Private Practice in residency?

[Leo Aquarius]

This may have been talked about in a previous thread, but is it possible to either A) start your own private solo practice as a 4th year resident, or B) "moonlight" in a private practice where you are a partner in a duo practice while a resident? Anyone know any residents who have done this? Is this possible? Thanks in advance.

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[vistaril]

This may have been talked about in a previous thread, but is it possible to either A) start your own private solo practice as a 4th year resident, or B) "moonlight" in a private practice where you are a partner in a duo practice while a resident? Anyone know any residents who have done this? Is this possible? Thanks in advance.

the essential problem with this is how are you going to be reimbursed??

You are not board eligible, so you can't get on insurance panels.

Which leaves cash pay. Who the heck is going to pay someone in training big bucks out of pocket?

 

[F0nzie]

You will need 3 things : 1. medical license 2. malpractice insurance 3. Approval from your program.

More importantly you will need to figure out how being on call 24/7 for your patients will be factored into your duty hours. Also consider the fact that getting paged for emergencies during the day may interfere with your academic obligations.

I give pp during residency the thumbs down. It starts out as a financial headache and overwhelming commitment-- and as a resident launching without all the necessary tools in your bag. IMO you are best off using your 4th year spare time designing your game plan (charting, billing, location, phone, fax, prescription pads, etc) and executing upon graduation.

Financially, you should expect to be in the hole for the first several months. Starting as a resident might just prolong this time period.

 

[vistaril]

You will need 3 things : 1. medical license 2. malpractice insurance 3. Approval from your program.

More importantly you will need to figure out how being on call 24/7 for your patients will be factored into your duty hours. Also consider the fact that getting paged for emergencies during the day may interfere with your academic obligations.

I give pp during residency the thumbs down. It starts out as a financial headache and overwhelming commitment-- and as a resident launching without all the necessary tools in your bag. IMO you are best off using your 4th year spare time designing your game plan (charting, billing, location, phone, fax, prescription pads, etc) and executing upon graduation.

Financially, you should expect to be in the hole for the first several months. Starting as a resident might just prolong this time period.

agree with all of this....but you leave out the most important part: How the heck is he going to get paid?

 

[F0nzie]

He could get creative and market himself as a resident who offers substantial discounts ie. free eval or half the rates.

I would not do this because the time and effort to launch a practice is exhausting and I would get demoralized if I didn't get paid and sank further into debt.

 

[vistaril]

He could get creative and market himself as a resident who offers substantial discounts ie. free eval or half the rates.
quote]

which would still be much more expensive in most cases than insurance based BOARD CERTIFIED private practice psychs.

sure, he'd be able to spend more time with patients(and would likely do a better job than the horrendous quality of care delivered by most insurance based outpt psychs), but that's not where the market is. Someone willing to 'shell out' for mh care is not going to go to a person in training.

 

[F0nzie]

Patients do not really care if you are board certified. I've had 1 patient's mother out of hundreds ask if my wife was board certified. The only reason this mother wanted to know was because her brother was an academic child psychiatrist in San Francisco.

If you offered a free eval today or tomorrow and charged $50 dollars for follow ups, 90% or more patients would accept this fee. Especially given your availability compared to other providers-- This was the case when I was ready to launch pp in an area where the average family income was only 35-40k per year.

 

[notdeadyet]

Many psychiatry programs, even those with loose moonlighting policies, specifically prohibit private practice.

 

[vistaril]

Patients do not really care if you are board certified. I've had 1 patient's mother out of hundreds ask if my wife was board certified. The only reason this mother wanted to know was because her brother was an academic child psychiatrist in San Francisco.

If you offered a free eval today or tomorrow and charged $50 dollars for follow ups, 90% or more patients would accept this fee. Especially given your availability compared to other providers-- This was the case when I was ready to launch pp in an area where the average family income was only 35-40k per year.

they may not care if you are board certified, but patients paying cash will likely care that the person is still in training. And $50 is still 20-30 dollars more than copays.

 

[TexasPhysician]

This may have been talked about in a previous thread, but is it possible to either A) start your own private solo practice as a 4th year resident, or B) "moonlight" in a private practice where you are a partner in a duo practice while a resident? Anyone know any residents who have done this? Is this possible? Thanks in advance.

I highly doubt any program would allow option A, but option B I've seen. It usually occurs when the practice owner with full-time staff hires a resident at an hourly rate or percentage of net pay. The moonlighting resident has the practice owner and staff to handle calls, charts, etc while you are handling academic duties.

 

[TexasPhysician]

they may not care if you are board certified, but patients paying cash will likely care that the person is still in training. And $50 is still 20-30 dollars more than copays.

An extra $20-30 is nothing if:
1. You want to be seen after 5pm
2. No psychiatrists nearby take your insurance
3. You want to be seen quickly.

The need exists in most areas of the country, but I doubt a resident would want to do this. Too much headache and overhead when there are plenty of gigs paying $100+/hour to residents.

 

[vistaril]

An extra $20-30 is nothing if:
1. You want to be seen after 5pm
2. No psychiatrists nearby take your insurance
3. You want to be seen quickly.

The need exists in most areas of the country, but I doubt a resident would want to do this. Too much headache and overhead when there are plenty of gigs paying $100+/hour to residents.

if there is a residency program in an area, there will be many psychiatrists that take insurance.

 

[TexasPhysician]

if there is a residency program in an area, there will be many psychiatrists that take insurance.

Not necessarily true. So untrue in some areas that residents have cash only patients at $120 per follow-up.

 

[michaelrack]

if there is a residency program in an area, there will be many psychiatrists that take insurance.

Agree with TExas Physician- although most psych attendings see individual patients separate from resident clinics; it is usually only for 8-10 hrs/week (and some don't take insurance for these patients). As far as resident clinics, these tend to unefficient and filled with chronic patients. There is often a waiting list and many with private insurance don't want to see a resident.

 

[vistaril]

Agree with TExas Physician- although most psych attendings see individual patients separate from resident clinics; it is usually only for 8-10 hrs/week (and some don't take insurance for these patients). As far as resident clinics, these tend to unefficient and filled with chronic patients. There is often a waiting list and many with private insurance don't want to see a resident.

I didn't neccessarily mean services from faculty at the residency program. What I meant was that if an area is large enough to support a psych residency, the area is very likely to have a psych or two in the area taking insurance.

I'll stand by my statement- texas physician can pick*any* location of a psych residency program out there, and I'll go and find a listed outpt psychiatrist within a reasonable distance who takes insurance.

 

[michaelrack]

I'll stand by my statement- texas physician can pick*any* location of a psych residency program out there, and I'll go and find a listed outpt psychiatrist within a reasonable distance who takes insurance.

this should be interesting.

 

[OldPsychDoc]

this should be interesting.

 

[Shikima]

I didn't neccessarily mean services from faculty at the residency program. What I meant was that if an area is large enough to support a psych residency, the area is very likely to have a psych or two in the area taking insurance.

I'll stand by my statement- texas physician can pick*any* location of a psych residency program out there, and I'll go and find a listed outpt psychiatrist within a reasonable distance who takes insurance.

What's the point Vistaril, besides the dysthymic, chicken-little routine?

 

[TexasPhysician]

I didn't neccessarily mean services from faculty at the residency program. What I meant was that if an area is large enough to support a psych residency, the area is very likely to have a psych or two in the area taking insurance.

I'll stand by my statement- texas physician can pick*any* location of a psych residency program out there, and I'll go and find a listed outpt psychiatrist within a reasonable distance who takes insurance.

Haha
You need to put more time into finding a gig rather than googling insurance providers.

I'm not verifying patients' search criteria for finding an insurance approved provider, not would I verify your results.

Do patients pay cash rates to residents in an established private practice and give that as a reason? Yes.

 

[vistaril]

this should be interesting.

it won't be interesting because he/she(not sure if texasphysician is male or female?) isn't going to list these supposed cities(large enough to have a residency program) where no psychiatrist in the area takes most commercial insurances. If able to defend such a statement, it would be easy to say "sure, in Galveston(or some other area where a residency program exists) there are no psychiatrists who take insurance".


The original point wasn't a terrible one(although many programs probably prevent such setups) and can almost certainly be defended to some degree. Heck it's an interesting idea that probably has merit in many areas depending on one's program. But defending it with ridiculous hyperbole isn't a good idea.

 

[moonshined]

.

 

[Shikima]

Plenty of those born and raised in the states with poor engrish skillz.

 

[digitlnoize]

When I was interviewing, I met a child fellow in his 5th year who had started his own private practice to moonlight in. I guess that's a bit different since he was adult BE (not sure if he'd actually taken it or not).

What about just owning a practice and hiring a psychiatrist to work there? Anyone thought of doing that? So your "moonlighting" would be running a business (albeit with slim profit margins)...

 

[TexasPhysician]

When I was interviewing, I met a child fellow in his 5th year who had started his own private practice to moonlight in. I guess that's a bit different since he was adult BE (not sure if he'd actually taken it or not).

What about just owning a practice and hiring a psychiatrist to work there? Anyone thought of doing that? So your "moonlighting" would be running a business (albeit with slim profit margins)...

I guess you could run a clinic, but it would probably be easier to run a simple franchise.

 

[michaelrack]

What about just owning a practice and hiring a psychiatrist to work there? Anyone thought of doing that? So your "moonlighting" would be running a business (albeit with slim profit margins)...

slim profit margins, and the possibility of losing a lot of money

 

[VMSmith]

It's definitely possible. PGY4 residents at MGH and Stanford are permitted to start private practices in the second half of the year, and are allowed to convert residency patients to their practice. I know of a recent MGH grad who charged $250 per therapy hour as a PGY4.

Obviously, they do not accept insurance. Cash only.

Sent from my GT-N5110 using Tapatalk

 

[vistaril]

It's definitely possible. PGY4 residents at MGH and Stanford are permitted to start private practices in the second half of the year, and are allowed to convert residency patients to their practice. I know of a recent MGH grad who charged $250 per therapy hour as a PGY4.

Obviously, they do not accept insurance. Cash only.

Sent from my GT-N5110 using Tapatalk

There is an mgh grad with a 15+ years of post-residency experience + analyst training in the community here. Her 'listed' fee is $200/hr but given all the discounts she gives for various reasons(financial, trainees, and others) her effective 'asking' rate is probably more like 155-160/hr cash pay. And like I said she's mgh trained + a ton of experience + formal analysis training. I only know this because she gave a few lectures awhile back to the residents on what it is like to do therapy as an individual in the community.

 

[Leo Aquarius]

There is an mgh grad with a 15+ years of post-residency experience + analyst training in the community here. Her 'listed' fee is $200/hr but given all the discounts she gives for various reasons(financial, trainees, and others) her effective 'asking' rate is probably more like 155-160/hr cash pay. And like I said she's mgh trained + a ton of experience + formal analysis training. I only know this because she gave a few lectures awhile back to the residents on what it is like to do therapy as an individual in the community.

This has nothing to do with what we're talking about. Now you're mixing apples with oranges. You want to play the "psychiatrists are paid pathetic rates" card again? This is a favorite theme of yours that creeps up month after month it seems.

Just to counter your example, I will disclose the going rates of private practice psychiatrists in my neck of the woods. Northern California, namely the Bay area and Palo Alto, range from $300 to $500 per hour. Southern California, namely Los Angeles range from $400 on up and further south like San Diego $300 to $400 per hour. You know how awesome those numbers are? If I could make that I'd be jumping for joy. At those rates psychiatrists in PP can make - if they wanted - $400,000. That would put someone in the top 1% of earners in America. That's awesome in my book. So don't try to make us feel like psychiatrists in PP are paid peanuts with your MGH with 15 years of experience making $150 per hour example. Rates are largely geographical.

Anyway, I think we're talking about the possibility of PP work while in residency.

 

[Shikima]

Cost of living also factors into rates - Ie: Bay area at $300+/hr.

 

[TexasPhysician]

There is an mgh grad with a 15+ years of post-residency experience + analyst training in the community here. Her 'listed' fee is $200/hr but given all the discounts she gives for various reasons(financial, trainees, and others) her effective 'asking' rate is probably more like 155-160/hr cash pay. And like I said she's mgh trained + a ton of experience + formal analysis training. I only know this because she gave a few lectures awhile back to the residents on what it is like to do therapy as an individual in the community.

So you are saying you know a psych doc making $150+/hr in your area? At 40 clinical hours/week with 7 weeks of vacation, that is 270k+/year. Have you called to ask if she wants a partner? Even giving her a 20% cut would put you ahead of your other options. Solved your low pay problem potentially.

 

[Psychotic]

Where is Vistaril located? If someone knows, please send me a private message. I need to know before I finalize my rank list...

 

[vistaril]

So you are saying you know a psych doc making $150+/hr in your area? At 40 clinical hours/week with 7 weeks of vacation, that is 270k+/year. Have you called to ask if she wants a partner? Even giving her a 20% cut would put you ahead of your other options. Solved your low pay problem potentially.

well if she grosses 270k(and I have no idea if she fills 40 clinical hours a week), then obviously she isn't going to make anywhere close to what she grosses.

Needless to say I don't have nearly the same skill set as she does though, so that's not a possibility for me.

 

[vistaril]

This has nothing to do with what we're talking about. Now you're mixing apples with oranges. You want to play the "psychiatrists are paid pathetic rates" card again? This is a favorite theme of yours that creeps up month after month it seems.

Just to counter your example, I will disclose the going rates of private practice psychiatrists in my neck of the woods. Northern California, namely the Bay area and Palo Alto, range from $300 to $500 per hour. Southern California, namely Los Angeles range from $400 on up and further south like San Diego $300 to $400 per hour. You know how awesome those numbers are? If I could make that I'd be jumping for joy. At those rates psychiatrists in PP can make - if they wanted - $400,000. That would put someone in the top 1% of earners in America. That's awesome in my book. So don't try to make us feel like psychiatrists in PP are paid peanuts with your MGH with 15 years of experience making $150 per hour example. Rates are largely geographical.

Anyway, I think we're talking about the possibility of PP work while in residency.

a quick google search shows that there are many psychiatrists in the bay area(even the cash pay ones) who work for far far less than the numbers you mention.

 

[whopper]

I've written this before. I'd advise against starting PP in residency. There's a learning curve to it and you will encounter unexpected problems and as a resident, likely without supervision, whose first priority should be the work in the program, this can really screw you up. Unless you're staying in the area, you're going to knowingly dump your patients when you leave residency.

If you stay in the area, your rep will start to establish and this move could dramatically hurt it. Starting a practice while still a resident suggests a picture that you're out for money and/or headstrong. This rep either sets you up as an epic hero or ultimate villain and you could only be the epic hero if you live up to expectations that could be unrealistic. Your program will know you did it, discuss it, and the rep will spread unless you dont' tell your program you're doing it, and if so, you're committing a serious violation of rules and if a resident did that while I was a PD, I'd seriously consider kicking the resident out of the program.

For a PD, a resident knowingly violating rules brings up serious questions as to the ethical character of the resident. At best, it suggests a resident that didn't know what they were doing, may have not had bad intentions, but was willing to play with fire in an area where patient safety is an issue.

The safest way to do this IMHO is do it in a place where you have guidance, they will gently teach you the business side of PP, and your program has to know about it. Places to look for this are faculty that you know and respect that have a PP outside the department, local practices with a good relationship with your department but this is still fraught with perils. E.g. if you stay in the area, and don't want to work for this PP, you likely would've had to sign a contract saying if you left that practice you can't practice anywhere within a specific geographic region. I also wouldn't call up every single practice in the area looking for work because some psychiatrists (in case you didn't know) are just plain bad and unethical and might lasso you into a bad situation.

This is something where most residents IMHO are just too green to sign onto anything that can have professional repurcussions for years. After you gain a few years of experience you know how to read between the lines in contracts among several other landmines that happen with these things.

For those that want to make a thriving and highly profitable PP, I'd recommend not jumping into this feet first. And this may sound odd, watch every episode of Ramsay's Kitchen Nightmares (the BBC version, not the pathetic Fox version) cause almost everything he mentions about restaurants does, in a business sense, translate into PP.

If any of you want to do PP, I invite you to give me a PM and leave me your phone number. I don't mind talking about it cause this is something that is not communicated effectively over written text. I've done it and may go back into it.

 

[IamPsychiatrist]

a quick google search shows that there are many psychiatrists in the bay area(even the cash pay ones) who work for far far less than the numbers you mention.

You do realize that fact doesn't contradict anything he said, right,

 

[Shikima]

Needless to say I don't have nearly the same skill set as she does though, so that's not a possibility for me.

I see what you did there.....

 

[daru1]

the essential problem with this is how are you going to be reimbursed??

You are not board eligible, so you can't get on insurance panels.

Which leaves cash pay. Who the heck is going to pay someone in training big bucks out of pocket?

This is false information. When I was not board eligible, I was able to panel on 3 different insurances. Don't let people tell you that you have to be board eligible to start a practice, although I'd say that finishing at least PGY-3 is a must.

 

[whopper]

You don't have to be board certified to get on insurance panels.

You can be, some of them will only accept board certified doctors, some of them it won't matter, some of them will require you be board eligible but get board certified within a certain time frame.

 

[Leo Aquarius]

Whopper and Fonzie make some excellent points. So would you guys then recommend graduating first, and working as a partner or an employee of a PP first to learn the ropes instead of starting solo?

 

[vistaril]

You don't have to be board certified to get on insurance panels.

You can be, some of them will only accept board certified doctors, some of them it won't matter, some of them will require you be board eligible but get board certified within a certain time frame.

well yeah I know on many/most of them you don't need to be board certified. But completing residency is a requirement on all the major ones I've looked into....

 

[whopper]

I think PP can be done immediately after residency (though I still think it's a bad idea) if you enter a PP where they will guide you in a manner that's in your own best interests.

But the problem here is you won't know that unless you know the guy running the operation personally. Until then you're Louie from Interview with the Vampire. He was made a vampire by Lestat, who had been one for several decades. Lestat intentionally kept Louie in the dark so Louie would be forced into servitude for Lestat.

You could happen onto a good attending that will want what's best for you but how will you know his real intent until you yourself figure out how the game is played?

IMHO new attendings still are green in several areas. A good professional track that keeps your options open is to take a job in an area and not think of yourself as committed to that specific clinical scenario for the rest of your life. Also consider a job scenario where you will have multiple clinical exposures such as in an academic center. Try a few things out. Do a good job and a good rep will follow. With each job you pick, figure out how the payment works. That is integral if you want to profit. You have to figure the business ends out.

Where I'm at, I wouldn't have been offered a job at the university if I didn't consistently show good work. Now that I'm here, I have a free range of opportunities if I want to stay including, for example, addiction, geriatrics, forensics, emergency, inpatient, consult, ECT, and if I wanted to pursue research I can. I can pretty much do anything here and I get to work with literally some of the top psychiatrists in the country as colleagues such as Doug Mossman, Paul Keck, Mike Keys, Henry Nasrallah, etc. IMHO working in this type of environment lets me choose to do anything I could ever possibly hope to do in this field, and if I ever chose to leave, I could arm myself in terms of knowledge in any area before I go, and after I left, I could keep connections with those high up in the field so I could call them for help. They pay here is good (I'm not going to say how much I make but it's >200K and my wife gets free tuition for her doctorate), and I have access to high paying forensics cases.

In PP, you're kind of on your own. If you're part of a group practice that helps, but make sure the people in the practice are solid. The last thing you want is to be in a group with people where you don't have faith in their clinical skills. A lawsuit, for example, could be launched against the entire practice, and not just against a poor practitioner in that practice.

 

[F0nzie]

Whopper and Fonzie make some excellent points. So would you guys then recommend graduating first, and working as a partner or an employee of a PP first to learn the ropes instead of starting solo?

I started solo and built from the ground up. I saw how a few other attendings ran their practices and I disagreed with most of the operations. I didn't learn anything except how I didn't want to run a practice. My advice-- think of your pp like burger king: have it your way. This is your opportunity to be free from all the administrative and beaucratic bullsh*t that tells you what to do and how to do it. It may not pay much in the beginning, but the freedom has value.

 

[whopper]

Mentioned this before in other threads. Get an office manager/secretary that you can rely upon. It's like being Kirk and having Scotty as your engineer. That is IMHO possibly one of the most important things. I've seen several terrible doctors do alright cause their office manager was really the person running the show.

 

[MacDonaldTriad]

As physicians, we all balance our incomes and manage our risk. As inpatients slip on to administrative days, you risk a discharge, or take a financial hit. Setting up a private practice during residency is no different, but here is some food for thought.

So you quietly start a practice and something bad happens…

Bailiff: Do you swear to tell the truth, and…

Program Director: I do.

Lawyer: Dr. So and so, as training director, what is the final sentence on your graduate’s completion of training letter?

Training Director: Dr. X had no documented evidence of unethical or unprofessional behavior in his training record, and there has been no question regarding ability to practice competently and independently.

Lawyer: Did the resident in question have such a sentence on any letter?

Training Director: No.

Lawyer: Would you say the resident in question was practicing psychiatry independently?

Training Director: He is a really good resident and a good guy in general.

Lawyer: Your honor, please direct the witness to answer my question.

Judge: The witness will answer the question.

Training Director: Yes.

Lawyer: Was this resident practicing without your knowledge?

Training Director: Yes.

Lawyer: No further questions your honor.

 

[whopper]

Pretty much any residency program will have it IN WRITING that a resident cannot moonlight without informing the program.

It will be very easy for a lawyer to find where it is in the contract, highlight it, show it on a large screen and demand the resident on cross-examination to repeat it five times in a very loud voice so the judge can hear it.

Such a case IMHO would be a 99% chance of having a seriously bad outcome for a resident. Even if the resident avoided being guilty of malpractice, it would be on paper that the resident was in violation of the legal standards of practice. One could even argue they were practicing without legal authority to do so. The lawyer could try to an out of court settlement and say something to the effect of....

"Would you really want the state medical board to find out that you were illegally practicing medicine? I really think you ought to settle for $50,000, Yes, I know the patient having a mild headache in your mind doesn't warrant that much money or a malpractice case but my client is a sensitive and caring man and that headache as he described it to me was one that was so serious he may have PTSD from it."

http://www.bettercallsaul.com/

 

[notdeadyet]

Get an office manager/secretary that you can rely upon. It's like being Kirk and having Scotty as your engineer. That is IMHO possibly one of the most important things. I've seen several terrible doctors do alright cause their office manager was really the person running the show.

True. And plenty of the inverse as well. Lots of great physicians have run practices in the ground by doing it all themselves.

It's the snowflake phenomenon. Many physicians have been told their whole life how brilliant/intelligent/special they are and low and behold they succeed in college, medical school, residency. Then they get into practice and assume that they can learn all this stuff themselves because of how brilliant/intelligent/special they are and end up running barely surviving practices that should be thriving or tanking outright because they fancy themselves accountants, billers, marketers, etc. rather than leveraging actual experts. You see the same phenomenon when physicians invest. "I can perform open-heart surgery.... how hard can it be to run a restaurant?"

 

[F0nzie]

Business carries a certain risk and many businesses fail-- even businesses that are started by individuals with actual business experience. Yes, you should know how to bill, store records etc. and if you don't or dont have the time then hire someone that does. However, a business owner regardless of expertise is always going to run into the unknown and there is no way to find out what it is until feet are placed into the water ie. I could decide to move my pp to New York using my current business model and struggle to break into the market. For all I know transferring to New York could be like me opening up a Blockbuster in Netflix city. Or a large group practice could set up shop next to me at my current location and put me out of business-- oops did not see that one coming. Or what if one of my primary referral source relocates to another city? With business you HAVE to take risks and you NEED to constantly revise your plan because market conditions are never static. Heck I had 16 patients in my pp last Monday and this week I only have 4. How many will I have in January 2015?

 

[TexasPhysician]

Pretty much any residency program will have it IN WRITING that a resident cannot moonlight without informing the program.

It will be very easy for a lawyer to find where it is in the contract, highlight it, show it on a large screen and demand the resident on cross-examination to repeat it five times in a very loud voice so the judge can hear it.

Such a case IMHO would be a 99% chance of having a seriously bad outcome for a resident. Even if the resident avoided being guilty of malpractice, it would be on paper that the resident was in violation of the legal standards of practice. One could even argue they were practicing without legal authority to do so. The lawyer could try to an out of court settlement and say something to the effect of....

"Would you really want the state medical board to find out that you were illegally practicing medicine? I really think you ought to settle for $50,000, Yes, I know the patient having a mild headache in your mind doesn't warrant that much money or a malpractice case but my client is a sensitive and caring man and that headache as he described it to me was one that was so serious he may have PTSD from it."

http://www.bettercallsaul.com/

While I don't disagree that informing your residency program is very important, I do not follow your legal argument.

Beginning a private practice without your program's knowledge may be grounds for job termination, but once you have an unrestricted state license, you have legal authority to practice medicine.

 

[michaelrack]

While I don't disagree that informing your residency program is very important, I do not follow your legal argument.

Beginning a private practice without your program's knowledge may be grounds for job termination, but once you have an unrestricted state license, you have legal authority to practice medicine.

I agree. Completing residency is not a requirement for practicing medicine independently. In addition to having an unrestricted medical license, it is also important to have your own DEA license (if you are prescribing controlled substances).

 

[whopper]

Double checked you are both right (well at least in the state of Ohio cause that's the law I checked). You can practice without graduating residency so long as you got your license.

But if you moonlight without telling the program you're violating their rules, not the state medical board's rules. So the state medical board will say you were alright on their end but the program would likely not.