Practice after intern year?

[LABrondo]

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Does anyone know how feasible it is to practice (I would guess cash clinic mainly) after intern year? I have heard of a few people doing it, depending on the state licensing requirements. Or even practicing psych after doing residency in a different specialty (like after IM/FM first)? How would one go about doing that?

 

[hamstergang]

These are generally terrible ideas but more context is needed. Without doing a psych residency, how could you hope to actually know enough to safely and confidently treat patients?

 

[Mass Effect]

Are you asking about leaving residency after intern year? Or do you mean moonlighting while in residency? Some states require more than one year before your full license. You need to look into your state's laws. You should complete a residency in psych if you want to treat mentally ill patients. Unless you do, you can't call yourself a psychiatrist and you likely won't know what you're doing, particularly when someone comes in with something more than depression.

 

[Splenda88]

There are some of these docs in south FL. Almost all of them I know do cash private practice primary care (sans psych).

 

[LABrondo]

I looked at the FSMB site with the state laws. Majority only need 1 year residency to practice fully. Some need 2. FMGs majority need 3 years but some only need 2. The neurology resident who was fired over the video of Uber driver attack incident was in her 4th year of neuro when she got fired, so she had 3 years of residency done. She is practicing psychiatry now in FL without any extra training in psychiatry. The psych resident at GWU who got fired for disciplinary actions (the one who sued GWU over discriminating over cancer) only finished her first year of residency. She is practicing as a full psychiatrist in VA as mainly cash clinic.

 

[Merely]

I looked at the FSMB site with the state laws. Majority only need 1 year residency to practice fully. Some need 2. FMGs majority need 3 years but some only need 2. The neurology resident who was fired over the video of Uber driver attack incident was in her 4th year of neuro when she got fired, so she had 3 years of residency done. She is practicing psychiatry now in FL without any extra training in psychiatry. The psych resident at GWU who got fired for disciplinary actions (the one who sued GWU over discriminating over cancer) only finished her first year of residency. She is practicing as a full psychiatrist in VA as mainly cash clinic.

how is a neuro resident practicing psychiatry that’s so messed up lol she probably has had like a couple months max in it

 

[whopper]

These are generally terrible ideas

After 1 year of training a resident doesn't have the skills or experience yet to practice on their own .

 

[heysexylady]

how is a neuro resident practicing psychiatry that’s so messed up lol she probably has had like a couple months max in it

She has an unrestricted license and theoretically can practice in any areas of medicine. I heard that she was practicing as GP in Florida.

 

[Sushirolls]

After 1 year of training a resident doesn't have the skills or experience yet to practice on their own .

Yes they do, especially when compared to ARNP, or PA.
Simply put I would rather my family or even myself be seen by an intern only trained Physician over an ARNP any day.

 

[PikminOC]

These are generally terrible ideas but more context is needed. Without doing a psych residency, how could you hope to actually know enough to safely and confidently treat patients?

How do mid-levels know?

 

[NITRAS]

Not as crazy as you’d think. Lots of psych and neurology overlap, and the medical license they give to the person who is BC/BE is the same as the one they give to the one who isn’t.

I wouldn’t suggest you blow off residency, as you will have way more opportunities as a BC/BE, (not to mention being better trained) but the world isn’t over if you don’t.

 

[Splenda88]

After 1 year of training a resident doesn't have the skills or experience yet to practice on their own .

I agree with you, but the system let people with way less training to practice independently... For instance, I saw an NP used propranolol as a first line agent for essential HTN, something that a 3rd year med student won't do.

In some case, extra year of residency do not add that much to one's training. When I was a PGY1, I saw PGY2 IM residents who were at the end of the academic year ran the floor with almost ZERO input from attendings. I was wondering what they will pick up as PGY3 resident that they would not pick it up if they were in their 1st year of attending-hood.

 

[Merovinge]

In some case, extra year of residency do not add that much to one's training. When I was a PGY1, I saw PGY2 IM residents who were at the end of the academic year ran the floor with almost ZERO input from attendings. I was wondering what they will pick up as PGY3 resident that they would not pick it up if they were in their 1st year of attending-hood.

They pick up lots of sub-specialty training to better interface with all their prospective consultants on an inpatient or outpatient setting as well as expand their ability to pickup Zebras. As well as reps with codes, outpatient setting, training interns/med students. Seems a bit gauche to think all of IM should be even shorter than 3 years as is.

 

[MBBSMOM]

Yes they do, especially when compared to ARNP, or PA.
Simply put I would rather my family or even myself be seen by an intern only trained Physician over an ARNP any day.

This is what is absolutely maddening about medicine. After intern year a intern already has more clinical hours then a NP/PA. Yet people seem to think they are unequipped for independent practice when we have NPs with 500 clinical hours being allowed to practice independently. It’s also maddening how medicine always seems to raise standards such as requiring Step 2CS and MOC. While NPs have diluted their standards and now a new grad RN with no experience can get into NP school. Then when they graduate in 2 years and collect 500 clinical hrs they can practice independently in 23 states.

 

[Sushirolls]

This is what is absolutely maddening about medicine. After intern year a intern already has more clinical hours then a NP/PA. Yet people seem to think they are unequipped for independent practice when we have NPs with 500 clinical hours being allowed to practice independently. It’s also maddening how medicine always seems to raise standards such as requiring Step 2CS and MOC. While NPs have diluted their standards and now a new grad RN with no experience can get into NP school. Then when they graduate in 2 years and collect 500 clinical hrs they can practice independently in 23 states.

And they are subpar clinical hours. Shadowing, seldom with actual charting/interviewing themselves. i.e. on par with 3rd year med student work at best, but not residency level autonomy.

 

[MBBSMOM]

And they are subpar clinical hours. Shadowing, seldom with actual charting/interviewing themselves. i.e. on par with 3rd year med student work at best, but not residency level autonomy.

Exactly they mostly shadow and rarely do any real clinical work.

 

[Mass Effect]

I feel like our mutual dislike for NPs and PAs is causing us to lose perspective. Frankly, neither an NP nor a PA nor a physician with only intern year should be working independently. None of them. They're all dangerous.

 

[Splenda88]

I feel like our mutual dislike for NPs and PAs is causing us to lose perspective. Frankly, neither an NP nor a PA nor a physician with only intern year should be working independently. None of them. They're all dangerous.

I would not call someone who completed PGY1 and practicing independently "dangerous". Of course, it not ideal. Many places let PGY2 moonlight...

I did an ER rotation in Puerto Rico when I was in med school and I think they do a better job in dealing with the midlevel issues. The only midlevel they have are CRNA... The state legislature let some hospital open 1-yr non-AGME accredited internship (these interns rotate in Peds, IM, FM, EM, OBGYN, Surgery) and license these physicians and let them practice outpatient and fast tract ED.

 

[Mass Effect]

I would not call someone who completed PGY1 and practicing independently "dangerous".

I would.

Many places let PGY2 moonlight...

And many places hire NPs and PAs for independent practice. That doesn't negate the dangerousness of it.

 

[finalpsychyear]

Medicine is utterly screwed up. I no longer care about any standards for anyone when NPs and PAs have independent practice by just lobbing the gov't organizations. Hell lets give prescribing rights to pharmacists, social workers any and all nursing degrees even lawyers while we are at it. When **** hits the fan over and over maybe the rules will go back to where they should have been in the first place. Medical doctors are the ONLY ones who should EVER prescribe meds NO exceptions. If your too damn stupid to get into medical school no shortcuts when it comes to people's lives sorry... you will NEVER prescribe meds EVER.

Thank god i'm done with medicine in 10 years. I cannot believe what happened to this amazing field. Disgusting.

Hopefully i can move to another country where only doctors prescribe medications.

 

[Sushirolls]

I feel like our mutual dislike for NPs and PAs is causing us to lose perspective. Frankly, neither an NP nor a PA nor a physician with only intern year should be working independently. None of them. They're all dangerous.

Many countries around the world rely upon physicians who only have an intern year training to be primary care physicians. MBBS, MBCh, etc
The US military still uses intern physicians to cover the medical needs of an entire ship.
Not dangerous.

I advocate and support the end of step III, level III and issuance of medical license for MD/DO grads in the US upon completion of medical school. Residency training should be optional, especially with the growth of ARNP and PA.

 

[MBBSMOM]

Medicine is utterly screwed up. I no longer care about any standards for anyone when NPs and PAs have independent practice by just lobbing the gov't organizations. Hell lets give prescribing rights to pharmacists, social workers any and all nursing degrees even lawyers while we are at it. When **** hits the fan over and over maybe the rules will go back to where they should have been in the first place. Medical doctors are the ONLY ones who should EVER prescribe meds NO exceptions. If your too damn stupid to get into medical school no shortcuts when it comes to people's lives sorry... you will NEVER prescribe meds EVER.

Thank god i'm done with medicine in 10 years. I cannot believe what happened to this amazing field. Disgusting.

Hopefully i can move to another country where only doctors prescribe medications.

Pharmacists after PGY-2 can already prescribe. Ever heard of psychiatric pharmacists? They can prescribe but not diagnosis which itself if quite illogical. The diagnosis could be wrong and the pharmacist is relying on the person who diagnosed them.

 

[Splenda88]

Many countries around the world rely upon physicians who only have an intern year training to be primary care physicians. MBBS, MBCh, etc
The US military still uses intern physicians to cover the medical needs of an entire ship.
Not dangerous.

I advocate and support the end of step III, level III and issuance of medical license for MD/DO grads in the US upon completion of medical school. Residency training should be optional, especially with the growth of ARNP and PA.

I agree step 3 and step 2 CS need be 'eliminated', but I agree one year of internship is ok to practice primary care... There are still 34 US states that physicians can practice independently after 1 year post grad training, but the issue is these physicians are severely limited when it come to finding jobs.

It's amazing how screwed up the system is. Alaska won't issue a license to a physician with one year post grad training and yet NP can practice medicine there independently.

 

[finalpsychyear]

Pharmacists after PGY-2 can already prescribe. Ever heard of psychiatric pharmacists? They can prescribe but not diagnosis which itself if quite illogical. The diagnosis could be wrong and the pharmacist is relying on the person who diagnosed them.

I can't even keep up with all the obscured things like this occurring. Some states allow psychologists too. Perhaps I can move to Texas in 10 years. That state at least does 2 things correct: No income taxes and limiting mid levels. I feel bad for those in med school or newly in residency for what things will be like for them.

 

[Sushirolls]

And here is a piece of sarcasm to capture the sentiment for some.

Hospital Security Successfully Lobbies for Independent Practice | GomerBlog

Reno, NV - In a rare demonstration of bipartisan support, hospital security officers were granted full and unrestricted rights to practice police work

gomerblog.com

 

[Mass Effect]

Many countries around the world rely upon physicians who only have an intern year training to be primary care physicians. MBBS, MBCh, etc
The US military still uses intern physicians to cover the medical needs of an entire ship.
Not dangerous.

I advocate and support the end of step III, level III and issuance of medical license for MD/DO grads in the US upon completion of medical school. Residency training should be optional, especially with the growth of ARNP and PA.

Treating a cold or a fever? Sure thing. Knock yourself out. If you do intern year, maybe you can even treat pneumonia and anxiety in college kids with no co-morbidities or psych history. But treating complex and/or treatment-resistant physical or mental health conditions without residency? Yeah, it's dangerous.

 

[clausewitz2]

Many countries around the world rely upon physicians who only have an intern year training to be primary care physicians. MBBS, MBCh, etc
The US military still uses intern physicians to cover the medical needs of an entire ship.
Not dangerous.

I advocate and support the end of step III, level III and issuance of medical license for MD/DO grads in the US upon completion of medical school. Residency training should be optional, especially with the growth of ARNP and PA.

Many countries around the world also allow pharmacists to prescribe and dispense basically anything they want and lean on them as de facto primary care docs. Some of them are quite good and I personally had an episode of heat stroke in a poorer SE Asian country treated entirely by the neighborhood pharmacist (IVF and everything). He was very knowledgeable, had English good enough to discuss medical concepts with a fair degree of sophistication, and I had zero complications.

I still don't want him to practice independently in the US.

I think you guys arguing for allowing interns to practice solo are not thinking through the extent to which this will undermine the position of residency-trained folks. Sure, an intern can probably handle 90% of what walks into a primary care clinic but most people get better most of the time. The overlap between that 10% where they are out of their depth and the folks who are going to have bad outcomes is extensive.

The access issue probably means we are inevitably going to see a shift in models to an initial tier of care that is not going to be staffed by BE/BC physicians to any meaningful extent. But the answer is to push for different supervision or coordination models, not to be blindly supportive of the guild and lobby to further weaken the role of people who did complete a residency.