I am not pediatric board certified and would like to sit for the exam. However my eligibility has expired and the ABP has now required that I do a clinical training year that is essentially equivalent to being a third year resident. I am already in practice so this means giving up my practice and trying to find a vacancy which is extremely difficult. However not only am I going to take a huge loss of income for a year but now I am told that I may not be eligible for the PGY-3 stipend as I have already completed residency training. Hospitals now want me to pay them $2000-$2500 per month for training and that does not even include malpractice and health insurance. That means that I may have to pay $30,000-$50,000 just to fulfill ABP requirement and of course I still need to sit for the boards. This is a significant financial commitment which will leave me in quite some debt. Has anyone heard of how to handle this? I can not believe the ABP would place a requirement like this that is so costly. Even though this affects only a minority of physicians we are still part of the practicing community. Please help anyone....
pediatric board ineligible
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I agree that this seems insane, and don't know how to approach this issue. It's unclear to me whether the ABP really thought this through in terms of what it would mean for programs, physicians and families. My guess is that a lot of people are just going to keep practicing and not bother with getting certified. It's already expensive enough to take the exam. There's no way I would take on that kind of debt and uproot my family for this. Hopefully others can have some useful input. Good luck.
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So, the ABP has a variety of rules, this includes both time limitations on passing the boards and a 3 strike (failures on pedi boards) and you need to redo a residency year rule. I'm not an expert on either but I suspect that waivers are impossible-to-absolutely impossible to obtain without a truly compelling reason that would probably involve a medal of honor or something like that and even then, I'm doubtful.
So, you didn't tell us why you're in this situation, but regardless, although you can appeal, I am not optimistic. Sorry I don't have any strategies for you as I don't think there's much that can be done.
Now then, I am surprised that no hospital is willing to let you do a year of residency for free if you take call. I wonder if you are geographically very limited or if you've looked at all residency openings in Freida and written to every pedi residency in the US? I also wonder if some programs would let you moonlight while doing this year.
Finally, as Stitch says, there are plenty of non-boarded pediatricians practicing out there. Sure, it is somewhat limiting and not ideal, but there are plenty of places that won't care. That may change with time, but I bet it won't completely.
Good luck
So, you didn't tell us why you're in this situation, but regardless, although you can appeal, I am not optimistic. Sorry I don't have any strategies for you as I don't think there's much that can be done.
Now then, I am surprised that no hospital is willing to let you do a year of residency for free if you take call. I wonder if you are geographically very limited or if you've looked at all residency openings in Freida and written to every pedi residency in the US? I also wonder if some programs would let you moonlight while doing this year.
Finally, as Stitch says, there are plenty of non-boarded pediatricians practicing out there. Sure, it is somewhat limiting and not ideal, but there are plenty of places that won't care. That may change with time, but I bet it won't completely.
Good luck
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Obtaining a medical license is an entirely different process than being board certified in a specialty. A medical license is given by a state based on established criteria in that state. Usually it means at least one year of residency in the US or Canada, in some states there are a range of other rules or more years required. With that license, one can practice medicine. What exactly that means is way beyond the scope of this post, but it might include providing care for children in some states and settings.
Now, residencies are under the auspices of the ACGME (for allopathic ones). Although the ACGME works with the various specialty boards, including the ABP (Am Bd Ped), they are not the same. Furthermore, lots of folks complete non-pediatric residencies and "practice" medicine including caring for children. This includes family medicine docs and even at times internists who might be practicing. Furthermore, it is possible for physicians who complete fellowship training in the US (e.g. in a pedi specialty) but have not done a pediatric residency in the US to practice their specialty.
The ABP does not determine who can get a medical license, who can provide care for children, or what limits of practice exist for non-boarded physicians. They only determine who meets their standards for becoming board certified. For a long-time, board certification in pediatrics was "lifetime". You took the test and never did it again. I did that for both pedi and neo. I chose to voluntarily recertify in neo but keep my lifetime certification in pedi and not voluntarily recertify pedi as it isn't useful for my practice. Currently it is unnecessary for most time-limited certifiers in pedi/subspecialty to recertify general pediatrics if they intend to practice only specialty medicine.
Now then, here's where it gets hazy. There are lots of reasons why a physician providing medical care to children (lets leave surgery, derm, anesthesia, etc out of this) as a primary care doc or in a specialty might not be board certified in pediatrics or a pedi specialty. They include:
1. Just graduated from residency and haven't taken the boards yet
2. Took the boards and failed and are waiting to retake
3. Were trained internationally and are not eligible for boards in pedi in the US (Didn't do a US/Canadian residency) but did do a fellowship in the US and thus have an unlimited medical license.
4. Simply chose not to take the boards (often related to family reasons - having a baby at home, etc)
5. Did not do a pediatric residency (e.g. did family medicine, EM) but are seeing children.
6. Are training in or working in another area but moonlighting in an urgicare center, etc.
7. Time-limited certification has lapsed.
8. Rare special exceptions to practice rules for experts from other countries.
I'm sure there are more. A medical license allows all of these to care for children. Individual hospitals may choose not to give any or all of these practice rights there and a group may choose to hire or not hire these. Almost all hospitals/groups would hire several of these categories depending on many factors. Why? Well, it's obvious for #1 and honestly I think it's obvious for some of the others for most places. Other places might simply be short-handed and be willing to take someone who is adequately trained in their view but not certified for one of those reasons. Not much stops you from hanging out the shingle and practicing as long as you don't call yourself a "board-certified pediatrician" if you're not. Easy enough to check at www.abp.org
Is this appropriate (probably your real question)?
In my mind, yes. It should be a goal for those who care for children to have the appropriate boards (which might include family medicine, etc) but it is not as simple as "no boards, no practice". Every situation has to be evaluated individually. There are great docs out there who fit into one of those categories and, for practical reasons, may never get boarded in any specialty.
Now, residencies are under the auspices of the ACGME (for allopathic ones). Although the ACGME works with the various specialty boards, including the ABP (Am Bd Ped), they are not the same. Furthermore, lots of folks complete non-pediatric residencies and "practice" medicine including caring for children. This includes family medicine docs and even at times internists who might be practicing. Furthermore, it is possible for physicians who complete fellowship training in the US (e.g. in a pedi specialty) but have not done a pediatric residency in the US to practice their specialty.
The ABP does not determine who can get a medical license, who can provide care for children, or what limits of practice exist for non-boarded physicians. They only determine who meets their standards for becoming board certified. For a long-time, board certification in pediatrics was "lifetime". You took the test and never did it again. I did that for both pedi and neo. I chose to voluntarily recertify in neo but keep my lifetime certification in pedi and not voluntarily recertify pedi as it isn't useful for my practice. Currently it is unnecessary for most time-limited certifiers in pedi/subspecialty to recertify general pediatrics if they intend to practice only specialty medicine.
Now then, here's where it gets hazy. There are lots of reasons why a physician providing medical care to children (lets leave surgery, derm, anesthesia, etc out of this) as a primary care doc or in a specialty might not be board certified in pediatrics or a pedi specialty. They include:
1. Just graduated from residency and haven't taken the boards yet
2. Took the boards and failed and are waiting to retake
3. Were trained internationally and are not eligible for boards in pedi in the US (Didn't do a US/Canadian residency) but did do a fellowship in the US and thus have an unlimited medical license.
4. Simply chose not to take the boards (often related to family reasons - having a baby at home, etc)
5. Did not do a pediatric residency (e.g. did family medicine, EM) but are seeing children.
6. Are training in or working in another area but moonlighting in an urgicare center, etc.
7. Time-limited certification has lapsed.
8. Rare special exceptions to practice rules for experts from other countries.
I'm sure there are more. A medical license allows all of these to care for children. Individual hospitals may choose not to give any or all of these practice rights there and a group may choose to hire or not hire these. Almost all hospitals/groups would hire several of these categories depending on many factors. Why? Well, it's obvious for #1 and honestly I think it's obvious for some of the others for most places. Other places might simply be short-handed and be willing to take someone who is adequately trained in their view but not certified for one of those reasons. Not much stops you from hanging out the shingle and practicing as long as you don't call yourself a "board-certified pediatrician" if you're not. Easy enough to check at www.abp.org
Is this appropriate (probably your real question)?
In my mind, yes. It should be a goal for those who care for children to have the appropriate boards (which might include family medicine, etc) but it is not as simple as "no boards, no practice". Every situation has to be evaluated individually. There are great docs out there who fit into one of those categories and, for practical reasons, may never get boarded in any specialty.
Thanks everyone for all your comments so far.
I am unfortunately in this situation and would like to meet the ABP requirements but am having a very hard time trying to make it happen. There are no guidelines or protocols to follow and programs are arbitrarily doing their own thing. My predicament is that a huge burden is placed on the physician as there are no advocacy or committee groups to which I can seek out assistance on my behalf. While the ABP does not require me to do a residency there aren't any programs near me willing to just find a spot to do a training year especially since I did not train there. Furthermore, I'm afraid this has turned into a huge profit making business for the hospitals even though I am willing to work for free. Yes some are charging $2500/mo. just to be at their facility which conservatively puts me out $30,000. Indeed I am limited by location as I have a family to consider but have now looked into moving and also contacted my training program. Again the added expense of moving/renting for a year and paying any hospital associated fees is a significant financial undertaking. I am just trying to understand how the ABP would have this requirement and not consider the challenges and burdens it places upon the physician to complete this endeavour. The logistical part of this process is really lacking and has now become an issue of a requirement that looks good in theory but practically speaking is extremely difficult and costly to fulfill.
Btw thanks for the Freida site. I will continue to look there as well.
I am unfortunately in this situation and would like to meet the ABP requirements but am having a very hard time trying to make it happen. There are no guidelines or protocols to follow and programs are arbitrarily doing their own thing. My predicament is that a huge burden is placed on the physician as there are no advocacy or committee groups to which I can seek out assistance on my behalf. While the ABP does not require me to do a residency there aren't any programs near me willing to just find a spot to do a training year especially since I did not train there. Furthermore, I'm afraid this has turned into a huge profit making business for the hospitals even though I am willing to work for free. Yes some are charging $2500/mo. just to be at their facility which conservatively puts me out $30,000. Indeed I am limited by location as I have a family to consider but have now looked into moving and also contacted my training program. Again the added expense of moving/renting for a year and paying any hospital associated fees is a significant financial undertaking. I am just trying to understand how the ABP would have this requirement and not consider the challenges and burdens it places upon the physician to complete this endeavour. The logistical part of this process is really lacking and has now become an issue of a requirement that looks good in theory but practically speaking is extremely difficult and costly to fulfill.
Btw thanks for the Freida site. I will continue to look there as well.
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@oldbearprofessor ... Can someone get an unrestricted US medical license by just completing a fellowship here, but did a residency in another country?
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There is no such thing as a "US medical license", all licenses are granted by states. I believe most if not all would agree to this (not sure for every state), but they must have passed the requisite tests such as the USMLEs. Getting a position as a fellow these days without a US/Canadian residency is difficult.
You may find this helpful
http://www.fsmb.org/usmle_eliinitial.html
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