ITO Pathway to ABO Board Certification

[Eyes T]

I am part of a large group practice that is looking to hire additional ophthalmologists. We have come across several applicants who completed their ophthalmology residency abroad, passed the USMLE exams and have since been practicing in the US, typically as fellows in academic programs. My understanding of the ITO pathway is that they must practice with an unrestricted license for 5 years in the US before being considered ABO board eligible. Prior to this period of board eligibility, these physicians are typically not able to be credentialed by many insurance carriers. Does anyone here have personal experience going through this pathway or worked with someone who did and was able to work in a private practice before finishing that 5 year period and achieving board eligibility?

---

Members don't see this ad.

 

[PLA2]

They don't have an unrestricted license if they did not complete residency in the US. That's why they're relegated to working in academic places only.

 

[Eyes T]

They don't have an unrestricted license if they did not complete residency in the US. That's why they're relegated to working in academic places only.

That's not true. If you complete the USMLE exams you are eligible for an unrestricted medical license in most if not all states, even if your residency was completed abroad. I know several physicians who have obtained medical licenses in multiple states via this pathway. The issue is more about getting credentialed with insurance companies before becoming board eligible.

 

[PLA2]

Then why do the IMGs come here and repeat residency?

 

[Trefoil]

Then why do the IMGs come here and repeat residency?

It is strange. I have run into IMG’s repeating residency here as well, and they always told me it was necessary. Looking at the requirements, it does seem that some states specify whether the residency is ACGME or not. It does say for the ITO program that you would need an unrestricted license and be practicing surgery, which would explain why they repeat residency. It’s hard to imagine a situation where you would be practicing surgery here for five years as an IMG who didn’t do residency here without board certification unless it was at an academic medical center as a fellow in which case it’s probably not an unrestricted license and may actually be observation based. Hell, there are states where you can’t have an unrestricted general practice license until you are in the second year of a US residency, so I’m not sure how you would get one an IMG.

It’s also worth noting that most of our fellowships are not ACGME based.

Edit: AMA for reference

Residency program requirements for international medical graduates

Learn how international medical graduates can enter a U.S. residency program, and the special requirements international medical graduates should consider.

www.ama-assn.org

 

[MstaKing10]

That's not true. If you complete the USMLE exams you are eligible for an unrestricted medical license in most if not all states, even if your residency was completed abroad. I know several physicians who have obtained medical licenses in multiple states via this pathway. The issue is more about getting credentialed with insurance companies before becoming board eligible.

This isn't accurate. You can sit for USMLE and pass as a foreign graduate, and can then obtain a state license. But to practice medicine in US one must have completed a US residency. The state license is a prerequisite to obtaining a residency in the foreign graduates intended field of practice.

 

[mjohnsonets]

I can't recall a private practice able to get someone through who has not completed a US residency on insurance and is not board eligible. The ITO pathway makes them board eligible and they can then go through the steps to become board certified. I have worked with docs who were able to practice in the US outside of an academic center before becoming BE and without a US-based residency but these were at large hospital systems in very rural areas. Even the docs themselves were a little in the dark about how this worked.

I have heard there are some grey areas that can be a workaround for this but would not recommend it.

 

[Ophthalmic Senator]

Then why do the IMGs come here and repeat residency?

They repeat the residency because it is the most viable way to practice and be board certified.

One path is to do a foreign residency then a US fellowship. Then try to impress that program so they accept you as a resident.

The ITO pathway is a rare pathway, I believe. In 2019, only 3 ITO's were either granted or applied for. My guess is the ITO pathway is for IMG's in an academic department to get board certified without repeating a residency.