Possibilities for board certification without residency

[yyy103]

Hi,

I am looking for some advice.

I qualified in the UK and have completed all my postgraduate training here. This includes IM, and completing two fellowships in my subspecialty. I also hold a PhD in my field.

I will be moving to the US to start another Fellowship in July. I do not have residency in the US. My Fellowship will not be ACGME accredited. I am full US citizen so have no Visa issues.

I have my ECFMG, and a limited license in my proposed state. I will plan to rapidly take Step 3 and get an unlimited license.

My questions is regarding getting board certified in my subspecialty (and IM by extension, as I understand that will be necessary).

I have scoured the ABIM website and found the section on Special Considerations for IMGs:

Eligible faculty will have:

• Completed three or more years of verified graduate medical education training in internal medicine and/or a subspecialty abroad.
• Certification in Internal Medicine from ABIM for certification in a subspecialty.
• An academic rank of Assistant Professor or higher.
• A full-time faculty appointment for a minimum of three (3) immediately prior and consecutive years at the same institution.
• Full-time faculty members are those who supervise and teach trainees (students, residents or fellows) in clinical settings that include direct patient care.
• The appointment must be at an LCME- or Canadian-accredited medical school or at an ACGME- or Canadian-accredited internal medicine residency or subspecialty fellowship training program.
• A valid, unrestricted and unchallenged medical license to practice medicine in the United States, its territories or Canada

My question is - is anybody aware of any other way to go about getting board certified at this stage in my career? Repeating Residency is obviously not an option. Does anybody have any experience of any extenuating circumstances?

I may have the scope to do another year's Fellowship, which would give me two years at the same institution - but neither of these will be ACGME accredited.

Any advice or past experiences that might be relevant would be greatly appreciated.

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[doc05]

Just redo your residency. It's only 3 years

 

[NotAProgDirector]

There is no other way, to my knowledge.

Also, I don't think you'll find that that your plan to "rapidly take Step 3 and get an unlimited license" is going to be very effective. All states (to my knowledge) require multiple years of ACGME accredited training in the US to be considered for a license.

 

[deleted480308]

There is no other way, to my knowledge.

Also, I don't think you'll find that that your plan to "rapidly take Step 3 and get an unlimited license" is going to be very effective. All states (to my knowledge) require multiple years of ACGME accredited training in the US to be considered for a license.

A number are only one for a license with a US med school, it might be different if trained overseas

 

[rokshana]

Hi,

I am looking for some advice.

I qualified in the UK and have completed all my postgraduate training here. This includes IM, and completing two fellowships in my subspecialty. I also hold a PhD in my field.

I will be moving to the US to start another Fellowship in July. I do not have residency in the US. My Fellowship will not be ACGME accredited. I am full US citizen so have no Visa issues.

I have my ECFMG, and a limited license in my proposed state. I will plan to rapidly take Step 3 and get an unlimited license.

My questions is regarding getting board certified in my subspecialty (and IM by extension, as I understand that will be necessary).

I have scoured the ABIM website and found the section on Special Considerations for IMGs:

Eligible faculty will have:

• Completed three or more years of verified graduate medical education training in internal medicine and/or a subspecialty abroad.
• Certification in Internal Medicine from ABIM for certification in a subspecialty.
• An academic rank of Assistant Professor or higher.
• A full-time faculty appointment for a minimum of three (3) immediately prior and consecutive years at the same institution.
• Full-time faculty members are those who supervise and teach trainees (students, residents or fellows) in clinical settings that include direct patient care.
• The appointment must be at an LCME- or Canadian-accredited medical school or at an ACGME- or Canadian-accredited internal medicine residency or subspecialty fellowship training program.
• A valid, unrestricted and unchallenged medical license to practice medicine in the United States, its territories or Canada

My question is - is anybody aware of any other way to go about getting board certified at this stage in my career? Repeating Residency is obviously not an option. Does anybody have any experience of any extenuating circumstances?

I may have the scope to do another year's Fellowship, which would give me two years at the same institution - but neither of these will be ACGME accredited.

Any advice or past experiences that might be relevant would be greatly appreciated.

the bolded parts are your rate limiters...you cannot become ABIM certified in a subspecialty without ABIM certification in the core specialty, meaning IM BC is needed.
basically these exceptions help Canadians.

if redoing an IM residency is an absolute no, then you would be best served to stay in the UK.

 

[twospadz]

I'm sorry but I don't know where you are getting your info. As a foregin grad, you will not be eligible for a license after at least 2 years of residency or more in every states. So you will have to do residency for at least 2 years. Not even US grads are exempted from at least 1 year of residency. Your credentials in the UK will not exempt you either.

 

[atomi]

It is possible for a foreign trained radiologist or radiation oncologist to become board certified in the US by either being hired by a teaching institution in a junior faculty role for 4 years or doing 4 years of unofficial fellowship at an academic program. I.e., becoming board certified WITHOUT doing an official residency.

 

[NotAProgDirector]

Mostly, no.

The problem is that the foreign trained doc can't get a license up front. Therefore, they can't do any clinical work. Most non-ACGME fellowships have some work component to help pay for the position. Like the OP of this thread, it might be possible for them to do a fellowship under a training license. However all of the official ACGME fellowships require that applicants already have completed core training in the specialty. So, like the OP, they can do a non-ACGME fellowship, but that usually doesn't count towards licensure requirements (although each state is different, so perhaps in some state it would work).

Since I answered "mostty, no", there must be some exceptions.

1. The requirement that applicants for fellowships have core US training does have an exception. If the applicant is "exceptionally qualified", the fellowship can ask the institution for an exception. This requires a review by the GMEC, and presumably a vote. This would then get the applicant into the ACGME fellowship under a training license, and they would be able to get the training needed (often 3 years, sometimes 2, and rarely 1). But they might not be able to sit for the boards. In IM, the chair of a department can request the ABIM consider exceptional candidates.

2. My knowledge is mostly around IM and it's fellowships. The requirement for core training before fellowship is part of the core program requirements, so should be universal. But perhaps other fields are more flexible.

3. It's possible that non-ACGME accredited training might be considered acceptable by some state boards. Plus, boards can make exceptions -- if someone "connected" enough is willing to advocate for someone, it's possible that they might consider someone with atypical training. Maybe. But this might open them to others applying, and claiming discrimination if rejected.

4. There are 50 states, perhaps a small number have a different pathway. For example, the "Assistant Physician" in Missouri.

 

[TraumaLlamaMD]

3. It's possible that non-ACGME accredited training might be considered acceptable by some state boards. Plus, boards can make exceptions -- if someone "connected" enough is willing to advocate for someone, it's possible that they might consider someone with atypical training. Maybe. But this might open them to others applying, and claiming discrimination if rejected.

So like the plots of Suits, but for doctors?

 

[kchan99]

I don't know about board certification, but in some states, there is an eminent medical faculty licensing pathway that does not require completing residency in the US, but at the same time, the scope of practice is limited and is related to their research or special skills.

 

[NotAProgDirector]

So like the plots of Suits, but for doctors?

Yes. But with less sex.

 

[Old_Mil]

It's difficult for a US trained physician, even a board certified one, to transition into the British System and vice versa. US board certified physicians are typically brought on as registrars in your system, and UK board certified physicians as residents in the ours.

Have you considered going to New Zealand, Australia, or Canada instead? In the latter two countries your pay should be close to what you will make in the US, less in New Zealand.

 

[rastko]

Does anybody know, if neuroradiology fellowships are all ACGME acc.? In addition, how can you as a IMG trained radiologist apply for the non-ACGME fellowships, as you need a state license, which you won't get without prior US ACGME experience?

 

[MumbleBee]

Just redo your residency. It's only 3 years

I want to redo residency but program directors say I can’t because I already used 3years of funding of government subsidies and no one wantsa non-funded resident who wants to be in a new specialty. Anyone know of programs that don’t care about funding or would let me complete a residency for no to minimal wages since I really only want to finish a residency and I don’t care about pay?
Changing from OB GYN to Family Med.

 

[Ironheme]

I want to redo residency but program directors say I can’t because I already used 3years of funding of government subsidies and no one wantsa non-funded resident who wants to be in a new specialty. Anyone know of programs that don’t care about funding or would let me complete a residency for no to minimal wages since I really only want to finish a residency and I don’t care about pay?
Changing from OB GYN to Family Med.

You need to reapply through the match. Programs will decide whether or not they want to take you. Have a compelling reason you want to switch. Apply broadly, and especially your home state.

 

[Apollyon]

The ACGME won't let you work for free (otherwise, rich parents would support their kids doing ortho and derm for free). I'd heard in the distant past that there were DO programs that you could attend for no pay, but, I don't know where, and if that even exists anymore.

 

[GoSpursGo]

I want to redo residency but program directors say I can’t because I already used 3years of funding of government subsidies and no one wantsa non-funded resident who wants to be in a new specialty. Anyone know of programs that don’t care about funding or would let me complete a residency for no to minimal wages since I really only want to finish a residency and I don’t care about pay?
Changing from OB GYN to Family Med.

I'm not an expert at this, but my general understanding is your best bet is going to be some of the larger programs that have a large number of residents spread across numerous specialties. If a hospital has literally hundreds of residents, it probably makes little difference if they have a few unfunded residents on their payroll; if you're in a small community program where that FM program is just about it, that government funding may be a big deal.

Ultimately, I agree with the poster above that you're unlikely to find the information you want online because it doesn't exist; whether or not a program would consider an unfunded resident is going to be tied to how competitive your application is, and nobody is going to give you an in-depth review of your application without actually applying. Just apply broadly, and you'll find out which programs are interested in potentially unfunded residents.

 

[braineddetermined]

If you passed all steps of USMLE and have ECFMG certificate, you can apply for Oklahoma state license. They acknowledge UK training. Practice for a while in Oklahoma till you become eligible for alternative pathway of board certification. I know people who have done this. It confusing and frustrating, but doable. Good luck!

Leave me your email and I can talk to you directly if you need guidance.

Just to make sure, you can get a medical license without completing 1 year of postgraduate accredited training if you’re already like the OP, a UK specialist?

“The applicant shall have satisfactorily completed twelve (12) months of progressive postgraduate medical training approved by the Board or by a private nonprofit accrediting body approved by the Board in an institution in the United States, its territories or possessions, or in programs in Canada, England, Scotland, Ireland, Australia or New Zealand approved by the Board or by a private nonprofit accrediting body approved by the Board”

 

[Piebaldi]

Just to make sure, you can get a medical license without completing 1 year of postgraduate accredited training if you’re already like the OP, a UK specialist?

“The applicant shall have satisfactorily completed twelve (12) months of progressive postgraduate medical training approved by the Board or by a private nonprofit accrediting body approved by the Board in an institution in the United States, its territories or possessions, or in programs in Canada, England, Scotland, Ireland, Australia or New Zealand approved by the Board or by a private nonprofit accrediting body approved by the Board”

No. You must pass all steps - 1-3 - in order to get a permanent license.

 

[braineddetermined]

No. You must pass all steps - 1-3 - in order to get a permanent license.

I already know that you must pass step 1, 2 ck/cs and 3. But what I’m not sure is that in case of OK do you also need to have 1 year of post graduate training (if you’re already UK trained) in an accredited program to get a license ( as the norm) or not? Can it be in an unaccredited program also acceptable?

 

[Piebaldi]

I already know that you must pass step 1, 2 ck/cs and 3. But what I’m not sure is that in case of OK do you also need to have 1 year of post graduate training (if you’re already UK trained) in an accredited program to get a license ( as the norm) or not? Can it be in an unaccredited program also acceptable?

Yes, you still have to do 1, and most frequently 2, years of training - for an IMG - in order to get a license. You can look at specific requirements on each board's website.

 

[LucidSplash]

I already know that you must pass step 1, 2 ck/cs and 3. But what I’m not sure is that in case of OK do you also need to have 1 year of post graduate training (if you’re already UK trained) in an accredited program to get a license ( as the norm) or not? Can it be in an unaccredited program also acceptable?

specific requirements for OK are found here:

http://www.okmedicalboard.org/download/672/MD_Application_Instructions.pdf

 

[Gastrapathy]

That sounds more difficult than a 3 year residency which would automatically let you practice anywhere.

 

[Samira Chandra]

My condition is also pretty similar. I attended three years resisency in my home country in a non-acgme accredited program. When I moved to the USA, I already was an old graduate (>5 years since med school graduation). I faced hard time finding an IM Residency spot. Then I suddenly received a subspeciality fellowship offer from an ACGME accredited NYC based program. I worked for the program for 8months and eventually decided to pursue the same fellowship training in a university based program who accepts candidate with international training.
Now, coming back to your question- is there anyway to be board certified without US residency training? Well, let me share what I've learned during my fellowship interview process. I was told by the chief of my new program during my interview day that - there will be two options for me to be board certified. No.1- doing US residency after the fellowship or, No.2- a fifth pathway. A fifth pathway is basically a faculty position that a teaching hospital can create for the candidate who has good international academic profile but lacks board certification. After working as a teaching faculty for the sponsoring program for 3 years, the candidate become eligible for ABIM board exam. I still am new to the process, if I get more information about the fifth pathway then I will share with you all.

Thanks

 

[rokshana]

My condition is also pretty similar. I attended three years resisency in my home country in a non-acgme accredited program. When I moved to the USA, I already was an old graduate (>5 years since med school graduation). I faced hard time finding an IM Residency spot. Then I suddenly received a subspeciality fellowship offer from an ACGME accredited NYC based program. I worked for the program for 8months and eventually decided to pursue the same fellowship training in a university based program who accepts candidate with international training.
Now, coming back to your question- is there anyway to be board certified without US residency training? Well, let me share what I've learned during my fellowship interview process. I was told by the chief of my new program during my interview day that - there will be two options for me to be board certified. No.1- doing US residency after the fellowship or, No.2- a fifth pathway. A fifth pathway is basically a faculty position that a teaching hospital can create for the candidate who has good international academic profile but lacks board certification. After working as a teaching faculty for the sponsoring program for 3 years, the candidate become eligible for ABIM board exam. I still am new to the process, if I get more information about the fifth pathway then I will share with you all.

Thanks

No that’s not what the fifth pathway was

ECFMG News | Important Announcement Regarding Fifth Pathway Certificates and USMLE Step 3

www.ecfmg.org

It also ended in 2009.

 

[Raryn]

No that’s not what the fifth pathway was

ECFMG News | Important Announcement Regarding Fifth Pathway Certificates and USMLE Step 3

www.ecfmg.org

It also ended in 2009.

I think what OP is discussing is the "special consideration" path and just used the wrong terminology for it. Every board is different, but ABIM's example is here: Candidates for Special Consideration | ABIM.org Someone who initially trained abroad but is now US faculty for 3 years may become ABIM eligible. They can then get their subspecialty certificates on that basis. From what I recall being told in the past is it's quite difficult to get that training path approved, but I don't know the specifics.

I know radiology and orthopedic surgery have paths as well, though there people often have to do multiple fellowships to qualify. I'm not sure about other fields.

 

[braineddetermined]

Radiology training, at least on paper, is pretty easy to be recognized if you’re already a radiologist in your home country. Only have to do 3 accredited fellowships and you’re board certified. There are also univ which have programs geared to IMG.

OT: I guess for dermatology there’s no “special recognition”

 

[rastko]

Radiology training, at least on paper, is pretty easy to be recognized if you’re already a radiologist in your home country. Only have to do 3 accredited fellowships and you’re board certified. ”

- Very hard to get 3 fellowships in a same institution
- you are not allowed to apply to an acgme fellowship
- since you don't get acgme training, after board certification, you are not eligible for a permanent state license, unless you do minimum of 3 years of some kind of acgme program
- after you do all that, it's almost impossible to get H1B visa, so you are yanked all around the US on one after another J1 visa

 

[braineddetermined]

- Very hard to get 3 fellowships in a same institution
- you are not allowed to apply to an acgme fellowship
- since you don't get acgme training, after board certification, you are not eligible for a permanent state license, unless you do minimum of 3 years of some kind of acgme program
- after you do all that, it's almost impossible to get H1B visa, so you are yanked all around the US on one after another J1 visa

It’s not entirely true. There are accredited fellowships which are open to IMG who don’t have a US residency.

Therefore you do 3 accredited fellowships, take the board exam and then you can get pretty much all the states’ licenses because you’ll have accredited training.

The visa issue: it depends.

 

[Dave1980]

Radiology training, at least on paper, is pretty easy to be recognized if you’re already a radiologist in your home country. Only have to do 3 accredited fellowships and you’re board certified. There are also univ which have programs geared to IMG.

OT: I guess for dermatology there’s no “special recognition”

It is 4 years of fellowship and it is difficult to get that. Many fellows show up and underperform, have social issues, or just get dropped for no apparent reason. The institution will not guarantee 4 years ahead of time.

 

[rastko]

It’s not entirely true. There are accredited fellowships which are open to IMG who don’t have a US residency.

Therefore you do 3 accredited fellowships, take the board exam and then you can get pretty much all the states’ licenses because you’ll have accredited training.

The visa issue: it depends.

By regulations from ACGME and ECFGM you are not allowed to apply for an ACGME fellowship without ACGME residency. I haven't heard of any exceptions to that rule, as it would be in violation of the regulations.
Visa: yeah, if you are a hard core academic & researcher, you can get O visa, which is better than J1 I guess. Or you get affiliated to that institution as an academic for 4 years, but you have to be an outstanding in your research area.

 

[guytakingboards]

THESE COMMENTS ARE IN REGARDS TO RADIOLOGY.

- Very hard to get 3 fellowships in a same institution
- you are not allowed to apply to an acgme fellowship
- since you don't get acgme training, after board certification, you are not eligible for a permanent state license, unless you do minimum of 3 years of some kind of acgme program
- after you do all that, it's almost impossible to get H1B visa, so you are yanked all around the US on one after another J1 visa

It is 4 years of fellowship and it is difficult to get that. Many fellows show up and underperform, have social issues, or just get dropped for no apparent reason. The institution will not guarantee 4 years ahead of time.

I wouldn't say "very hard". For programs that have a lot of fellowship programs (particularly a lot of undesirable ones like nucs, PET, thoracic and emergency), it's not hard to get 4 fellowships in the same institution. It's usually larger academic programs. There is absolutely an understanding between the program and FMG that all parties are agreeing to a 4-year track as long as the trainee doesn't prove to be awful.

As for the state licensing eligibility, that's highly state dependent. In my program, a FMG fellow got his state license after the 2nd of his 3 non-ACGME fellowships. He stayed on as faculty and after a year became board certified.

By regulations from ACGME and ECFGM you are not allowed to apply for an ACGME fellowship without ACGME residency. I haven't heard of any exceptions to that rule, as it would be in violation of the regulations.
Visa: yeah, if you are a hard core academic & researcher, you can get O visa, which is better than J1 I guess. Or you get affiliated to that institution as an academic for 4 years, but you have to be an outstanding in your research area.

That's true per the rules, but I've seen a few alternate pathway fellows do ACGME fellowships like VIR and neuro and have that count as one of their 4 fellowships.

I'm not 100% certain, but i believe it just means they wouldn't be allowed to obtain CAQ the traditional way. They would also have to do the "Alternate Pathway to Subspecialty Certification".

 

[rastko]

Thanks "guytakingboards"
Good to know that! Are you into rads? A FMG?

 

[guytakingboards]

Thanks "guytakingboards"
Good to know that! Are you into rads? A FMG?

Yes, I'm a radiologist. I'm an AMG but trained at a program that had several alternate pathway FMG fellows and attendings.