Not board eligible: what's the ceiling?

[happymedgrad]

Hi all,

I've been searching for hours and haven't found what I'm looking for yet. I hope someone can help.

If an IMG (med school, IM residency, gen cards) goes to the US for a research fellowship (HMS) then transitions to subspecialty training and wants to stay on as an attending what is the best he or she could hope for in terms of remuneration and center\location? Obviously unwilling to go back and do a residency to get board certified. Also, the research will not be a big feature long term due to the prohibitive cost and unrealistic time frame required to get properly trained, so at most 'dabbling'.

From my hours of reading I gather a non boards physician might get a job as an employee in an academic hospital but I've no sense of what that pays or how many opportunities there are like that. In short, what's the ceiling for someone in the situation I described?

Thanks.

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[Raryn]

Hi all,

I've been searching for hours and haven't found what I'm looking for yet. I hope someone can help.

If an IMG (med school, IM residency, gen cards) goes to the US for a research fellowship (HMS) then transitions to subspecialty training and wants to stay on as an attending what is the best he or she could hope for in terms of remuneration and center\location? Obviously unwilling to go back and do a residency to get board certified. Also, the research will not be a big feature long term due to the prohibitive cost and unrealistic time frame required to get properly trained, so at most 'dabbling'.

From my hours of reading I gather a non boards physician might get a job as an employee in an academic hospital but I've no sense of what that pays or how many opportunities there are like that. In short, what's the ceiling for someone in the situation I described?

Thanks.

This question has two possible answers.

1) Theoretically, someone who is a very accomplished individual that completed their training abroad can get hired by an academic medical center as faculty with no limits on their pay relative to any of the other faculty. Academicians make less than doctors in private practice, but not all that much less. After a certain period of time (a minimum of 8 years) the chair of the department can even sponsor such an individual to get board eligibility/the ability to take the certification exam. Please see http://www.abim.org/certification/policies/candidates-special-consideration.aspx
2) The chance that you actually manage to make it down that pathway is practically zero. From what I understand, it's practically never used.

 

[gutonc]

Here's another issue you may not have thought about. Lots of states will allow for licensing a "foreign scholar" which is basically the same as a resident's limited license. But, at the same time, some states (mine included) are cracking down on these and requiring these "foreign scholars" to, at the very least, take and pass all the Steps before being allowed to continue to practice after a certain period of time. So the BC/BE thing is an issue but the state licensing thing is a much bigger potential problem.

 

[happymedgrad]

This question has two possible answers.

1) Theoretically, someone who is a very accomplished individual that completed their training abroad can get hired by an academic medical center as faculty with no limits on their pay relative to any of the other faculty. Academicians make less than doctors in private practice, but not all that much less. After a certain period of time (a minimum of 8 years) the chair of the department can even sponsor such an individual to get board eligibility/the ability to take the certification exam. Please see http://www.abim.org/certification/policies/candidates-special-consideration.aspx
2) The chance that you actually manage to make it down that pathway is practically zero. From what I understand, it's practically never used.

Thanks for the reply and link.

Just to clarify two points relating to your 1st one: I wouldn't complete my training abroad, it would be a fellowship in the US. You may have meant completed basic training up to but not including subspecialty training which would be correct. Second, I would not be an academician I think. My original plan was to go that route via a PhD but it seems unfeasible and I'm toning down my aspirations in that regard. I'll get a year or two high quality research but not enough to launch a career, so in ten or twenty years time wherever I am I will most likely be a clinician, maybe with a small element of research depending on the institution and availability of resources\time.

Is there really no limit on pay if someone not board eligible gets hired? I can't make full sense of the system but I thought someone in that situation would get paid a fixed salary by the hospital and that it would be comparatively paltry (mid 100s? 200? I haven't a clue) compared to the private jobs you see advertised starting at a good 6 figures for an interventional cards subspecialty (300 or 350k or whatever). I suppose this is what I hope for clarity on.

To put it more simply I have 2 choices: a fellowship now in Europe with a definitely restricted income thereafter in a creaking medical system and most importantly a lot of uncertainty about the future (7 years austerity and still no growth. My daughter who is now 1 year old will be a debt worker. Way to go Angela and co). Or sit the usmles, wait, then do a fellowship in the US which would take longer, cost more money and put my family through a bit more pain.

I'm trying to figure out what the chances are that option 2 will lead to a bigger reward. Sorry for the long post but any further help is much appreciated.

 

[happymedgrad]

Here's another issue you may not have thought about. Lots of states will allow for licensing a "foreign scholar" which is basically the same as a resident's limited license. But, at the same time, some states (mine included) are cracking down on these and requiring these "foreign scholars" to, at the very least, take and pass all the Steps before being allowed to continue to practice after a certain period of time. So the BC/BE thing is an issue but the state licensing thing is a much bigger potential problem.

P

Thanks for the reply. I have 3 years acgme IM (abroad) and would sit the usmles (prob this year). I checked and can't see additional requirements for licensing in any state. Are there any I've missed?

 

[deleted480308]

P

Thanks for the reply. I have 3 years acgme IM (abroad) and would sit the usmles (prob this year). I checked and can't see additional requirements for licensing in any state. Are there any I've missed?

Where is there acgme overseas?

 

[gutonc]

Where is there acgme overseas?

There is a program called ACGME-I which accredits foreign training programs (currently in Singapore, Qatar and UAE) to the same standards as US programs.

P

Thanks for the reply. I have 3 years acgme IM (abroad) and would sit the usmles (prob this year). I checked and can't see additional requirements for licensing in any state. Are there any I've missed?

I think there's some misunderstanding (perhaps intentional on the part of the programs who seek the accreditation) about what the ACGME-I means. It is not intended to substitute for US residency training and completion of it does not qualify one for US licensure (regardless of completing the Steps) or BC/CE, nor is it intended as a stepping stone to a US fellowship. Yes, it's true that you can apply for a fellowship in the US but your chances are small and (unless you choose something like nephrology which residents in the US are fleeing like rats from a sinking ship) are getting smaller as the number of residents in the US increases and some sub-specialties cut back on training spots to help prevent this problem.

So you need to add into your calculus above the fact that you might not every get a job in the US no matter how well you do on the Steps. To the salary issue, academic salaries are lower than PP salaries. If you were to complete the Steps, complete a US training program and obtain a state license or 3 in the US, you would not be limited to jobs in academic settings. But that's a lot of "ifs" to hang the next 5 or so years of your life on. Add the visa issues you (and your family) will encounter and you're going to "really" have to want this.

 

[flipmd]

I have an uncle who never did residency in the US but finished additional Cards subspecialty training, then went into an academic/research > clinician role in a big program. His mentors (very big names in Cardiology/CT Surg who all doctors I'm sure have at least heard of) applied for and got an exemption for him and is now fully licensed. Still licensed, but the whole thing happened in the early 80s or even late 70s, so....

 

[gutonc]

I have an uncle who never did residency in the US but finished additional Cards subspecialty training, then went into an academic/research > clinician role in a big program. His mentors (very big names in Cardiology/CT Surg who all doctors I'm sure have at least heard of) applied for and got an exemption for him and is now fully licensed. Still licensed, but the whole thing happened in the early 80s or even late 70s, so....

And this is the key. It's also the reason people keep going offshore for med school. This is not the way the world works these days. Don't pretend that it will...assume that it won't.

 

[happymedgrad]

There is a program called ACGME-I which accredits foreign training programs (currently in Singapore, Qatar and UAE) to the same standards as US programs.

I think there's some misunderstanding (perhaps intentional on the part of the programs who seek the accreditation) about what the ACGME-I means. It is not intended to substitute for US residency training and completion of it does not qualify one for US licensure (regardless of completing the Steps) or BC/CE, nor is it intended as a stepping stone to a US fellowship. Yes, it's true that you can apply for a fellowship in the US but your chances are small and (unless you choose something like nephrology which residents in the US are fleeing like rats from a sinking ship) are getting smaller as the number of residents in the US increases and some sub-specialties cut back on training spots to help prevent this problem.

So you need to add into your calculus above the fact that you might not every get a job in the US no matter how well you do on the Steps. To the salary issue, academic salaries are lower than PP salaries. If you were to complete the Steps, complete a US training program and obtain a state license or 3 in the US, you would not be limited to jobs in academic settings. But that's a lot of "ifs" to hang the next 5 or so years of your life on. Add the visa issues you (and your family) will encounter and you're going to "really" have to want this.

Sorry. I was wrong about acgme. I meant my training is recognised by ecfmg and i can sit the usmles.

Also, I've already interviewed for fellowships in the US and been accepted...but for 2 or 3 years hence. I have a european fellowship for later this year which would kill the research stone dead and narrow the long term options to home only.

So... (and I'm really sorry, i feel like I've phrased my question badly 2 or 3 times), my final training if i go with US fellowship is potentially: foreign med school --> foreign IM -->foreign gen cards --> US research --> US subspecialty fellowship

I'll have the usmles also (is this what you call steps btw?).

My understanding is that i wont be board eligible with this hand I've dealt myself and I want to understand the potential jobs/salary i could get. A poster (raryn) above said someone in this situation could earn what any faculty in an academic center makes, is this true and if so what do they make on average? You yourself mentioned about not being limited to academic settings but in the context of 'completed US training'...do you mean completed IM and cards residencies and got boards or do you mean the path i will have completed? If a non-board eligible physician somehow got hired by a PP would they be paid a relatively low wage or could they clear what their colleagues make?

Sorry for going on (esp with the focus on money but unfortunately it's such a huge part of the decision regarding how much short-medium term pain to invest. I've already been through the mill and have massive debt. If my earning in the US would max at 150 - 200k/year i should truncate research and go with the home/european fellowship option. If it's 250 or above then i should sign up for US route and give it my best shot. If it's 300-400+ I would sign in blood, sorry to say) and i really do appreciate the ongoing help.

 

[McSap]

If your fellowship has been accepted but is not due to start for another 2-3 years, would it be possible to delay it by another 1-2 years to allow you to complete an IM residency first? Given that you've already been accepted to a fellowship, its likely you would get into a residency somewhere (with decent USMLE scores etc), and this pathway would greatly increase your job prospects in the long term by making you board eligible, assuming you are 100% committed to wanting to practice in the US, and assuming you can work out whatever visa issues you may have. (plus you would have a realistic shot at your 300-400 target salary)

Trust me, i know how hard of a prospect it is to be going back to repeat a residency, i'm a current applicant in a not too dissimilar situation from yourself, but 3 years will go by fast and will be worth it in the long term.

 

[DrBacchi]

Apply for a residency instead of fellowship and you'll be BE/BC, do acgme fellowships even accept non-acgme residents anymore?

 

[happymedgrad]

If your fellowship has been accepted but is not due to start for another 2-3 years, would it be possible to delay it by another 1-2 years to allow you to complete an IM residency first? Given that you've already been accepted to a fellowship, its likely you would get into a residency somewhere (with decent USMLE scores etc), and this pathway would greatly increase your job prospects in the long term by making you board eligible, assuming you are 100% committed to wanting to practice in the US, and assuming you can work out whatever visa issues you may have. (plus you would have a realistic shot at your 300-400 target salary)

Trust me, i know how hard of a prospect it is to be going back to repeat a residency, i'm a current applicant in a not too dissimilar situation from yourself, but 3 years will go by fast and will be worth it in the long term.

Thanks for the reply. It's a good thought to consider repeating a residency and it has crossed my mind. The main purpose of my thread I suppose was to try to find out what I could make if I didn't go back and end up board certified. I still feel like I don't know but I think i'm gonna go with an american fellowship anyway and see what comes my way. I see what you're saying about an IM residency being worth it in the long term but I wasn't really aiming for the sky-high salaries you see advertised, more just the best i can get with what i have.

thanks everyone for all your help.

 

[DrBacchi]

What fellowship have you been accepted to?

 

[flipmd]

The question is not how much you'll earn without BC/BE, but whether you'll be able to do any CLINICAL work at all without it. Likely answer with only few exceptions would be probably not.