sit for the boards. That is really difficult.

 

[colbgw02]

I am happy that I did the old system.

In the new system, after 3 months of starting your first job, you have to sit for the boards. That is really difficult.

As am I. I'm at a teaching program, and the R3s are (appropriately) clueless as to what to expect from the coming core exam. Sadly, I have no advice to offer them, having been certified under the old system. The ABR has done a horrible job of telling residents how to prepare for this test. The study guides they published were way too vague; they might as well have just said "learn all of radiology".

 

[MossPoh]

I call that "weatherman-ing" the expectations. Just a vague, broad hand motion over a large pile of stuff...with a 10-20% chance of precipitation.

 

[DrBowtie]

Wasn't path and rads virtually the only fields that you could end residency BC? I thought I remembered hearing that when the new changes were announced.

 

[dude1344]

Wasn't path and rads virtually the only fields that you could end residency BC? I thought I remembered hearing that when the new changes were announced.

Yep. Now pathology is the only field where you can finish residency with board certification. Every other field you take boards after you're out.

 

[Neuronix]

Over in rad onc we're board eligible halfway through our R5 year and take the oral boards after our first year out. But that doesn't force us into fellowship. Currently few grads do fellowship. You can get an assistant prof or private practice job without too much trouble straight out of residency. So just because you're not board certified, it doesn't mean that you can't get a good job in other specialties as long as you're board eligible.

Length of training is pretty arbitrary, and I feel like the radiology board screwed you guys over a few years ago. They also flooded your market with FMGs who took the fellowship to board certification pathway, which keeps demand for radiologists low enough that they can force you to jump through whatever hoops they want.

My concern is that rad onc will take the hint and keep us around an extra year too so they can have the cheap skilled labor known as a fellow.

 

[colbgw02]

Over in rad onc we're board eligible halfway through our R5 year and take the oral boards after our first year out. But that doesn't force us into fellowship. Currently few grads do fellowship. You can get an assistant prof or private practice job without too much trouble straight out of residency. So just because you're not board certified, it doesn't mean that you can't get a good job in other specialties as long as you're board eligible.

Length of training is pretty arbitrary, and I feel like the radiology board screwed you guys over a few years ago. They also flooded your market with FMGs who took the fellowship to board certification pathway, which keeps demand for radiologists low enough that they can force you to jump through whatever hoops they want.

My concern is that rad onc will take the hint and keep us around an extra year too so they can have the cheap skilled labor known as a fellow.

The problem with the bold part is that we're not talking about carte blanche here. Radiology practices have a long-standing expectation that new employees are fully-trained and ready to produce on day 1, so it'll be an adjustment for them. They will adjust, no doubt, because they'll have to, but the people exiting training during the transition period are likely to bump up against unreasonable expectations borne of the old system.

There's also the question of risk. We all know that a business takes a risk when they hire someone new, but heretofore that risk was mitigated because the employee came with board certification, which gave the practice reasonable assurances regarding his competence. Now, practices are forced to hire people who, at least in theory, may never become board-certified (and in PP radiology, that's a show stopper). So, if you're going to have to dismiss someone due board failure, then it is much safer to hire the fellowship-trained guy for 4 months than the general rads for 16 months, having "wasted" a whole year's worth of resources on the latter.

A semantics issue: for specialties that become boarded after residency, is it really correct to refer to yourself as BE while still in training? My thinking is that successful completion of residency is a requirement for BC, so until you've checked that block, then you're not BE.

 

[DrBowtie]

I'm curious how people will choose their certifying exam blocks. Will people doing fellowships choose 3 of that same specialty or go a more generalist route and choose 3 different?

I think aside from job market, that is a reason to do a fellowship vs straight to job is it gives you time to prepare for the cert.

 

[shark2000]

But even without the new system, most graduates were doing fellowship.

There was a very short period of time in the history of radiology between 2003 and 2005, that because of booming of job market people did not do the fellowship. Otherwise, even in 70s and 80s people used to do fellowship. I have a partner in practice who did 2 years of neuroradiology fellowship in late 70s.

IMO, doing a fellowship is good at many levels. The only flip side is one extra year. Believe me, it is worth it.

 

[Neuronix]

A semantics issue: for specialties that become boarded after residency, is it really correct to refer to yourself as BE while still in training? My thinking is that successful completion of residency is a requirement for BC, so until you've checked that block, then you're not BE.

The only reason I use it that way is because one can moonlight during the senior year in radiation oncology practice because of "board eligible" status.

 

[vistaril]

The problem with the bold part is that we're not talking about carte blanche here. Radiology practices have a long-standing expectation that new employees are fully-trained and ready to produce on day 1, so it'll be an adjustment for them. They will adjust, no doubt, because they'll have to, but the people exiting training during the transition period are likely to bump up against unreasonable expectations borne of the old system.

There's also the question of risk. We all know that a business takes a risk when they hire someone new, but heretofore that risk was mitigated because the employee came with board certification, which gave the practice reasonable assurances regarding his competence. Now, practices are forced to hire people who, at least in theory, may never become board-certified (and in PP radiology, that's a show stopper). So, if you're going to have to dismiss someone due board failure, then it is much safer to hire the fellowship-trained guy for 4 months than the general rads for 16 months, having "wasted" a whole year's worth of resources on the latter.

A semantics issue: for specialties that become boarded after residency, is it really correct to refer to yourself as BE while still in training? My thinking is that successful completion of residency is a requirement for BC, so until you've checked that block, then you're not BE.

so you guys can't bill and get reimbursed by insurance and medicare/aid by just being BE? That would suck....

 

[colbgw02]

so you guys can't bill and get reimbursed by insurance and medicare/aid by just being BE? That would suck....

I'm having a hard time seeing how you drew that conclusion, but I'm fairly certain that BE physicians can still bill. Otherwise, freshly trained docs wouldn't get paid. I would think that some insurance companies reimburse less for work done by someone who is BE as compared to BC, but many physicians right out of training are employees or salaried, so they may not realize that they get paid less per unit work performed.

Regarding privileges, I would think that a hospital's credentialing office would be able to distinguish between someone who is BE because they can't pass or won't try to pass their boards as opposed to someone who is on schedule to be BC.

The real problem, and it's only a near and intermediate term issue, is the competitive nature of the radiology marketplace. Good practices want to be able to advertise that all of their radiologists are board-certified and X% are fellowship-trained. Heretofore they've been able to do that easily because radiologists were either certified at the end of residency or before fellowship ended, but they won't be able to do that truthfully for the 4 months after they hire a new radiologist out of fellowship. My suspicion is that partners will be hesitant to make those hires initially, but then - eventually - they'll realize that the only people available to hire are BE radiologists.

 

[shark2000]

I'm having a hard time seeing how you drew that conclusion, but I'm fairly certain that BE physicians can still bill. Otherwise, freshly trained docs wouldn't get paid. I would think that some insurance companies reimburse less for work done by someone who is BE as compared to BC, but many physicians right out of training are employees or salaried, so they may not realize that they get paid less per unit work performed.

Regarding privileges, I would think that a hospital's credentialing office would be able to distinguish between someone who is BE because they can't pass or won't try to pass their boards as opposed to someone who is on schedule to be BC.

The real problem, and it's only a near and intermediate term issue, is the competitive nature of the radiology marketplace. Good practices want to be able to advertise that all of their radiologists are board-certified and X% are fellowship-trained. Heretofore they've been able to do that easily because radiologists were either certified at the end of residency or before fellowship ended, but they won't be able to do that truthfully for the 4 months after they hire a new radiologist out of fellowship. My suspicion is that partners will be hesitant to make those hires initially, but then - eventually - they'll realize that the only people available to hire are BE radiologists.

Agree.

The first two or three class have to compete with people in the old system. But once the system becomes established, it will become routine to hire BE.