License/DEA without BC

[uclabruins47]

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Just a general question about what can I do now that I have a license/DEA but of course, still in residency without certification (i'm in IM)

I know there are things that technically we can do, but I want to know on a realistic level what I can do at this level. Moonlighting I know is one option, but on a full time level, hypothetically lets say if I don't want to do residency anymore, is there anything I can do clinically or nonclinically? Thanks.

 

[Pilot Doc]

The general theme is that you have to go someplace that has a hard time recruiting docs for whatever reason

1) urgent care
2) ER
3) hospitalist type coverage - more likely on the code team end of the spectrum rather than true hospitalist
4) work physicals, disablility evails, etc
5) non-clinical work in industry - a number of consulting firms have historically hired docs. Not sure if that is true now, though

Someone is going to say "there's no way you can do ER (or whatever) with only an intership." Just gotta go someplace rural and hungry enough.

 

[uclabruins47]

The general theme is that you have to go someplace that has a hard time recruiting docs for whatever reason

1) urgent care
2) ER
3) hospitalist type coverage - more likely on the code team end of the spectrum rather than true hospitalist
4) work physicals, disablility evails, etc
5) non-clinical work in industry - a number of consulting firms have historically hired docs. Not sure if that is true now, though

Someone is going to say "there's no way you can do ER (or whatever) with only an intership." Just gotta go someplace rural and hungry enough.

Thanks, that's very informative. I would assume that "someplace" would of course include a rural area. However would any urban area be included as well?

 

[Pilot Doc]

Thanks, that's very informative. I would assume that "someplace" would of course include a rural area. However would any urban area be included as well?

With only an internship, I think any serious clinical work would be hard to get. Maybe work in a STD or botox clinic or something. You could probably swing urgent care as well. Lots more possibilities after 2 yrs of residency.

 

[Wrigleyville]

If the question is: "are there any jobs I can do while providing high quality care to patients", the answer is no. If your question is: "can I get a job somewhere doing whatever", the answer is yes. You can work at the VA, or doc-in-a-box, or pharma work, etc. Basically anything that doesn't require much in the way of insurance company certification, because they won't touch you.

 

[Dr. V]

You can always just hang out your shingle as a primary care physician. All you need is a medical license and malpractice insurance. (The ability to get an unrestricted license is state dependant).

Many ER's need licensed docs, and I am betting those urban ER's probably need willing ER docs as bad as the rural ER's do. There are always walk in clinics as well, or you could start your own walk in clinic.

An unrestricted license is just that, unrestricted. All you have to do is find the job and make sure you are insured.

 

[Pilot Doc]

If the question is: "are there any jobs I can do while providing high quality care to patients", the answer is no.

That's not true - you just have to understand the (significant) limits to your expertise.

In my experience, the VA won't hire anyone with less than 3 years residency training.

 

[Pilot Doc]

All you have to do is find the job and make sure you are insured.

Don't even have to do that if you're willing to go bare. Bad idea, but not illegal.

 

[mjl1717]

That's not true - you just have to understand the (significant) limits to your expertise.

In my experience, the VA won't hire anyone with less than 3 years residency training.

The VA has the power to wave rules...

 

[dr0277341283141]

I'm thinking of saving some more money and living on a beach in El Salvador for the rest of my life.

 

[dragonfly99]

All the VA's in my area require a finished residency before they will hire you...
Also, all the doc in the boxes I checked with while in residency did not want to hire residents to moonlight...medicine fellows (i.e. with a completed residency) they would. The reason they gave was the ability to be credentialed by most or all of the insurance companies they accept does not exist if you haven't finished residency.

I'm sure there is SOME job out there that would take you, but my question is whether you really want to do this to yourself in terms of limiting yourself so much clinically. If you leave residency you might not be able to get another one, and if the job you find doesn't work out, and/or things change in the future (i.e. you get an evil boss, etc.) you might be up a creek. I'm thinking you have done at least 1.5 years of residency...if so, it doesn't make a lot of sense to me to bail out now...especially if you are in a 3 year residency. Surely you can stick it out for another 1.5 years. If not, I still think it would be better to switch residencies, maybe to a different field, if you can't stand yours.

If you want to get out of clinical medicine totally, then trying to find a doc in the box, or a hospital moonlighting job, etc. that would hire you (i.e. probably for lower pay, etc.) at least part time so that you can survive would be a good idea. There are definitely moonlighting jobs around that you can get with only part of a residency - group homes for the disabled, maybe hospice or nursing homes, whatever is available at your teaching hospital (taking overflow medicine admits, etc.). If you want to get one, it would probably be best to get a regular gig set up before you quit your residency, because usually they ask for references...

 

[Dr. V]

All the VA's in my area require a finished residency before they will hire you...
Also, all the doc in the boxes I checked with while in residency did not want to hire residents to moonlight...medicine fellows (i.e. with a completed residency) they would. The reason they gave was the ability to be credentialed by most or all of the insurance companies they accept does not exist if you haven't finished residency.

That may be what they told you but that would be untrue. (It may be true for your state, but untrue in general).

All that is required for insurance to use you as a provider is an unrestricted license. If the state gives you a license and you meet those requirements then the insurance company will accept your credentials.

That's why I said it was state specific. If you are in a state that doesn't give an unrestricted license unless residency is completed then no, insurance wouldn't pay because you are not a fully licensed physician.

If you have an unrestricted license then you can do what you want and the insurance company will honor it because you do indeed have an unrestricted license to practice medicine. In my state the only requirement for an unrestricted license is to complete intern year and pass all steps of the USMLE. FMG's/IMG's have to do 2-3, not sure which, but after they get their unrestricted license it's the same deal, it's unrestiricted.

 

[dragonfly99]

I know for a fact that our VA will not hire docs who haven't completed a residency. There may be other VA's that do, but I know 100% that the several VA's in my area do not. And this doesn't hold just for IMG's - it's for all docs. There may be other VA's that are more desperate for a doc that would hire any doc with a license, but in general not having finished a residency is a red flag and it also means the doc has less training, and in general hospitals and health systems would rather hire a doc who is fully trained vs. one who is not.

OP, you can probably scrounge for some kind of job with just a license, but to me it's 1000% better to just suck it up and finish another 1-1.5 years of residency and then you can be eligible for a zillion more jobs. The only exception I'd make is if there's just no way you can make it through residency, and/or you plan to quit clinical medicine soon, and just are planning on moonlighting to make ends meet up until the time you bail in a year or two.

 

[Dr. V]

you can say it ain't true

Why yes, I can say it isn't true especially if you actually read what was posted instead of trying to go off on some tangent about the VA that I never commented on (BTW, I know for a fact the VA will hire docs without completing their residency, know SEVERAL docs working at the VA right now that never finished residency, but that's not what I was disagreeing with anyway. I would agree with you for the most part about the VA and say it is increasingly difficult to get a job at the VA now with the Walter Reid stuff in the news and the fact that more American docs are going to the VA system due to the declining reimbursements in the private sector).

The part I said wasn't true was that you had to have completed residency for insurance to pay, and I specifically said "that may be what they told you" but that isincorrect.

However, if you notice I said it was also somewhat state dependant, depending on what each state required for an unrestricted license. As long as you do have an unrestricted license then the insurance company will pay.

So, indeed the basic premise that you must finish residency to get paid by insurance is false. What is required is an unrestricted license (which you can get in many states after completing just an intern year and passing the step exams).

 

[michaelrack]

. As long as you do have an unrestricted license then the insurance company will pay.

This is not true for many insurance companies

 

[Winged Scapula]

This is not true for many insurance companies

Agreed. I know that several insurance companies not only required an unrestricted license, but proof of completion of residency and Board Eligibility. Next step will be requiring you to be Board Certified.

 

[bulgethetwine]

The VA has the power to wave rules...

Perhaps this includes waiving the necessity of being literate in the English language, but probably not. Sorry

Also, the concept that an urban ER would let someone currently in first or second year of residency work without supervision is hilarious (as distinct from those who have been doing it for years who may or may not have had more than one or two years of training back in the day, and even these are few and far between).

 

[confused_amused]

Is there any reason that a resident with an unrestricted license and insurance wouldn't be allowed to moonlight in a nursing home? You shouldn't even need a DEA number in my estimation, correct?

 

[Winged Scapula]

Is there any reason that a resident with an unrestricted license and insurance wouldn't be allowed to moonlight in a nursing home? You shouldn't even need a DEA number in my estimation, correct?

Yes. If your program prohibits it.

 

[DrJosephKim]

Options: Cash-only practice.

Don't expect to get on any insurance plans. Policies get stricter every year.