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Can physicians obtain board certification without residency?

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I am looking to bounce ideas off someone who can give me some advice on how to best proceed regarding board certification without residency. I am a UK-trained emergency medicine and ICU specialist. I am also a Ph.D. I am doing research in critical care at a large academic institution in the US. My wife has started a “start-up” company that is doing well and I am committed to staying in the US. 

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 specialty without board certification. Board certification 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’d be willing to practice medicine outside of your specialty area, there are ways to obtain a medical license without pursuing US-based specialty training. The exact requirements vary from state to state.

In California, IMGs must complete 36 months of accredited postgraduate training in the US or Canada (this rule takes effect on January 2020). So, if you plan to practice in California, it is not any quicker to obtain just a license than to get board certification.

California does have what they call a Special Faculty Permit in which internationally trained physicians who have been recognized as academically eminent in their field of specialty can be permitted to practice at a specific institution. This requires that the applicant be sponsored by the Dean of a California medical school in which a great need exists to fill positions. It can be an option if you have connections and can get your foot in the door with a California medical school.

The options for physicians who have a state license but no board certification are limited. Most hospitals and insurance companies require board eligibility. A cash-based private practice is a possibility for doctors in this situation.

For any IMGs desiring to practice clinical medicine, the best bet is to buckle down and complete US training. 

Option #3: Focus your career on research instead of clinical practice

An academic position without a clinical component is something you may want to consider. Your PhD is a huge asset. California is chock-full of large institutions of higher education that would value you for the research and teaching you can provide. 

The focus of your research could be on topics closely related to either emergency medicine or intensive care medicine, for which your previous training and experience would be quite meaningful. 

A career in research at a medical school would also allow you to work closely with physicians and have the potential to broadly impact patient care.

Option #4: Explore non-clinical career options in areas of interest to you

Your background makes you a solid candidate for a number of non-clinical careers aside from full-time research positions. Though you won’t be treating patients directly in these roles, your work can greatly influence the care that patients ultimately receive. 

Consider opportunities in:

Your medical training will certainly not be going to waste if you choose to work in one of these areas.

Making a decision about where to head with your career requires that you really consider what your professional goals are and what type of work makes you happy. You have a lot of options. They are just somewhat different than what you initially had in mind for yourself. 

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