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How to get an ABMS board certification without fellowship

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For allopathic physicians in the US, the most highly-regarded board certifications are those offered by the American Board of Medical Specialties (ABMS). In fact, many physician employment positions require active ABMS board certification. Most of these certifications necissitate completion of an accredited residency or fellowship program.

Most, but not all.

If you’re already board certified, there are ways to achieve a second ABMS board certification without doing a fellowship.

Why would you want a board certification without fellowship?

Medical fellowships are excellent training programs. For physicians who have completed (or nearing the end of) residency who want to further specialize, pursuing a fellowship makes sense. But a fellowship may not be feasible or desirable for some doctors. For example, physicians who:

  • Have shifted their focus since residency but don’t want to go back to being a “trainee”
  • Are in financial situations requiring more than a fellow’s salary
  • Can’t accommodate a demanding fellowship schedule

Two ways to obtain ABMS board certification without fellowship

Here are two approaches to gaining a subspecialty certification without completing a fellowship.

The “practice pathway” for newly recognized subspecialties

Typical requirements for taking the board certification exam for an ABMS-recognized subspecialty include:

  • Completion of medical school,
  • Proof of a valid state medical license,
  • Certification in a qualifying primary specialty,
  • Completion of a fellowship accredited by Accreditation Council for Graduate Medical Education (ACGME).

When a new subspecialty is accepted by the ABMS; however, there are physicians who have essentially been practicing the subspecialty for years without ABMS certification, since the subspecialty certification didn’t exist.

To address this issue, there is typically a 5- to 6-year period following ABMS acceptance of a subspecialty in which physicians can achieve board certification through what is known as the “practice pathway.” In this scenario, physicians must demonstrate that they’ve actively practiced medicine in the subspecialty area for a certain number of hours over the past several years.

Exact requirements vary by subspecialty, though physicians can expect a requirement of somewhere around 2000 hours of relevant practice in the previous five years in order to be eligible for certification through a practice pathway.

For some subspecialties, there is only one primary board certification that qualifies the physician to apply for practice pathway certification. For example, micrographic dermatologic surgery has recently been approved by the ABMS. Certification – regardless of whether it’s gained through the initial practice pathway or by fellowship completion – will, naturally, only be available to dermatologists.

Other new subspecialties are co-sponsored by two or more boards. Neurocritical care is an example of a newly approved subspecialty that is open to physicians certified by the American Board of Psychiatry and Neurology, the American Board of Anesthesiology, the American Board of Emergency Medicine, or the American Board of Neurological Surgery. Once applications start being accepted, the practice pathway will be available for 6 years.

Here’s a great deal for physicians who are board certified in any ABMS primary specialty: A couple of the more recently approved subspecialties are cross-disciplinary, meaning that physicians from any of the ABMS member boards may be practicing medicine in the field and are therefore potential candidates for board certification.

There are currently two practice pathway opportunities for physicians of any primary specialty. Both are offered through the American Board of Preventive Medicine, though you don’t need to be a preventive medicine specialist to be eligible. These include addiction medicine, which has a practice pathways through 2021, and clinical informatics, whose practice pathway is available through 2022.

The diplomat pathway

New subspecialties typically come about through the work of active societies, associations, and non-ABMS board organizations. These organizations sometimes offer their own certifications. Once the subspecialty is recognized by the ABMS, physicians carrying that certification may have the opportunity to be grandfathered into the new subspecialty as long as they meet other eligibility requirements.

An example of this pathway is the subspecialty of addiction medicine. Prior to approval by the ABMS, the American Board of Addiction Medicine (ABAM) offered a board certification to physicians who met their standards for education and knowledge in the field of addiction medicine. Until 2021, diplomats of the ABAM are eligible to apply for ABMS certification without the practice time requirements of the practice pathway.

How to find an opportunity for board certification without fellowship

Most physicians who are actively engaged in a medical discipline that isn’t formally recognized by the ABMS as a subspecialty will be acutely aware of that fact. For those interested in a board certification who aren’t in a position to do a fellowship, consider a few steps that may get you there:

  1. Professional involvement. Become involved with the major professional organization within your field to keep abreast of any efforts they are making to achieve ABMS recognition.
  2. Non-ABMS certification. If there is an organization offering a certification program, consider obtaining it.
  3. Practice within the discipline. Keep track of any work you do within the realm of the subspecialty, including hours worked, who your supervisors were, and what duties you performed.

Should you ever be eligible for ABMS board certification down the road, you’ll be ready. Here are a few disciplines that may be vying for ABMS recognition in the near future:

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