Life after TY

[Livinthedream1023]

Hello everyone, this is my first post on here. Followed SDN for years, from undergraduate studies to medical school and now residency, love it.

I am in a state that needs 2 years of post graduate training to earn your MD License. I have searched on my states labor website as well as google and on here but cant seem to find a straight forward answer. I will be completing a 2nd year of TY here soon (don't want to get into many details as why I did 2 years of TY) and will be eligible to apply and receive my license. What type of medicine can I actually practice? Can I open a general practice office? Will I be stuck in urgent cares for the rest of my life? I know I will never be board certified and go to any hospitals.

Just curious as to what some of your ideas are for life after a couple years of TY.

Thanks!
Livinthedream1023

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[futureapppsy2]

Hello everyone, this is my first post on here. Followed SDN for years, from undergraduate studies to medical school and now residency, love it.

I am in a state that needs 2 years of post graduate training to earn your MD License. I have searched on my states labor website as well as google and on here but cant seem to find a straight forward answer. I will be completing a 2nd year of TY here soon (don't want to get into many details as why I did 2 years of TY) and will be eligible to apply and receive my license. What type of medicine can I actually practice? Can I open a general practice office? Will I be stuck in urgent cares for the rest of my life? I know I will never be board certified and go to any hospitals.

Just curious as to what some of your ideas are for life after a couple years of TY.

Thanks!
Livinthedream1023

Why aren’t you able to go onto a residency?

 

[gutonc]

Hello everyone, this is my first post on here. Followed SDN for years, from undergraduate studies to medical school and now residency, love it.

I am in a state that needs 2 years of post graduate training to earn your MD License. I have searched on my states labor website as well as google and on here but cant seem to find a straight forward answer. I will be completing a 2nd year of TY here soon (don't want to get into many details as why I did 2 years of TY) and will be eligible to apply and receive my license. What type of medicine can I actually practice? Can I open a general practice office? Will I be stuck in urgent cares for the rest of my life? I know I will never be board certified and go to any hospitals.

Just curious as to what some of your ideas are for life after a couple years of TY.

Thanks!
Livinthedream1023

Get into a full residency and complete it.

 

[the argus]

Hello everyone, this is my first post on here. Followed SDN for years, from undergraduate studies to medical school and now residency, love it.

I am in a state that needs 2 years of post graduate training to earn your MD License. I have searched on my states labor website as well as google and on here but cant seem to find a straight forward answer. I will be completing a 2nd year of TY here soon (don't want to get into many details as why I did 2 years of TY) and will be eligible to apply and receive my license. What type of medicine can I actually practice? Can I open a general practice office? Will I be stuck in urgent cares for the rest of my life? I know I will never be board certified and go to any hospitals.

Just curious as to what some of your ideas are for life after a couple years of TY.

Thanks!
Livinthedream1023

State licenses are not specialty specific, you either have a license to practice medicine or not. So technically there are no legal limits on what you can do.

So why can't I as an IM subspecialty fellow go open an OBGYN or neurosurgical practice?
1. You will not get malpractice insurance to cover things you are not qualified to do, because...
2. You will get sued for a lot of money, and lose.
3. Your state medical board will eventually revoke your license if they have evidence you are doing things you are not qualified to do.


So in reality, the ONLY option in your current situation is to try and open a general outpatient practice (or find an existing one that will hire you). And then hope you can find a malpractice insurance carrier that will cover you. And then hope you can find enough patients that are willing to see a doctor that isn't actually trained to provide general outpatient care (which you are not after only doing TY).

I agree with the above posters. Try and get into a family medicine residency program. It will add some additional years to your training, but will make your post-training life infinitely easier.

 

[Gastrapathy]

Presuming you’ve exhausted every Avenue to get a residency (seriously, every one) and you are an AMG, you can get a license and then look at prison medicine, disability exams, the Indian Health Service, wound care or possibly some urgent cares. So, that’s why you got the advice above. Best of lucj

 

[Livinthedream1023]

Thank you everyone for the replies. I gave it some thinking and like you mention Gastrapathy, I have not exhausted all avenues of a categorical residency, and will keep trying for one. I am optimistic, but at the same time just wanting to know of a back up plan.

Thanks!

 

[Hellopitty]

Physician Tycoon — Coming Soon

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Career alternatives for doctors who do not match in residency or do not complete residency.

www.nonclinicaldoctors.com

'I've Had It With Medicine!' 16 Options for Second Careers - Page 6

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[chocomorsel]

State licenses are not specialty specific, you either have a license to practice medicine or not. So technically there are no legal limits on what you can do.

So why can't I as an IM subspecialty fellow go open an OBGYN or neurosurgical practice?
1. You will not get malpractice insurance to cover things you are not qualified to do, because...
2. You will get sued for a lot of money, and lose.
3. Your state medical board will eventually revoke your license if they have evidence you are doing things you are not qualified to do.


So in reality, the ONLY option in your current situation is to try and open a general outpatient practice (or find an existing one that will hire you). And then hope you can find a malpractice insurance carrier that will cover you. And then hope you can find enough patients that are willing to see a doctor that isn't actually trained to provide general outpatient care (which you are not after only doing TY).

I agree with the above posters. Try and get into a family medicine residency program. It will add some additional years to your training, but will make your post-training life infinitely easier.

Except how long ago could doctors just finished with medical school hang out a shingle to practice general medicine without any sort of residency?
I disagree that OP isn’t qualified to practice general medicine after two years of TY.

 

[the argus]

Except how long ago could doctors just finished with medical school hang out a shingle to practice general medicine without any sort of residency?
I disagree that OP isn’t qualified to practice general medicine after two years of TY.

Eh, I disagree.

1. There's a reason that's not the standard anymore. Medicine is more complicated than it used to be, including general outpatient medicine, and requires more training to become competent.

2. While transitional year curriculums vary widely, they almost never put an emphasis on general outpatient medicine. They are for people who are going on to more advanced specialty training and are not designed to prepare you to be a PCP.

There's a big difference between completing 2 years of IM/FM versus 2 transitional years. Completing 2/3 of a curriculum that is designed to produce general medicine providers is not ideal but is probably sufficient for most people. Completing 2 years of a curriculum that is designed to be a 1 year intro into a more advanced specialty and puts minimal emphasis on outpatient medicine is not sufficient.

 

[Cherbourg]

Thank you everyone for the replies. I gave it some thinking and like you mention Gastrapathy, I have not exhausted all avenues of a categorical residency, and will keep trying for one. I am optimistic, but at the same time just wanting to know of a back up plan.

Thanks!

Look into Preventive Medicine and Occupational Medicine residencies. People tend to forget (or not know) about those.

 

[Vandalia]

Except how long ago could doctors just finished with medical school hang out a shingle to practice general medicine without any sort of residency?
I disagree that OP isn’t qualified to practice general medicine after two years of TY.

200 years ago you could practice surgery without even being able to read.

In other words, that is not a valid argument.

 

[chocomorsel]

200 years ago you could practice surgery without even being able to read.

In other words, that is not a valid argument.

Give me a frigging break. They have one two years of TY. That is plenty sufficient. Y'all want to make it sound like he's trying to be a neurosurgeon. It's primary care and nurses are doing it and plenty of other fields.
So why are states allowing doctors to continue to get unrestricted licenses then at one and two years PGY if they are so damn unequipped to handle having an "unrestricted licenses" to practice?
OP don't listen to the naysayers. Open up shop and do what you gotta do. Get you some texts and keep up with the guidelines. You will be fine. I know people who've been in your shoes and are doing just fine.

 

[smq123]

Give me a frigging break. They have one two years of TY. That is plenty sufficient. Y'all want to make it sound like he's trying to be a neurosurgeon. It's primary care and nurses are doing it and plenty of other fields.
So why are states allowing doctors to continue to get unrestricted licenses then at one and two years PGY if they are so damn unequipped to handle having an "unrestricted licenses" to practice?
OP don't listen to the naysayers. Open up shop and do what you gotta do. Get you some texts and keep up with the guidelines. You will be fine. I know people who've been in your shoes and are doing just fine.

Telling the OP to "finish a full residency and become at least BE" is hardly being a naysayer.

I don't think you understand how many guidelines there are to keep up with. And that's assuming that you can get contracts with insurers when you're not BE/BC.

If you hang out a shingle as a "PCP," you'll be held to the same standard as someone who is BC. And, having worked with people who only completed 1 year of post-graduate training, that has a high likelihood of not ending well.

 

[chocomorsel]

Telling the OP to "finish a full residency and become at least BE" is hardly being a naysayer.

I don't think you understand how many guidelines there are to keep up with. And that's assuming that you can get contracts with insurers when you're not BE/BC.

If you hang out a shingle as a "PCP," you'll be held to the same standard as someone who is BC. And, having worked with people who only completed 1 year of post-graduate training, that has a high likelihood of not ending well.

Well, clearly the OP is having a difficult time finishing residency and that is why they are posting. For you to tell them to finish something that they most likely CANNOT is hardly practical. So unless you have a spot to offer the OP your advice is useless as it's something I am sure the OP has thought of and contemplated and has attempted, much to no avail. But thankfully he or she is "optimistic."
Whatever the case, seems like most likely the OP cannot complete a full residency. So telling he/she that they are not equipped to be a PCP instead of guiding them down the right path to become a good PCP is being a "naysayer." Not everyone is lucky enough to finish residency and I have known a few who didn't and I was almost one of those.
I stand by what I said, which is that the OP can make a competent PCP with two years of PGY training as there are plenty of y'all hiring and training midlevels to do the job.
Good luck OP.

 

[Hellopitty]

Curriculam Vitae

Carlos K. Wesley, MD EDUCATION PRINCETON UNIVERSITY: Graduated cum laude, AB Molecular Biology, 1997. Thesis topic: "Molecular and Cellular Characterization of

www.drcarloswesley.com

This guy didn't complete his residency, opened a hair transplant practice. So yes you can open your own clinic

 

[Splenda88]

You can open your own clinic. I know many general practice docs in south FL who have their own clinic.

If you don't want to open your own clinic, work for Indian Health Service. You will have an 8am to 5pm M-F job making ~200k/yr while seeing < 10 patients per day. I have a friend who is doing it right now and he loves his job. They might even give you ~20k/yr in student loan repayment. Not sure if they still doing that.

 

[Splenda88]

Well, clearly the OP is having a difficult time finishing residency and that is why they are posting. For you to tell them to finish something that they most likely CANNOT is hardly practical. So unless you have a spot to offer the OP your advice is useless as it's something I am sure the OP has thought of and contemplated and has attempted, much to no avail. But thankfully he or she is "optimistic."
Whatever the case, seems like most likely the OP cannot complete a full residency. So telling he/she that they are not equipped to be a PCP instead of guiding them down the right path to become a good PCP is being a "naysayer." Not everyone is lucky enough to finish residency and I have known a few who didn't and I was almost one of those.
I stand by what I said, which is that the OP can make a competent PCP with two years of PGY training as there are plenty of y'all hiring and training midlevels to do the job.
Good luck OP.

People in our profession are not supportive... The same people who are telling OP he won't be a good PCP have NP/PA as their colleagues. As you said, some of them even hire them.

 

[Splenda88]

Eh, I disagree.

1. There's a reason that's not the standard anymore. Medicine is more complicated than it used to be, including general outpatient medicine, and requires more training to become competent.

2. While transitional year curriculums vary widely, they almost never put an emphasis on general outpatient medicine. They are for people who are going on to more advanced specialty training and are not designed to prepare you to be a PCP.

There's a big difference between completing 2 years of IM/FM versus 2 transitional years. Completing 2/3 of a curriculum that is designed to produce general medicine providers is not ideal but is probably sufficient for most people. Completing 2 years of a curriculum that is designed to be a 1 year intro into a more advanced specialty and puts minimal emphasis on outpatient medicine is not sufficient.

By the way, many FM programs in Canada are only 2 years.

 

[chocomorsel]

By the way, many FM programs in Canada are only 2 years.

They drink too much of the damn Kool Aid they are given I tell you. Thank you. I was trying to see if FM in the US had was two years at one recent point and couldn’t only because anesthesia used to be three years total up until 1990 or so. And I think the GP anesthetist in Canada train for two years total as well. My BFF from Med school didn’t finish her surgical residency and has had a PCP clinic for five years now.

 

[Splenda88]

They drink too much of the damn Kool Aid they are given I tell you. Thank you. I was trying to see if FM in the US had was two years at one recent point and couldn’t only because anesthesia used to be three years total up until 1990 or so. And I think the GP anesthetist in Canada train for two years total as well. My BFF from Med school didn’t finish her surgical residency and has had a PCP clinic for five years now.

Academia has brainwashed most of us TBH.



Do people really believe that you need 4y + 4y + 3 years residency to be a PCP?

Will outcomes be worse if the whole process is: 2-year prereqs + 3-year med school and 2-6 years residency (total 8-12 years)?

Is board certification every 10 yrs really needed to be a good physician?

Do we really need 1-yr prelim for Ophtho, Radonc, Radiology etc... that contributes very little to the overall training according to the docs in these specialties?

Is 3-year in IM really needed for all the IM subspecialties? By the way, GI fellowship was only 2 yrs recently (1990s).

Are residents trained in 4-yr EM programs become better attending than the ones in 3-yr programs?

Do we really need a pediatrics hospitalist fellowship for physicians who complete peds residency? This is the most ridiculous one.



People should start asking themselves these questions?

 

[the argus]

People in our profession are not supportive... The same people who are telling OP he won't be a good PCP have NP/PA as their colleagues. As you said, some of them even hire them.

You guys are missing the point. The issue is not that the OP only did 2 years or residency. The issue is the training they have received was in no way designed to teach them how to be a competent outpatient provider.

Is your argument really that being a PCP is so easy that you don't need any real training to do it? If so, then that makes me think that you just haven't actually spent any time around a good PCP. I am not a PCP, but I have enough respect for what they do that I think you actually need some amount of relevant training to do it well.

And this whole NP/PA straw man argument is silly. Is the OP going to be considered a physician or a midlevel provider? Are they are going to only see the most straightforward and simple cases and make ~1/3 of what an actual PCP would make?

By the way, many FM programs in Canada are only 2 years.

Again, that is 2 years of a curriculum designed to train you to become a PCP. Transitional years are designed as 1 year programs as an intro into more advance training. Repeating a transitional year twice is not the same as completing a designed 2 year curriculum.

This is akin to saying someone who took chem 101 twice has the same knowledge base as someone who took chem 101 then 202.

 

[Splenda88]

You guys are missing the point. The issue is not that the OP only did 2 years or residency. The issue is the training they have received was in no way designed to teach them how to be a competent outpatient provider.

Is your argument really that being a PCP is so easy that you don't need any real training to do it? If so, then that makes me think that you just haven't actually spent any time around a good PCP. I am not a PCP, but I have enough respect for what they do that I think you actually need some amount of relevant training to do it well.

And this whole NP/PA straw man argument is silly. Is the OP going to be considered a physician or a midlevel provider? Are they are going to only see the most straightforward and simple cases and make ~1/3 of what an actual PCP would make?

Again, that is 2 years of a curriculum designed to train you to become a PCP. Transitional years are designed as 1 year programs as an intro into more advance training. Repeating a transitional year twice is not the same as completing a designed 2 year curriculum.

This is akin to saying someone who took chem 101 twice has the same knowledge base as someone who took chem 101 then 202.

More 80% of PCP work are straight forward cases (HTN, DM, dyslipidemia, skin conditions, MSK pain, COPD/asthma, CHF, UTI, URI, STDs, wellness check, screenings etc...). Maybe my PC clinic is atypical. It probably will take OP ~1 yr to become a good PCP as long as he is dedicated...

I understand it won't be easy, but if OP does his/her homework, he/she will be fine. I never said being PCP is easy. However, it's nothing difficult that someone who did 2-yr TY can't do.


None of us here is saying it's ideal... Let's be honest here: Primary care outpatient is not radiology or pathology or surgery. I am saying that as a PGY3 IM resident.

 

[Matthew9Thirtyfive]

People in our profession are not supportive... The same people who are telling OP he won't be a good PCP have NP/PA as their colleagues. As you said, some of them even hire them.

These are all logical fallacies. The answer to NPs providing ****ty care is not to allow undertrained physicians to practice as well. OP didn’t complete a primary care residency. Saying “it’s just primary care” is super condescending and diminishes what PCPs do. Saying “they do it so we should too” is not a valid argument.

I am totally with you if someone is saying an NP is qualified to practice primary care but a physician with 2 TY years isn’t. That’s ludicrous. But I don’t think anyone here is saying that.

 

[Splenda88]

These are all logical fallacies. The answer to NPs providing ****ty care is not to allow undertrained physicians to practice as well. OP didn’t complete a primary care residency. Saying “it’s just primary care” is super condescending and diminishes what PCPs do. Saying “they do it so we should too” is not a valid argument.

I am totally with you if someone is saying an NP is qualified to practice primary care but a physician with 2 TY years isn’t. That’s ludicrous. But I don’t think anyone here is saying that.

At the end of the day, OP can do whatever he/she wants. Almost every single state will grant him/her a medical license.

I am a PCP. It's not condescending to say that primary care is not radiology or surgery. That is the truth.

As I said, it's not ideal. But OP can become competent in in 6-12 months if he/she does his homework.

Many (probably most) IM programs (including mine) do not prepare their residents to be competent on day 1 to do outpatient medicine.

 

[Hellopitty]

They drink too much of the damn Kool Aid they are given I tell you. Thank you. I was trying to see if FM in the US had was two years at one recent point and couldn’t only because anesthesia used to be three years total up until 1990 or so. And I think the GP anesthetist in Canada train for two years total as well. My BFF from Med school didn’t finish her surgical residency and has had a PCP clinic for five years now.

Need 5 years of training for anesthesia in canada

 

[chocomorsel]

Need 5 years of training for anesthesia in canada

Uhmm, nope, although I was initially wrong as it's not two years but three years. One year of anesthetic training after completing an FP residency which has been told above to be two years. These doctors are called Family Practice Anesthesiologists and practice in rural areas.
I looked into moving to Canada about a decade ago, and I remember they had a shorter course for FPs.

 

[chocomorsel]

These are all logical fallacies. The answer to NPs providing ****ty care is not to allow undertrained physicians to practice as well. OP didn’t complete a primary care residency. Saying “it’s just primary care” is super condescending and diminishes what PCPs do. Saying “they do it so we should too” is not a valid argument.

I am totally with you if someone is saying an NP is qualified to practice primary care but a physician with 2 TY years isn’t. That’s ludicrous. But I don’t think anyone here is saying that.

Nobody is saying provide "****ty care." Just pointing out that two years of TY is a huge, huge stepping stone to be a good PCP. Someone provide me with a general 2 years FP residency schedule versus 2 TY and I bet we can all see that there is a ton of overlap.
Maybe less clinic, but I would like to know what it is that you all learn in clinic that you don't learn in the hospital. I am with @Splenda88
I have a friend who did three years of surgical residency that took over a long standing FP practice and was encouraged to pursue this by her predecessor and is doing well. She didn't believe she could do it, but guess what, he believed in her and guided her and she took over. That's what we should be encouraging instead of "Finish residency!". I am sure if that were still an option, OP would jump at it.

And the whole, "It's not fair, If I had to do three years, you need to as well:-(" is a total cry-baby argument. Life's not fair, and OP will have lots of hurdles getting credentialed by insurance companies but stop saying they will provide subpar care.

Come on, can we learn to support each other instead of admonish each other?

 

[Splenda88]

Nobody is saying provide "****ty care." Just pointing out that two years of TY is a huge, huge stepping stone to be a good PCP. Someone provide me with a general 2 years FP residency schedule versus 2 TY and I bet we can all see that there is a ton of overlap.
Maybe less clinic, but I would like to know what it is that you all learn in clinic that you don't learn in the hospital. I am with @Splenda88
I have a friend who did three years of surgical residency that took over a long standing FP practice and was encouraged to pursue this by her predecessor and is doing well. She didn't believe she could do it, but guess what, he believed in her and guided her and she took over. That's what we should be encouraging instead of "Finish residency!". I am sure if that were still an option, OP would jump at it.

And the whole, "It's not fair, If I had to do three years, you need to as well:-(" is a total cry-baby argument. Life's not fair, and OP will have lots of hurdles getting credentialed by insurance companies but stop saying they will provide subpar care.

Come on, can we learn to support each other instead of admonish each other?

Curriculum | Transitional Year | Graduate Medical Education | IU School of Medicine

Access curriculum information about the IU School of Medicine Methodist Hospital Transitional Year Residency Program.

medicine.iu.edu

If you passed step 1/2 ck-cs/3 and do the above curriculum for 2 yrs and yet can't practice outpatient primary care, I am not sure what will prepare you.

 

[chocomorsel]

Curriculum | Transitional Year | Graduate Medical Education | IU School of Medicine

Access curriculum information about the IU School of Medicine Methodist Hospital Transitional Year Residency Program.

medicine.iu.edu

If you passed step 1/2 ck-cs/3 and do the above curriculum for 2 yrs and yet can't practice outpatient primary care, I am not sure what will prepare you.

Keep it real my sister!! Keep it real!!!

 

[tracheatoedoc]

The only good option is to complete a residency and become board certified. If you can’t accomplish that, then there are options in general practice and urgent care. You probably won’t have hospital privileges.

 

[Moose A Moose]

Except how long ago could doctors just finished with medical school hang out a shingle to practice general medicine without any sort of residency?
I disagree that OP isn’t qualified to practice general medicine after two years of TY.

Oh yeah? I’m sure you’d love to personally take him under your wing of liability and continued training for glaring deficits. TY is not training to be a complete internist or family physician. Even after two years.

OP: find a FM or IM residency in rural nowheresville and finish your training.

 

[Splenda88]

Oh yeah? I’m sure you’d love to personally take him under your wing of liability and continued training for glaring deficits. TY is not training to be a complete internist or family physician. Even after two years.

OP: find a FM or IM residency in rural nowheresville and finish your training.

Did you look at the transitional year curriculum that I posted above? It's literally doing 2-yr of FM.

 

[chocomorsel]

OP stop wasting your time on naysayers. Go out there and conquer the damn world!

 

[chocomorsel]

Did you look at the transitional year curriculum that I posted above? It's literally doing 2-yr of FM.

They don’t have to. They are so far up their own ass and drinking all the kool aid that they can’t see through all the murk.

 

[Splenda88]

They don’t have to. They are so far up their own ass and drinking all the kool aid that they can’t see through all the murk.

People in medicine have that overinflated sense of themselves. As a PGY3 IM resident, I posted 80-90% of what I see in clinic everyday and then posted a TY curriculum that show residents are exposed to all those and more, and still you find someone that says 'well, OP should do it the way it has been done.'

I dont know about other specialties: Primary care is not extremely difficult. I can list 20 diagnoses right now that if I am admitting 10 patients today in my tertiary center, 8-9 out these 10 patients will be admitted with one these diagnoses.

No one is saying OP will be like an FM resident on day 1, but after 6 months, his care will be indistinguishable to someone who graduated from FM residency if he does his homework.

 

[deleted1025203]

People in medicine have that overinflated sense of themselves. As a PGY3 IM resident, I posted 80-90% of what I see in clinic everyday and then posted a TY curriculum that show residents are exposed to all those and more, and still you find someone that says 'well, OP should do it the way it has been done.'

I dont know about other specialties: Primary care is not extremely difficult. I can list 20 diagnoses right now that if I am admitting 10 patients today in my tertiary center, 8-9 out these 10 patients will be admitted with one these diagnoses.

No one is saying OP will be like an FM resident on day 1, but after 6 months, his care will be indistinguishable to someone who graduated from FM residency if he does his homework.

You're IM. You don't do peds, women's health, OB, or EM like an FM doc does yet you want an untrained GP to just hop in and go with it, learning hard knocks style?

 

[Sushirolls]

You're IM. You don't do peds, women's health, OB, or EM like an FM doc does yet you want an untrained GP to just hop in and go with it, learning hard knocks style?

Online trained ARNPs are doing it. PAs are doing it.

We really need re-adjust the metrics of state based medical licensure in this country. Step 3/level 3 needs to be dropped. Graduating from a medical school MD/DO and completing step/level 1 & 2 should allow eligibility for an unrestricted medical license. Intern years or TY should only be required of international medical graduates.

Residencies and fellowships won't disappear. Continuing to pigeon hole medical graduates into our current paradigm is only going to hurt physicians as a whole in this country and hasten the demise of all physicians. As midlevels will simply have a competitive advantage in eyes of politicians, and bean counters.

The blinders that some docs have on for intern trained physicians when compared to midlevels is just mind boggling. For me and my family I will choose an intern physician over a PA or ARNP every time.