Practicing anesthesia without US residency?

[anbuitachi]

I always thought you cant practice without doing residency here , but i recently found out at my friend's institution has MDs from other countries, practicing anesthesia at the institution without doing a residency in the US. the MD is from abroad, mostly asia. Some of them did a 1 yr fellowship here and others didnt. Obviously not board certified.

anyone know more about this in terms of legally and billing? are the institutions just billing for them as a department? how are they getting malpractice insurance to cover them? (or does malpractice insurance not care?)

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[BLADEMDA]

Alternate Path for Entry for Primary Certification
The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into our exam system for primary certification in anesthesiology. The objective of the program is to encourage outstanding internationally trained and certified anesthesiologists to become productive members of U.S. academic anesthesiology programs. A record of documented achievement in teaching and/or scholarship, rather than the potential for future success, is critical to acceptance into the AEP program, as is the ability of the sponsoring department to provide an outstanding academic environment.

An anesthesiology department can have as many as four international medical graduates enrolled in the AEP program at one time. AEP program participants will spend four years in an academic anesthesiology training program as fellows, researchers or faculty members. Participants are expected to actively participate in departmental educational activities and to otherwise retain or gain basic anesthesiology knowledge and experience that would help them to attain ABA certification. Participants approved to begin the AEP program after Jan. 1, 2014, will take the staged exams for primary certification.

• Program Guidelines

 

[anbuitachi]

Alternate Path for Entry for Primary Certification
The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into our exam system for primary certification in anesthesiology. The objective of the program is to encourage outstanding internationally trained and certified anesthesiologists to become productive members of U.S. academic anesthesiology programs. A record of documented achievement in teaching and/or scholarship, rather than the potential for future success, is critical to acceptance into the AEP program, as is the ability of the sponsoring department to provide an outstanding academic environment.

An anesthesiology department can have as many as four international medical graduates enrolled in the AEP program at one time. AEP program participants will spend four years in an academic anesthesiology training program as fellows, researchers or faculty members. Participants are expected to actively participate in departmental educational activities and to otherwise retain or gain basic anesthesiology knowledge and experience that would help them to attain ABA certification. Participants approved to begin the AEP program after Jan. 1, 2014, will take the staged exams for primary certification.

• Program Guidelines

i didn tknow that but i think its a bit different from what im takling about. from what i hear, none of them are board certified. none of them are in 'training' either. they are simply hired as attendings and work, and make the same $ as other BC attendings. the hospital is by no means a strong academic center, it's more like a community level academic center in underserved area

some did 1 yr fellowship (like in neuro anesthesia) elsewhere,

i guess what is the major difference between employing anesthesiologist from another country now here in the US vs US residency graduate who never managed to pass the boards?

 

[BLADEMDA]

i didn tknow that but i think its a bit different from what im takling about. from what i hear, none of them are board certified. none of them are in 'training' either. they are simply hired as attendings and work, and make the same $ as other BC attendings. the hospital is by no means a strong academic center, it's more like a community level academic center in underserved area

some did 1 yr fellowship (like in neuro anesthesia) elsewhere,

i guess what is the major difference between employing anesthesiologist from another country now here in the US vs US residency graduate who never managed to pass the boards?

As an academic center they can have visiting attendings and grant them privileges. These physicians must get licensure from the state but after that the privileges are up to the institution. As for malpractice insurance maybe the academic center is self-insured? Again, the institution has a lot of leeway in this situation. As for billing, these physicians can bill as non board certified anesthesiologists.

 

[BLADEMDA]

Practicing without board certification?

I recently heard about a lot of physicians in the U.S. (private practitioners mostly) practicing medicine without being board certified. I understand that there are "fake" boards that give certification that are completely legal and that there is variation among which specialties are more...

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[BLADEMDA]

Some Academic Centers or Hospitals require Board Certificatioin after 3 or 5 or 6 years post Residency/Fellowship to maintain privileges. Other hospitals may NOT have this requirement. These days most institutions expect BOARD CERTIFICATION at some point after training to maintain privileges.

So, Board Eligible may work for a time but then you lose eligibility and are not certified. This means you will likely lose your hospital privileges. At that point you can seek out surgicenter work for example paying you a lot less than a real, Board Certified physician would earn doing that same work.

Board Eligibility for each specialty is TIME LIMITED so you may need to go back to an academic center where the Chair can "certify" you as re-eligible to re-enter the process once again. The CHAIR gets cheap labor and you get paid a low salary as a fellow or junior attending.

 

[anbuitachi]

As an academic center they can have visiting attendings and grant them privileges. These physicians must get licensure from the state but after that the privileges are up to the institution. As for malpractice insurance maybe the academic center is self-insured? Again, the institution has a lot of leeway in this situation. As for billing, these physicians can bill as non board certified anesthesiologists.

insurance billing is significantly different depending on board certification?

Non US graduate non boarded vs BC US grad vs BE US grad is significantly different in amount billed?

 

[Lidolover]

The State that I know has many more windows on this matter is Pennsylvania.
Unless you become board certified (after 3 fellowships or many clinical years as board eligible), the salary is comparatively much lower.

many such examples out there ............

 

[urge]

I always thought you cant practice without doing residency here , but i recently found out at my friend's institution has MDs from other countries, practicing anesthesia at the institution without doing a residency in the US. the MD is from abroad, mostly asia. Some of them did a 1 yr fellowship here and others didnt. Obviously not board certified.

anyone know more about this in terms of legally and billing? are the institutions just billing for them as a department? how are they getting malpractice insurance to cover them? (or does malpractice insurance not care?)

The roadblock is that usually no hospital wants to credential you if you are not trained in the US.

But once they decide to credential you, you work and bill like any other licensed physician.

Places that have issues recruiting staff are the ones you see credentialing non US trained physicians.

Is your friend doing residency in a rough town/city?

 

[anbuitachi]

The roadblock is that usually no hospital wants to credential you if you are not trained in the US.

But once they decide to credential you, you work and bill like any other licensed physician.

Places that have issues recruiting staff are the ones you see credentialing non US trained physicians.

Is your friend doing residency in a rough town/city?

Oh so international physicians can come here and bill the same. So what about opening clinics for other specialties? IM doc can come here, pass steps, get license, and open own private practice and bill?

Yea sort of rough area

 

[nimbus]

insurance billing is significantly different depending on board certification?

Non US graduate non boarded vs BC US grad vs BE US grad is significantly different in amount billed?

No difference in amount billed or collected AFAIK.

 

[urge]

Oh so international physicians can come here and bill the same. So what about opening clinics for other specialties? IM doc can come here, pass steps, get license, and open own private practice and bill?

Yea sort of rough area

As long as you have a license, citizenship (or working visa), and funding, I don’t see what is stopping you. Usually one of those 3 is an issue.

 

[deleted697535]

i guess what is the major difference between employing anesthesiologist from another country now here in the US vs US residency graduate who never managed to pass the boards?

Are you implying foreign trained anesthesiologists cant manage to pass your boards? ;-)

Boards that you pass as a CA3 whereas Canadians/Australians/UK struggle to pass their own boards as PGY5-7?
The australian one is notoriously hard with deep pharmacology. The UK has a 40% pass rate most years.

 

[urge]

Are you implying foreign trained anesthesiologists cant manage to pass your boards? ;-)

Boards that you pass as a CA3 whereas Canadians/Australians/UK struggle to pass their own boards as PGY5-7?
The australian one is notoriously hard with deep pharmacology. The UK has a 40% pass rate most years.

I can see why they struggle vs. the American CA3.

I‘ll give you a hint: Americans invented anesthesia.

Need I say more?

 

[shepardsun]

We have had a few guys from Australia come through our department over the last five to ten years, they need to go back and take the USMLEs to get a US license but I don't think they are then treated any differently billing/privileges wise

 

[anbuitachi]

Are you implying foreign trained anesthesiologists cant manage to pass your boards? ;-)

Boards that you pass as a CA3 whereas Canadians/Australians/UK struggle to pass their own boards as PGY5-7?
The australian one is notoriously hard with deep pharmacology. The UK has a 40% pass rate most years.

lol what. course not. i meant foreign trained who dont do residency here and so mostly cant take the boards

just curious why more people dont come and start own practice if residency is not actually an obstacle to billing. i dont think steps are that big of a hurdle if all they have to do is pass

 

[Lidolover]

lol what. course not. i meant foreign trained who dont do residency here and so mostly cant take the boards

just curious why more people dont come and start own practice if residency is not actually an obstacle to billing. i dont think steps are that big of a hurdle if all they have to do is pass

...because most people want to have a life?!?!?!

 

[nimbus]

lol what. course not. i meant foreign trained who dont do residency here and so mostly cant take the boards

just curious why more people dont come and start own practice if residency is not actually an obstacle to billing. i dont think steps are that big of a hurdle if all they have to do is pass

It’s an uncommon path but it’s been done.

2nd update to "CA license, but no board cert. How to get life back on track with a baby?"

To recap: Back in November 2017, I was a new father and was desperate to get back into medicine. I thought my best bet would be to get back into residency (I was hoping to get into anesthesiology back then). In September 2018, I began what I thought was going to be a temporary work taking care...

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[BLADEMDA]

lol what. course not. i meant foreign trained who dont do residency here and so mostly cant take the boards

just curious why more people dont come and start own practice if residency is not actually an obstacle to billing. i dont think steps are that big of a hurdle if all they have to do is pass

1. Board Certification- This is now a requirement at most good hospitals. That means you must go through the "process" to become eligible to sit for the specialty Board in the USA.

2. Licensure- Each state has its own requirements. Typically, a full unrestricted license requires passing all exams and a 1 year fellowship/intern as a minimum. Some states may require Board Eligibility for IMGs to get a license.

3. Many IMGs have come to the USA to practice medicine. I have literally met dozens or more in my career. As a whole, they are an exceptional group of people who work hard and love this country.

4. Relocating to a new country and learning the customs/ways is a big deal. Plus, they leave family behind thousands of miles away from their adopted city.

 

[anbuitachi]

...because most people want to have a life?!?!?!

i mean instead, they come here and do residency.

eg a lot of IM foreign doctors come here and choose to apply for residency and go thru it, then maybe open practice. As opposed to just come here, pass USMLEs and open practice, w/o residency.

I guess there are a lot of hurdles. Maybe like blade said some states require a yr of training for license which would make it much harder

 

[B-Bone]

i mean instead, they come here and do residency.

eg a lot of IM foreign doctors come here and choose to apply for residency and go thru it, then maybe open practice. As opposed to just come here, pass USMLEs and open practice, w/o residency.

I guess there are a lot of hurdles. Maybe like blade said some states require a yr of training for license which would make it much harder

just so we're all on the same page, every state in the union requires at least one year of GME to get a license, and most require 2-3 years GME (or more) for foreign grads to get a license. here are the state by state licensure requirements:

FSMB | State Specific Requirements for Initial Medical Licensure

 

[anbuitachi]

just so we're all on the same page, every state in the union requires at least one year of GME to get a license, and most require 2-3 years GME (or more) for foreign grads to get a license. here are the state by state licensure requirements:

FSMB | State Specific Requirements for Initial Medical Licensure

doesnt say what type of GME , or where it was obtained. Some states specifically state ACGME years, most just say graduate years. so could be graduate years from other countries?

 

[B-Bone]

doesnt say what type of GME , or where it was obtained. Some states specifically state ACGME years, most just say graduate years. so could be graduate years from other countries?

I didn't look at every state, but every one I did specifically required US or Canadian GME.

 

[DrN2O]

In California it's called section 2113. The foreign trained faculty is allowed to be licensed and practice only within the medical school. Some of them do eventually take USMLE so they can be fully licensed for private practice, if they so choose.

Special Programs - David Geffen School of Medicine - Los Angeles, CA

Permits, appointments, and requirements for special programs.

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[Splenda88]

Oh so international physicians can come here and bill the same. So what about opening clinics for other specialties? IM doc can come here, pass steps, get license, and open own private practice and bill?

Yea sort of rough area

I know of a few in neurology at U of Miami... They only did a neuro fellowship in the US and are licensing in the state of FL to practice medicine, but they are not board certified.