Practicing in US without US residency?

[oculutens]

Hi guys,
I have seen some ophthalmologist who has not to get their residency in the US but gets a faculty position following a clinical fellowship in the US. I would like to ask about, how it is difficult to find a job in the USA for someone who has done a clinical fellowship but has not graduated from US based residency program?

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[Fascia Lata]

I have done it. I would say this should not be taken as a backdoor, and many more than those you have seen getting hired as faculty members after only completing US fellowships have failed to achieve the same. The only legitimate way of “getting a foot in the door” is through completing an accredited US residency program. It is never a good idea to plan one’s future mimicking outliers. The individual circumstances surrounding each of these experiences make them irreproducible. I do not mean to discourage you, completing a US fellowship for a foreign graduate is a tremendous achievement on its own, and I cannot recommend it enough for whoever is able to get in, but doing it in the hope of practicing in the US is, in most cases, disappointing.

 

[Splenda88]

I have done it. I would say this should not be taken as a backdoor, and many more than those you have seen getting hired as faculty members after only completing US fellowships have failed to achieve the same. The only legitimate way of “getting a foot in the door” is through completing an accredited US residency program. It is never a good idea to plan one’s future mimicking outliers. The individual circumstances surrounding each of these experiences make them irreproducible. I do not mean to discourage you, completing a US fellowship for a foreign graduate is a tremendous achievement on its own, and I cannot recommend it enough for whoever is able to get in, but doing it in the hope of practicing in the US is, in most cases, disappointing.

Why not? as long as you have a medical license...

There are a few in the neurology department at the University of Miami Miller School of Medicine.

Also, once you have a medical license, you can do whatever you want. Not sure how easy it is to have hospital privilege since it appears that these people can't be board certified.

 

[EyeGuy15]

Don't waste your time. Hospitals won't allow you privileges to do surgical procedures. The liability issues are huge in ophthalmology, and in 2019, it just won't happen. In addition, insurance companies are very strict about credentials if you want to bill for ophthalmology specific codes. Don't waste your time thinking it is going to be possible for you to do ophthalmological procedures of any sort without doing an accredited ophthalmology residency (US/Canada). Your residency in ophthalmology from another country means nothing, even if you do a "clinical fellowship" in the USA. Clinical fellowships for foreign ophthalmology residency graduates are designed for two reasons: to help boost an applicant's resume who is applying for an ACGME accredited ophthalmology residency and to give foreign doctors extra training with the plan to go back to their home country and continue to practice.

Technically, you can do whatever you want if you have a medical license, but there are a lot of barriers in place to stop people from doing so. Especially in a procedure heavy field like ophthalmology. Neurology and neuro-ophthalmology (non-procedural) may still be possible, but if you want to do any sort of procedure on a patient (clinic or OR), it just won't happen.

 

[Fascia Lata]

Don't waste your time. Hospitals won't allow you privileges to do surgical procedures. The liability issues are huge in ophthalmology, and in 2019, it just won't happen. In addition, insurance companies are very strict about credentials if you want to bill for ophthalmology specific codes. Don't waste your time thinking it is going to be possible for you to do ophthalmological procedures of any sort without doing an accredited ophthalmology residency (US/Canada). Your residency in ophthalmology from another country means nothing, even if you do a "clinical fellowship" in the USA. Clinical fellowships for foreign ophthalmology residency graduates are designed for two reasons: to help boost an applicant's resume who is applying for an ACGME accredited ophthalmology residency and to give foreign doctors extra training with the plan to go back to their home country and continue to practice.

Technically, you can do whatever you want if you have a medical license, but there are a lot of barriers in place to stop people from doing so. Especially in a procedure heavy field like ophthalmology. Neurology and neuro-ophthalmology (non-procedural) may still be possible, but if you want to do any sort of procedure on a patient (clinic or OR), it just won't happen.

I (as well as others) am/are practicing surgical ophthalmology via the foreign residency+US fellowship route (in 2019). Again, doable, but not standard, and not readily reproducible.

 

[EyeGuy15]

I (as well as others) am/are practicing surgical ophthalmology via the foreign residency+US fellowship route (in 2019). Again, doable, but not standard, and not readily reproducible.

When did you do your fellowship? Years ago this was viable. Someone trying to do this today, wouldn't count on it.

 

[Fascia Lata]

When did you do your fellowship? Years ago this was viable. Someone trying to do this today, wouldn't count on it.

Graduated fellowship July 2018. Hired as a faculty member, spent one year as an assistant professor, and starting private practice as of next Monday. PM me if interested to know more.

 

[Fascia Lata]

When did you do your fellowship? Years ago this was viable. Someone trying to do this today, wouldn't count on it.

But I agree with you, this should never be counted on.

 

[Slide]

There are a few attendings out there, but these are outliers and do not treat these as the norm, because the process in how these attendings are able to be faculty are very, very, condition and state specific.

For academic centers, the center has to file an exception to the ACGME accrediting bodies due to some sort of hardship or for an exceptional candidate (typically a well known big wig internationally). The VA is a bit more forgiving, but similar situation. If you did your residency in Canada, your chances are much better (I think there is some reciprocity between the US and Canada regarding training).

The big hold ups are this:
-Board certification (Requirements for Certification | American Board of Ophthalmology). If you want to be board certified, the requirements specifically state finishing a US or Canadian residency. 20-30 years ago, board certification wasn't a big deal, but nowadays if you want to bill insurance, it's a necessity.
-State medical licensure: each state is different but you have to fulfill that state's requirements to obtain a license. Some of them (including mine) specifically state you have to do a residency in the US in order to have a license. No license, no practice.
-Supply and demand. Most places aren't so desperate to hire someone who hasn't finished a residency in the US or in Canada. There are some exceptions in big cities, but they are almost always in fields where there is a large predominance of IMG/FMGs (neurology, psych, etc.).

 

[Fascia Lata]

There are a few attendings out there, but these are outliers and do not treat these as the norm, because the process in how these attendings are able to be faculty are very, very, condition and state specific.

For academic centers, the center has to file an exception to the ACGME accrediting bodies due to some sort of hardship or for an exceptional candidate (typically a well known big wig internationally). The VA is a bit more forgiving, but similar situation. If you did your residency in Canada, your chances are much better (I think there is some reciprocity between the US and Canada regarding training).

The big hold ups are this:
-Board certification (Requirements for Certification | American Board of Ophthalmology). If you want to be board certified, the requirements specifically state finishing a US or Canadian residency. 20-30 years ago, board certification wasn't a big deal, but nowadays if you want to bill insurance, it's a necessity.
-State medical licensure: each state is different but you have to fulfill that state's requirements to obtain a license. Some of them (including mine) specifically state you have to do a residency in the US in order to have a license. No license, no practice.
-Supply and demand. Most places aren't so desperate to hire someone who hasn't finished a residency in the US or in Canada. There are some exceptions in big cities, but they are almost always in fields where there is a large predominance of IMG/FMGs (neurology, psych, etc.).

Agree with you. These are the exception rather than the rule, and the circumstances surrounding each situation are highly irreproducible. Btw, there is now a route for board certification for foreign trained ophthalmologists who have been practicing the US with surgical privileges for a minimum of 5 years

Certification for Internationally Trained Ophthalmologists (ITO) | American Board of Ophthalmology

The American Board of Ophthalmology is now accepting applications from qualified internationally trained ophthalmologists (ITOs) who are currently practicing ophthalmology in the United States and wish to become board certified.

abop.org

Medical licensure in these cases is typically in the form of a limited/institutional license (can be called a faculty license or license for conceded eminence, etc, depending on the state), but some states, including mine, allow transitioning to a full non-restricted medical license after practicing for a number of years with an institutional license. These are typically handled by the state board on a case by case basis.

Insurance billing is not an issue when you work in a University setting, but it has been more challenging for me as I am transitioning into private practice. Credentialing with insurances and surgery centers was not a piece of cake. Got credentialed at the end, but there were 2 insurances that would not credential me.

Take home message, completing an accredited US residency remains the only straightforward, unequivocal route to practice in the US. Sporadic lucky folks have gotten, and are still getting, into the system through the aforementioned route. However, this should never be considered a standard alternative route, and relying on a future similar opportunity is a gamble that should never be relied on.

 

[EyeGuy15]

Every now and then I encounter a physician who was an ophthalmologist like 10-15+ years ago in another country, but did a less competitive residency in the United States and is now a practicing hospitalist, family medicine physician, pediatrician etc. For some reason they think if they all of a sudden do an ophthalmology "clinical fellowship" (often with a private practice) in the United States, they will be able to be a practicing ophthalmologist when they finish the "fellowship". These are the delusional ones who should know they won't be able to practice ophthalmology through this route and credentialing with hospitals and insurance companies won't happen. No malpractice insurance company will even entertain insuring someone like this to perform the duties of an ophthalmologist. Hopefully the OP understands this.