Published by Lookforzebras
- There are not viable paths to board certification without residency in the US
- Complete an accredited residency program in the US
- Obtain a medical license for limited clinical practice options
- Focus your career on research instead of clinical practice
- Explore non-clinical career options in areas of interest to you
Q: I’m seeking advice from someone who can help me explore the best path forward for obtaining board certification without residency. I’m a UK-trained specialist in emergency medicine and ICU, as well as a Ph.D. researcher in critical care at a major academic institution in the U.S. With my wife’s successful startup thriving, I’m committed to staying in the U.S. and looking for guidance on my options.
I want to circumnavigate residency but can’t find a way to obtain board eligibility. Is this possible? I would like to continue doing research and work as a specialist. Any advice would be welcome. Thanks!
A:There is not a way to accomplish exactly what you’ve described, which is working as a board-certified emergency medicine or critical care specialist in the US without having completed a residency in the US or Canada.
The fact that your training was outside of the US and that you’d prefer not to complete a US-based residency are definitely complicating factors.
There are not viable paths to board certification without residency in the US
Two years of US-based training is required for an international medical graduate (IMG) to even become licensed in the state of California. Moreover, very few employment arrangements will allow a physician to practice a Board Certification Without Residency . Board Certification Without Residency demands additional residency training in the US.
That said, there are several aspects of your situation that expand the number of options you have. These include your PhD and research experience, your relationship with a large academic institution in the US, and your previous specialty training in both emergency medicine and intensive care.
You have some great routes to take if you’re open to redirecting your career plan. Some possibilities are:
- Complete a residency in order to work as a specialist
- Get licensed and practice as a non-specialist
- Focus your career on research
- Take a non-clinical job in an area of interest to you
I’ll go into some detail on each of these below.
Option #1: Complete an accredited residency program in the US
Repeating your post-graduate medical training is obviously not your first choice, but I do encourage you to weigh this option heavily. It is the best means for you to reach your current goals.
Physicians trained outside of the US need to complete graduate medical education in the US to be eligible for American Board of Medical Specialties (ABMS) board certification. This requirement holds true regardless of the training completed outside of the US, though there are certain exceptions for Canadian training programs. ABMS certification is typically required for physicians to be credentialed at US hospitals.
In some cases, such as for the American Board of Internal Medicine, up to a year of training abroad prior to entering an accredited training program in the US can be counted toward the total requirement.
There are board-certifying bodies other than the ABMS. The most well-known among these is the American Board of Physician Specialties (ABPS), which also requires completion of an accredited residency program in either the US or Canada to obtain certification. There certainly is the possibility for certifying organizations to change their requirements down the road or for new bodies to enter the space.
There are possibilities for foreign-trained physicians to complete a non-ACGME accredited fellowship under a training license; however, this does not assist in acquiring ABMS board certification.
Option #2: Obtain a medical license for limited clinical practice options
If you’re open to practicing outside your specialty, you may get a medical license without US-based specialty training, though requirements vary by state
In California, IMGs must complete 36 months of accredited postgraduate training in the US or Canada (effective January 2020). So, getting a license isn’t faster than earning board certification.
However, California offers a Special Faculty Permit for internationally trained physicians recognized as experts in their field. A California medical school dean must sponsor the applicant, making strong connections essential.
Without board certification, options are limited. Most hospitals and insurers require board eligibility, though a cash-based private practice is possible.
For IMGs wanting to practice clinically, completing US training remains the best path
Option #3: Focus your career on research instead of clinical practice
Consider an academic role without clinical duties. Your Ph.D. is a strong asset, and many universities in California would value your research and teaching skills.
Additionally, you can focus on topics related to emergency or intensive care medicine, where your experience is especially relevant.
Moreover, a research career at a medical school allows you to collaborate with physicians and ultimately make a broad impact on patient care
Option #4: Explore non-clinical career options in areas of interest to you
Your background opens doors to many non-clinical careers beyond full-time research. While you won’t treat patients directly, your work can still impact their care.
Consider opportunities in:
- Pharmaceutical research and development or medical affairs
- Hospital or healthcare system administration
- Management or healthcare consulting
Your medical training remains valuable in these fields. Choosing your next step means reflecting on your career goals and what work truly fulfills you. You have plenty of options—they’re just different from your original plan..