What can you do after just an intern year?

[MissAmanda]

What can someone do after just an internship year in internal medicine? One of the interns on my rotation said her classmate is burned out and leaving training after his intern year and wants to eventually open something like a hair laser center. I assume he will have his medical license by then and is already an "MD" - but is he legally allowed to do that?

This made me wonder, in general, what is someone with a license but no complete residency allowed to do? I know many residents can moonlight starting their second year of residency. To what extent can someone with just an internship, having completed Step 3 and obtained their license and prescribing rights, practice medicine or work in a clinic?

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[FutureInternist]

Work as an ER "doctor" @ the VA where you call even more consults than a normal ER doctor, and over-rule a 3rd year resident, who knows more than you, about an admission

 

[Top Gun]

What can someone do after just an internship year in internal medicine? One of the interns on my rotation said her classmate is burned out and leaving training after his intern year and wants to eventually open something like a hair laser center. I assume he will have his medical license by then and is already an "MD" - but is he legally allowed to do that?

This made me wonder, in general, what is someone with a license but no complete residency allowed to do? I know many residents can moonlight starting their second year of residency. To what extent can someone with just an internship, having completed Step 3 and obtained their license and prescribing rights, practice medicine or work in a clinic?

Very little, to be honest with you. To obtain hospital privileges, virtually all hospitals are going to require you to be board-certified, or at least board-eligible. To be board-eligible requires completing a whole residency. Furthermore, most insurance companies are going to be very reluctant, with good reason in my opinion, to have a physician who has not completed residency on their panels, which will greatly limit your ability to practice (or at least practice and get paid for it). You might be able to find work in a medispa or with the prison system/Indian Health Service or with an insurance company doing physicals, but that's pretty much it. Personally, I think its foolish for any physician to try going out into practice after just completing intern year. You just don't have enough knowledge or experience yet.

 

[peppy]

If it was easy to find work with just an internship, you wouldn't see so many of us slogging through the whole residency. 🙂

 

[Perrotfish]

What can someone do after just an internship year in internal medicine? One of the interns on my rotation said her classmate is burned out and leaving training after his intern year and wants to eventually open something like a hair laser center. I assume he will have his medical license by then and is already an "MD" - but is he legally allowed to do that?

This made me wonder, in general, what is someone with a license but no complete residency allowed to do? I know many residents can moonlight starting their second year of residency. To what extent can someone with just an internship, having completed Step 3 and obtained their license and prescribing rights, practice medicine or work in a clinic?

1) Join the military and be a general medical officer. Provide primary care to active duty servicemen either in garisson or in a warzone. Think of it as adolescent medicine with a particularly healthy patient population Unfortunately if you don't get board certfied there is a limit to how far they will promote you.

2) Do primary care in undesirable areas. Really undesirable, like rural flyover country

3) Prison medicine. If you prefer working at a larger medical center, most prisons systms hire Internship only docs for their primary care slots.

4) Drug medicine: if you're not that ethical, you can make a good living writing a series of perscriptions for methadone or, in California, for Pot. This should not be confused with a career in actual rehabiliations centers, which generally hire fellowship trained psychiatrists.

5) Cosmetic procedures. Anything defined as a 'cosmetic procedure' like hair transplant surgery, laser skin resurfacing, or botox isn't yet under the umbrella of a particular residency, but is still practiced by anyone with a license. For practical purposes, of course, you probably want to do some kind of an apprenticeship under someone who knows what they're doing first.

6) Anything you want, if you're willing to set up your own shop operate with expensive/no malpractice insurance. A medical license entitles you do anything medical, and perscribe any drug. Residencies are trade organizations and your diploma from them has no actual legal standing. If you're willing to set up shop on your own you can, theoretically, set up practice as a neurosurgeon, nephrologist, or whatever. Down the street from my medical school there was a dermatology practice run by a guy who had no training other than an Internship in Neurosurgery. It drove ther dermatologists nuts (they may also have had a point about his competence) but there was nothing they could do about it. He was a doctor, and a doctor can practice any part of the field of medicine. Now arguing that you met the 'standard of care' to a jury, or obtaining malpractice insurance, is of course a whole other animal.

 

[DrAwsome]

1) Join the military and be a general medical officer. Provide primary care to active duty servicemen either in garisson or in a warzone. Think of it as adolescent medicine with a particularly healthy patient population Unfortunately if you don't get board certfied there is a limit to how far they will promote you.

2) Do primary care in undesirable areas. Really undesirable, like rural flyover country

3) Prison medicine. If you prefer working at a larger medical center, most prisons systms hire Internship only docs for their primary care slots.

4) Drug medicine: if you're not that ethical, you can make a good living writing a series of perscriptions for methadone or, in California, for Pot. This should not be confused with a career in actual rehabiliations centers, which generally hire fellowship trained psychiatrists.

5) Cosmetic procedures. Anything defined as a 'cosmetic procedure' like hair transplant surgery, laser skin resurfacing, or botox isn't yet under the umbrella of a particular residency, but is still practiced by anyone with a license. For practical purposes, of course, you probably want to do some kind of an apprenticeship under someone who knows what they're doing first.

6) Anything you want, if you're willing to set up your own shop operate with expensive/no malpractice insurance. A medical license entitles you do anything medical, and perscribe any drug. Residencies are trade organizations and your diploma from them has no actual legal standing. If you're willing to set up shop on your own you can, theoretically, set up practice as a neurosurgeon, nephrologist, or whatever. Down the street from my medical school there was a dermatology practice run by a guy who had no training other than an Internship in Neurosurgery. It drove ther dermatologists nuts (they may also have had a point about his competence) but there was nothing they could do about it. He was a doctor, and a doctor can practice any part of the field of medicine. Now arguing that you met the 'standard of care' to a jury, or obtaining malpractice insurance, is of course a whole other animal.

I think you provided a good overall run through of options. I'd also like to add that doing medical evaluations for Medicare, disability, etc pays moderately decently. You can also be a "medical director" for spa type places (you don't even need to open the spa yourself/invest any $$), just need to supervise it, and can make a cool 5-10 grand at some places, you can also work in healthcare consulting which has become a boom industry recently and pays more than many specialties sadly, work for epic, look into healthcare management, etc

While I would recommend anyone who has gone through med school to finish at least SOME sort of residency, there are a few options. But how stable they are, well that's different.

 

[gutonc]

I think you provided a good overall run through of options. I'd also like to add that doing medical evaluations for Medicare, disability, etc pays moderately decently. You can also be a "medical director" for spa type places (you don't even need to open the spa yourself/invest any $$), just need to supervise it, and can make a cool 5-10 grand at some places, you can also work in healthcare consulting which has become a boom industry recently and pays more than many specialties sadly, work for epic, look into healthcare management, etc

While I would recommend anyone who has gone through med school to finish at least SOME sort of residency, there are a few options. But how stable they are, well that's different.

There are really 2 issues here. The first is, what are you legally allowed to do (which has been pretty well covered here and above). The second is what will you "practically" be able to do. They are often 2 very different things.

People often mention pharma and consulting as something you can do without completing a full residency. This may be true, but I recently attended a meeting with a global pharmaceutical company that was trying to recruit me and one other person at my institution. They came to us and had a half dozen different docs there including the only physician they've ever hired straight out of fellowship (not residency, not med school...sub-specialty fellowship). Everybody else had 5-30 years in practice/research as subspecialists before joining that company. So while I suppose it's theoretically possible, it's not a real, practical option for 99.9% of people.

Most of the clinical gigs that don't require BC/BE will require a lot of luck and a significant capital outlay on your part to get going. The non-clinical gigs are certainly out there but they're also hard to find. I anticipate a couple of our non-regular users will be here in the next day or 3 to offer to tell you about them for the low, low price of $9999.99.

Finally, I don't want to sound like I'm calling anybody out, but if you want to read about how this kind of thing can go spectacularly poorly, head on over to this thread and read through it in it's entirety (the first 1/3 of it is dedicated to something irrelevant to the topic at hand but the rest of it is very germane).

 

[DrAwsome]

There are really 2 issues here. The first is, what are you legally allowed to do (which has been pretty well covered here and above). The second is what will you "practically" be able to do. They are often 2 very different things.

People often mention pharma and consulting as something you can do without completing a full residency. This may be true, but I recently attended a meeting with a global pharmaceutical company that was trying to recruit me and one other person at my institution. They came to us and had a half dozen different docs there including the only physician they've ever hired straight out of fellowship (not residency, not med school...sub-specialty fellowship). Everybody else had 5-30 years in practice/research as subspecialists before joining that company. So while I suppose it's theoretically possible, it's not a real, practical option for 99.9% of people.

Most of the clinical gigs that don't require BC/BE will require a lot of luck and a significant capital outlay on your part to get going. The non-clinical gigs are certainly out there but they're also hard to find. I anticipate a couple of our non-regular users will be here in the next day or 3 to offer to tell you about them for the low, low price of $9999.99.

Finally, I don't want to sound like I'm calling anybody out, but if you want to read about how this kind of thing can go spectacularly poorly, head on over to this thread and read through it in it's entirety (the first 1/3 of it is dedicated to something irrelevant to the topic at hand but the rest of it is very germane).

For starters, I remember that thread well, even though I'd like to forget it. 🙂
Second, like I said in my post, I highly suggest people to do some sort of residency, not just get out of med school/internship cold turkey. I think that limits possibilities tremendously.

I personally never mentioned pharma-pharma is a completely different beast from consulting. Healthcare consulting is very very very different from pharma. You are 100% correct in saying that with pharma, you have to complete residency, and given the nature of pharma, docs in specialties like yours are probably some of the most appealing, along with probably cardiologists, etc.

It is not that difficult to get into healthcare consulting however. I personally was recently offered a position at Mckinsey, and know of a number of fellow colleagues who got fed up with clinical medicine and switched over to consulting as well. Sure, most of us do have residency, and graduate degrees in addition to the MD, but many of these gigs don't require them. 1 of my colleagues went to Mckinsey, and others to different jobs in consulting. Pay starts at about primary care levels, and goes up with time. For many people who are sick of the medical culture, it's not a bad option. Can everyone get it? No of course not, but the option is out there.

Also, I would agree with you as well that those places that charge you for "leads" are out to scam you, but I never suggested paying anyone to find non clinical opportunities. Most people with some entreprenurial spirit should be able to find them if they search.

I have also read Dr. Kim's website on non clinical opps for physicians and I do think he's right about many of the things he says on there. There are indeed options, they just take some looking.

Lastly, there have been a number of docs who I know with some business savvy who have set up home care type services, and other run of the mill acute problem clinics that are mostly cash based and they have done just fine. Some have even hired staff so they don't operate them.

 

[gutonc]

For starters, I remember that thread well, even though I'd like to forget it. 🙂
Second, like I said in my post, I highly suggest people to do some sort of residency, not just get out of med school/internship cold turkey. I think that limits possibilities tremendously.

Sorry...I was quoting you for convenience and because I largely agree with the points you made. I was mostly responding to the OP.

And while it's true that you didn't mention pharma, many people do just assume that jobs in pharma are a cakewalk for anybody with an MD. Also...a lot of consulting jobs have hours that suck just as much as being a senior resident (although with admittedly fewer overnights), often with travel on top of that. But you definitely won't get sued for malpractice while consulting.

 

[DrAwsome]

Sorry...I was quoting you for convenience and because I largely agree with the points you made. I was mostly responding to the OP.

And while it's true that you didn't mention pharma, many people do just assume that jobs in pharma are a cakewalk for anybody with an MD. Also...a lot of consulting jobs have hours that suck just as much as being a senior resident (although with admittedly fewer overnights), often with travel on top of that. But you definitely won't get sued for malpractice while consulting.

That's ok, I'll forgive you this time. 🙂 Pharma jobs are certainly not a cakewalk, for sure, we definitely agree on that. I could never do pharma, consulting on the other hand, it's a cool gig. Some people love traveling and see it as a plus though, and love the nice hotels, eating on the company's dime at nice places, actually being respected in what you do and not challenged all the time by others who think they always know better *cough nurses* and so forth. And yes you won't get sued either which is always a nice perk. Surprisingly too, the salaries attached to consulting gigs are quite generous as well. I sadly think it's an alternative that a large number of MDs will consider if the medicine culture does not improve.