What employment possibilities are there for doctors (I'm an FMG) who ..........

[KeratinPearls]

USCE: 2 externships with very positive supporting LORs.
ECFMG certified: Steps 1, 2ck and cs, all first attempt with good scores.
I really believe that my graduation year (10+ years) is the determining factor and is the reason I say this is the last time I will participate since I can't change that and so many programs have a graduation date cutoff.

I know of a guy who had 99s on his Steps but was like 10 years out of medical school. Guess what? His wife is a resident in the program, so he prematched into the program. Your best best would be to somehow get "inside" the program and get to know the PD and chairman. This shouldn't be impossible esp. when considering FP.

What about Step 3? Have you taken it? Kick arse on it, target a program and get to know the PD and chair.

Good luck.

---

Members don't see this ad.

 

[Top Gun]

I know of a guy who had 99s on his Steps but was like 10 years out of medical school. Guess what? His wife is a resident in the program, so he prematched into the program. Your best best would be to somehow get "inside" the program and get to know the PD and chairman. This shouldn't be impossible esp. when considering FP.

What about Step 3? Have you taken it? Kick arse on it, target a program and get to know the PD and chair.

Good luck.

Um, there is another thread where the OP claims she matched for next year. Its in the All-Students Forums. The title is something along the lines of "What happened to free and open discussion on SDN?" I don't know whether its really true whether she matched or not, but since she claimed it, I guess we should take her at her word for now.

 

[Doowai]

This thread devolved a bit, but since the question is still one that concerns many people who read here I thought I would post this:

Yesterday I spoke with a guy in Mesa Arizona who graduated from Ross several years ago. He told me he had problems with his USMLE's but finally passed. He got into a surgical residency in Colorado. He completed one year and did not want to finish the program and dropped out. He had 3 children at the time.

He got certified as a first assist through ABSA (www.ABSA.net) , which at the time required someone with an MD degree (foreign or otherwise) have a year of post grad training to certify. They now require 2 years of post-grad training.

In lieu of an MD degree and 2 years of post-grad training, another option is an AA (or other degree such as MD) that includes a semester of biology, chemistry, physics, public speaking, pharmacology, microbiology, pathophysiology and some other stuff; plus graduating from one of the approved programs. ABSA lists several approved programs which include 9 months of online coursework, a 6 day hands on class, and completing an internship including first assisting in 135 cases.

So considering someone like Danica would have the academic qualifications completed they would just need to complete the internship, 6 day course and online study portion - all of which could be completed in 9 months.

A surgical first assist is not the same as a surgical tech. Surgical first assists can charge the same first assist fee as an MD that first assists - but only to private insurances from what I understand. Surgical assists who get certified this way cannot get paid by government funded programs like Medicare or Tricare. As a surgical first assist you do your own insurance billing. The guy I spoke with yesterday said his income has averaged from a low of $160K to a high of $390K.

 

[Doowai]

A surgical first assist is not the same as a surgical tech. Surgical first assists can charge the same first assist fee as an MD that first assists - but only to private insurances from what I understand. Surgical assists who get certified this way cannot get paid by government funded programs like Medicare or Tricare. As a surgical first assist you do your own insurance billing. .

Of course if the next president creates a Universal Health care system, and it follows medicare guidelines a surgical first assist in this manner would be screwed. Under medicare regulations only a licensed MD can get paid for first assisting.

 

[Blade28]

The guy I spoke with yesterday said his income has averaged from a low of $160K to a high of $390K.

$390k to be a surgical assist?!

 

[Winged Scapula]

$390k to be a surgical assist?!

Must be doing a lot of exposures or Ortho cases (they pay much much more than you would believe).

 

[Blade28]

Must be doing a lot of exposures or Ortho cases (they pay much much more than you would believe).

Man. That's amazing.

 

[Faebinder]

Wow, can a resident with 1 year internship work as a first assist? This is amazing.

 

[core0]

Wow, can a resident with 1 year internship work as a first assist? This is amazing.

Anybody can work as a first assist. There are still plenty of assists around who have absolutely no formal training. Hospital credentialing generally frowns on this now though. The issue would be getting credentialed as a physician to do only first assist. Where I was we had a few semi-retired surgeons who did this, but they previously had privileges. I'm not sure if a physician could apply for just first assist privileges without all the accompanying other duties (call, admission privileges etc). As a physician you can get better reimbursement than other providers. Medicare reimburses physicians at 18% of the surgeons fee and PA and NPs at 85% of that (14.5% if I remember correctly). If you work for two spine surgeons for example and just do assisting you can make some good coin.

David Carpenter, PA-C

 

[Doowai]

Must be doing a lot of exposures or Ortho cases (they pay much much more than you would believe).

Yes, he told me he primarily does ortho. The certification is national and you don't have to go state to state. All states recognize it, but in California Texas and NY you have to be an RN to legally use the certification to first assist.

 

[Doowai]

Anybody can work as a first assist. There are still plenty of assists around who have absolutely no formal training. Hospital credentialing generally frowns on this now though. The issue would be getting credentialed as a physician to do only first assist. Where I was we had a few semi-retired surgeons who did this, but they previously had privileges. I'm not sure if a physician could apply for just first assist privileges without all the accompanying other duties (call, admission privileges etc). As a physician you can get better reimbursement than other providers. Medicare reimburses physicians at 18% of the surgeons fee and PA and NPs at 85% of that (14.5% if I remember correctly). If you work for two spine surgeons for example and just do assisting you can make some good coin.

David Carpenter, PA-C

Again medicare and other government funded insurance apparently does not reimburse for people with this certification, but no licensure.

 

[core0]

Yes, he told me he primarily does ortho. The certification is national and you don't have to go state to state. All states recognize it, but in California Texas and NY you have to be an RN to legally use the certification to first assist.

There is a huge difference between national certification and state certification or licensure. The ABSA certification is not recognized by any state. It is a private corporation set up to administer a test and "certify" surgical assistants. Only RNs can use the term RNFA just as only CSTs can legally use the term CST/FA. However both of these certifications are unrecognized by the vast majority of the states. Not sure about New York or California, but off the top of my head, only Texas, Illinois, and Kentucky license surgical assistants. Texas has proposed not licensing them for a variety of reasons as seen here:
http://www.sunset.state.tx.us/79threports/tsbme/issue10.pdf
In particular their discussion of the training is somewhat illuminating.

Again medicare and other government funded insurance apparently does not reimburse for people with this certification, but no licensure.

They only reimburse Non-physician providers that have an NPI. In this case that would be PAs, NPs and CNMs. Medicare looked at this in 2004:
The GAO report recommended bundling first assist fees into hospital payments (which showed their lack of understanding on how first assists are used)
http://www.vascularweb.org/professionals/Government_Relations/PDF_Doc/GAOReportonSurgAsst011404.pdf
This does provide a good background on the various individuals that provide first assist services and their training. As well as pointing out that the majority are hospital employees (although there is a considerable amount of contention over this).
Medpacs reply was found here:
http://www.medpac.gov/publications/congressional_reports/Dec04_CRNFA.pdf
This deals only with the original request for the GAO report (to determine whether RNFAs should be reimbursed for first assisting (in their report the GAO went considerably beyond their charge). They recommended more study, but the general consensus was that since RNFAs are not true NPPs that reimbursement should not be extended (true NPPs are able to manage the patient in both the pre-operative and post operative period).

David Carpenter, PA-C

 

[Winged Scapula]

Anybody can work as a first assist. There are still plenty of assists around who have absolutely no formal training. Hospital credentialing generally frowns on this now though. The issue would be getting credentialed as a physician to do only first assist. Where I was we had a few semi-retired surgeons who did this, but they previously had privileges. I'm not sure if a physician could apply for just first assist privileges without all the accompanying other duties (call, admission privileges etc). As a physician you can get better reimbursement than other providers. Medicare reimburses physicians at 18% of the surgeons fee and PA and NPs at 85% of that (14.5% if I remember correctly). If you work for two spine surgeons for example and just do assisting you can make some good coin.

David Carpenter, PA-C

You can, at least in NY, NJ and AZ. I had friends in those states, completed residency, but were not working full-time and therefore, took jobs as surgical assistants without being required to take call or have admitting privileges. In one case, my friend took a lengthy maternity leave and has not gone back to her surgical practice but does FA prn and in the others, one is waiting for an SO to finish her residency before taking a perm job as a surgeon and in the other, he had a year off between residency and fellowship and worked doing FA.

 

[medicienne]

Hi, Danica, I am in a similar position and could not apply early enough and to enough programs d/t personal problems. Hang in there.

This is my second match season and I'm not doing it again for personal reasons.
I've already done the research and externship things (pleural) and they haven't helped. Frankly, my chances this year are dismal and I realize that.

I need to explore my options and find an alternative and the right time is now because after match day everyone will be busy planning for July. I have six weeks to do so.