working as a PGY1-trained (non-residency) physician

[crazybrancato]

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Hello,

I'm completing my PGY1 year soon here, then going off to do research. To be honest, I'm not sure if I'll be returning to my residency program, to finish. I might just pursue a career path strictly in research. However, I would like to maintain my clinical skills, to some extent.

I've often heard of (and met) physicians that work in EDs, in doc-in-the-boxes, as solely PGY1 trained physicians (meaning they never, or have yet to finish a residency program).

Is it possible to do this, to just work in an ED or a doc-inthe-box, just as a pgy1 trained MD? Again, I'm asking b/c, although I want research to be my main path, it would be nice to maintain some clinical skills.

any thoughts, thank you in advance.

 

[tkim]

If you were licensed you might find an urgent care to work in, but few EDs will hire a non-boarded physician.

Bear in mind that you will still have to have malpractice for either environment, and you will either be refused coverage for ER work, or the cost will be prohibitive. Do you really want to take on the responsibility and liability for any and all comers to the ED with only one year of training?

 

[crazybrancato]

If you were licensed you might find an urgent care to work in, but few EDs will hire a non-boarded physician.

Bear in mind that you will still have to have malpractice for either environment, and you will either be refused coverage for ER work, or the cost will be prohibitive. Do you really want to take on the responsibility and liability for any and all comers to the ED with only one year of training?

thank you for your reply, that's a very valid and strong point. Just out of curiosity then, why is this even allowed? Why are we allowed to obtain licensure after pgy1 and completion of the step exams . . .if practicing after pgy1 is so frowned upon now? Why not grant licensure only after someone has completed a formal residency?

In any case, i wouldn't be looking to work in a high-acuity trauma ED ... would be more on the end of low-acuity community hospital. But perhaps the urgent care route is safer.

 

[tkim]

I don't know why it's allowed, but it might be somewhat of a holdover when more people did one year of internship, got their license and opened up a practice as a "GP".

However, if you suggested ending early licensing, you would get howls of disapproval from residents who want to moonlight and require an unrestricted, i.e., not a training or institutional license in order to do so.

Also, in the past there were greater numbers of residencies that required a one-year transitional or preliminary year before moving on to advanced training, and that seems to coincide with the one year of training and taking step 3.

The military also sends people who have only completed one year of internship out in the field as General Medical Officers, and they require an unrestricted medical license, so that might have something to do with it as well.

I waited until the early part of my third year of EM residency to moonlight in an urgent care. It's not the easily recognizable/treatable stuff that was the worry, but the subtle, easily missed stuff that might require further workup that I would decide to send home that kept me up at night.

 

[crazybrancato]

However, if you suggested ending early licensing, you would get howls of disapproval from residents who want to moonlight and require an unrestricted, i.e., not a training or institutional license in order to do so.

I'll bet!

I waited until the early part of my third year of EM residency to moonlight in an urgent care. It's not the easily recognizable/treatable stuff that was the worry, but the subtle, easily missed stuff that might require further workup that I would decide to send home that kept me up at night.

I hear you, thanks for the input. I would tread very cautiously!

 

[DIce3]

If you have the option of staying with your current residency program and finishing out your training, you should. Failure to complete the residency will haunt you for the rest of your career. As a GP, your practice options will be severely limited: Harder to get commercial insurance contracts, medical staff privileges, and respect from your patients and fellow providers.

 

[crazybrancato]

If you have the option of staying with your current residency program and finishing out your training, you should.

I don't (was doing a prelim TY year). Am research bound, doing a post-doc, then, hopefully onto academia.

Failure to complete the residency will haunt you for the rest of your career. As a GP, your practice options will be severely limited: Harder to get commercial insurance contracts, medical staff privileges,

. Understood, and this is how it should be.

and respect from your patients and fellow providers.

Ok, so let me play a little devil's advocate here. Suppose you are a pgy-1 trained physician (like some of the old time docs that are still practicing) . . .If you work within a limited scope of practice---treating minor things, say mostly acute care, outpatient cases, NOT ICU players or difficult hosp admissions--and if you work hard, striving to provide a good service to your patients, never hesitating to ask for help when necessary, etc etc . . . .then why wouldn't you earn the respect of your patients and fellow providers???

 

[DIce3]

In a remote town of 800, there will be no issue. In a city of 200,000+, fellow physicians will be nice to your face but will not value your care as much as a general internist. You will always have this stigma. As for patients, it will be hit and miss. Most patients will have no idea what you did or did not do. Heck, I see patients who have been only seeing a PA for years and call them Dr.... But I will guess that 5% of patients will not see you simply because you are not board certified in something. Here is the thing: in 20 years if you change to clinical medicine, that 5% is going to sting alot and keep on stinging for the rest of your career. Research is a young person's game and when you are 50, you may want to get out of that race and practice general medicine. Again, only trying to help with some advice but I would seriously work on getting boarded in IM, FP, or something else so you have a real clinical profession to fall back on. Unless... you just hate clinical medicine and don't want to hear about snot and diarrhea, then you can forget about doing more residency years.

 

[Danbo1957]

You can work after PG1 in many states, not all, whether inpatient in rural or underserved urban areas, or outpatient most anywhere-- there will be plenty of "GP" work available to keep up your clinical skills. As you should now know, licensed MD's with PG1 are valuable in research, especially when hooking up with Ph.D's in clinical trials (and don't worry about age limitations, you'll still be called Professor after 50).

 

[crazybrancato]

In a.

ok, thank you all for your replies, this was very helpful. I appreciate you taking the time to respond.