Getting full licensure after quitting residency

[toothless rufus]

A question: is it possible to get your full license if you quit residency before you get it? Since the initial full license application requires LORs or whatnot from your program. I doubt they would be inclined to provide these apparently necessary documents if you quit. Or is there a way to do this?

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[tkim]

A question: is it possible to get your full license if you quit residency before you get it? Since the initial full license application requires LORs or whatnot from your program. I doubt they would be inclined to provide these apparently necessary documents if you quit. Or is there a way to do this?

NY and MA, did not require "LOR" for my license.

 

[cabinbuilder]

All comes down to the state you are trying to get licensed in. Some states let you get a license after completing intern year and passing step III. Other states require that you finish residency and require verification from the residency program that your certificate that you have submitted is valid.

Really limiting yourself by not finishing residency.

 

[michaelrack]

many states do require you to list several (often 3) references. The state medical board will then send a form to fill out to the references.

 

[NotAProgDirector]

It also depends on whether you're a US grad or an IMG, the rules tend to be different.

All states will require some paperwork from your residency program, usually documenting the length of training and whether your work was satisfactory. It will also depend on whether you quit, or were fired. If you were fired for cause, then the residency program will likely be required to report that to the state licensing authority. That doesn't mean that you won't get licensed, but it certainly means there would be more scrutiny.

Since no one has linked to it yet, here is the list of all of the states and their basic licensing requirements:http://www.fsmb.org/usmle_eliinitial.html

You should check the specific link (on that list) to the state you're interested in.

 

[toothless rufus]

NY and MA, did not require "LOR" for my license.

So does that mean I could apply to, for example, one of these states that do not require any documentation from a home program, and then once you have an unrestricted license you can obtain one in any other state just based on the fact that you have a full license already?

All comes down to the state you are trying to get licensed in. Some states let you get a license after completing intern year and passing step III. Other states require that you finish residency and require verification from the residency program that your certificate that you have submitted is valid.

Really limiting yourself by not finishing residency.

I have no immediate plan to quit residency, just want to be prepared for any eventuality should it occur. Some states require you to Finish residency before you get your license? Interesting. I thought it was universal that you only need to finish your intern year to be eligible for a full license. There has to be a website showing requirements by state I would assume.

many states do require you to list several (often 3) references. The state medical board will then send a form to fill out to the references.

Thats fine, if that means that I can use any 3 references and not have to be dependent on my program in order to obtain my full license.

 

[NotAProgDirector]

It appears we both submitted posts simultaneously.

There is a list of states and requirements, the link is above.

You will absolutely, positively, in all states, in all cases, need to get some documentation about your residency training to get a license. No state is going to give you a license because some other state did. In fact, the opposite is true -- when you apply for a state license, the more other licenses you have the more complicated it is to get a new one, since each state wants documentation from the other states that nothing "bad" has happened. The more other licenses you have, the slower the process and the more paperwork involved.

 

[toothless rufus]

It appears we both submitted posts simultaneously.

There is a list of states and requirements, the link is above.

You will absolutely, positively, in all states, in all cases, need to get some documentation about your residency training to get a license. No state is going to give you a license because some other state did. In fact, the opposite is true -- when you apply for a state license, the more other licenses you have the more complicated it is to get a new one, since each state wants documentation from the other states that nothing "bad" has happened. The more other licenses you have, the slower the process and the more paperwork involved.

Thanks for the link and the info.

 

[cabinbuilder]

Oregon, Alaska, and Nevada I had to verify that I finished residency

 

[tkim]

So does that mean I could apply to, for example, one of these states that do not require any documentation from a home program, and then once you have an unrestricted license you can obtain one in any other state just based on the fact that you have a full license already?

No, there's no 'recipocity' for medical licensure across states. Every state board wants their slice of the pie, and as mentioned above, if you get a license and then move to another state to practice, you will have to report the previous license and they verify that license as well.

Really, the only time during residency that you should be getting a license is if your program requires you to get one, you plan on settling and practicing in that state, or if you plan on moonlighting before graduating.

I did moonlighting while in residency, and moved to another state for practice, but if I were to move to yet another state, I would now have to report the two previous licenses and they would have to verify them. Gets complicated fast.

I've also heard, but don't think it's valid, that you should never let your old licenses expire, but you should keep them active so you can easily move back and practice without having to go through the hoops again for that state. Seems simple enough but then you have to pay license fees for each state and make sure your CME's cover each state.

 

[Law2Doc]

...
Really, the only time during residency that you should be getting a license is if your program requires you to get one, you plan on settling and practicing in that state, or if you plan on moonlighting before graduating...

While i dont totally disagree with you for the average person, I would point out that it's administratively much harder to strip someone of a license than not to issue them one in the first place. So folks who end up having trouble in medicine/residency will be benefitted by having obtained a license at the earliest juncture, because you'll still have it to fall back on if things go sour.

 

[Winged Scapula]

I've also heard, but don't think it's valid, that you should never let your old licenses expire, but you should keep them active so you can easily move back and practice without having to go through the hoops again for that state. Seems simple enough but then you have to pay license fees for each state and make sure your CME's cover each state.

What you want to do is not let them expire but rather inactive them. Doing so releases you from paying annual/biannual fees and CMEs but makes it easier to reactivate should you decide you want to use the license again. Letting the license expire means you have to start from scratch again in terms of paperwork and verification.

 

[peppy]

If you're thinking of quitting, keep in mind that if someone does get terminated or has to resign from residency, it's not that easy to find work without being BE/BC.
I'm not sure that having your license would really be that useful even though in theory you could work with it. From what has been posted on here, it seems like sometimes people can get a job at an urgent care or with a home care company, but that seems to be more of a luck thing and not something you can rely on. Of course, pill mills will hire you, but then you're asking for trouble.
If there is some kind of problem in your residency that makes you worry you might have to resign or get fired, I would try to come up with a concrete plan for where you'll be able to work before going to the trouble and expense of getting licensed. The preferred route would be to try to minimize the damage and try to get into a different residency though.

 

[docu]

A question: is it possible to get your full license if you quit residency before you get it? Since the initial full license application requires LORs or whatnot from your program. I doubt they would be inclined to provide these apparently necessary documents if you quit. Or is there a way to do this?

yes it is possible. Get LOR's before you leave, just in case you may need them. Usually the licensure board will ask you for a notarized PD approval letter or something like that. FCVS can sometimes send the PD's an electronic form so they can approve you electronically, which basically usually just requires a signature. Even at malignant programs I was at, they still approved me for my license, so you never know!

Basically if you want a job as a GP (licensed but not BE/BC), you will have a hard time finding one as peppy said. I had to create my own jobs. I opened up my own home care company. But the money is not always that great. You could also open up a clinic in a happening area of patients, but the overhead is high, because you have to hire front desk, etc. you may have to take a loan to start up. I dont even qualify for a loan though lol. Or you could get in with a group of doctors. I have a profit share in a company with some docs, so that was enough for me. I was about to start up my own clinic but didn't want the headaches. as a GP you can either take cash or medicare/medicaid/blue cross blue sheid. some billers can help you get credentialled in more insurances.

 

[chocomorsel]

While i dont totally disagree with you for the average person, I would point out that it's administratively much harder to strip someone of a license than not to issue them one in the first place. So folks who end up having trouble in medicine/residency will be benefitted by having obtained a license at the earliest juncture, because you'll still have it to fall back on if things go sour.

Totally agree. That's why I am in the crappy boat I am in.

 

[8335789]

I did 2 yrs residency before switching fields. The scuttlebutt of the hospital was "oh yeah I'd go moonlight and make a lotta money!" I found there to be a few barriers to this however: 1) the facilities I contacted all requested a certain number of hours experience working in their particular setting, 2) if moonlighting outside your area of expertise, you are putting patients at risk, and 3) when you put patients at risk, you put your freshly minted license at risk and 4) there is a reason everyone else finishes a residency before taking full responsibility for patients. When I pick a physician to take care of me or my family, um they had better be fully trained. Patients deserve someone who knows what they are doing. That said, I know people who have done it, but always within their own specialty.

 

[Crazy8s]

Okay, answer this

I am a GP with an open unrestricted license. However, I am unable get credentialed to work without supervision. Who decided this and are there ways to change this? Isn't that what having a medical license means? A decade ago I was terminated from a residency. Have been doing H&Ps.

 

[Raryn]

Okay, answer this

I am a GP with an open unrestricted license. However, I am unable get credentialed to work without supervision. Who decided this and are there ways to change this? Isn't that what having a medical license means? A decade ago I was terminated from a residency. Have been doing H&Ps.

An unrestricted license is just that: an unrestricted license. Someone who did 1-2 years of any residency can theoretically get a license that would allow them to legally practice medicine in whatever form they want (minus prescribing a few specific medications that are restricted). You could do an IM intern year and then practice brain surgery.

Of course, you'd have to find a hospital that allows you to do brain surgery and an insurance company to reimburse you. Neither of which would ever happen, given they have no indication that you'd know what you were doing.

That's the rub. You have an unrestricted license to practice medicine, but no hospital, clinic, or insurance company is required to certify you. They can and do have their own criteria that is stricter than the licensing board.

So what does that mean for you? Well, you need a paycheck. Very unlikely you'll find a hospital that lets you work there. But there's often plenty of urgent cares that just need warm bodies. I'd look into those. Or companies looking for someone to do disability physicals. Or sometimes prisons just need someone with a pulse/license to meet regulatory standards. Or hell, you could even open your own private practice and just see medicare patients, they're probably the easiest insurance to get certified for. You have a bunch of options, just significantly fewer than you'd have if you finished residency.

 

[Crazy8s]

An unrestricted license is just that: an unrestricted license. Someone who did 1-2 years of any residency can theoretically get a license that would allow them to legally practice medicine in whatever form they want (minus prescribing a few specific medications that are restricted). You could do an IM intern year and then practice brain surgery.

Of course, you'd have to find a hospital that allows you to do brain surgery and an insurance company to reimburse you. Neither of which would ever happen, given they have no indication that you'd know what you were doing.

That's the rub. You have an unrestricted license to practice medicine, but no hospital, clinic, or insurance company is required to certify you. They can and do have their own criteria that is stricter than the licensing board.

So what does that mean for you? Well, you need a paycheck. Very unlikely you'll find a hospital that lets you work there. But there's often plenty of urgent cares that just need warm bodies. I'd look into those. Or companies looking for someone to do disability physicals. Or sometimes prisons just need someone with a pulse/license to meet regulatory standards. Or hell, you could even open your own private practice and just see medicare patients, they're probably the easiest insurance to get certified for. You have a bunch of options, just significantly fewer than you'd have if you finished residency.

 

[Crazy8s]

Thank you for your informative, realistic answer. I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer. Seems to me after a decade and several years of successful work experience they shouldn't care what I do. How can I minimize their damage if I decide to try to return to residency?

 

[mvenus929]

Thank you for your informative, realistic answer. I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer. Seems to me after a decade and several years of successful work experience they shouldn't care what I do. How can I minimize their damage if I decide to try to return to residency?

What did you do that they are actively blocking your attempts to get a new position?

 

[deleted480308]

What did you do that they are actively blocking your attempts to get a new position?

That's the story i want

 

[Raryn]

Thank you for your informative, realistic answer. I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer. Seems to me after a decade and several years of successful work experience they shouldn't care what I do. How can I minimize their damage if I decide to try to return to residency?

There's nothing you can really do at this point.

No one will take you as a resident without a letter from your prior program's PD. If they state that they unequivocally do not recommend you for further training, you're more or less done. Especially if it's been >10 years since you've graduated medical school, your chance of getting into a residency is for all intents and purposes, zero.

Your options are this point are things similar to what I mentioned above. You completed enough of your program to get an unrestricted license, get a job that just requires that. Insurance physicals. Disability reviews. Some urgent cares (this is location specific). Whatever you can find. Nothing will pay as much as a fully trained BC physician would get (except some super-shady pill-mills you really should avoid), but it will be enough to put food on the table.

Good luck.

 

[Crazy8s]

That's the story i want

If you must know, I messed up badly, repeatedly until I was finally run out of town on a rail.

 

[Crazy8s]

That's the story i want

I messed up badly, repeatedly, until I was run out of town on a rail.

 

[Crazy8s]

What did you do that they are actively blocking your attempts to get a new position?

actively blocking?! That's not what my LOR's say....

 

[Crazy8s]

There's nothing you can really do at this point.

No one will take you as a resident without a letter from your prior program's PD. If they state that they unequivocally do not recommend you for further training, you're more or less done. Especially if it's been >10 years since you've graduated medical school, your chance of getting into a residency is for all intents and purposes, zero.

Your options are this point are things similar to what I mentioned above. You completed enough of your program to get an unrestricted license, get a job that just requires that. Insurance physicals. Disability reviews. Some urgent cares (this is location specific). Whatever you can find. Nothing will pay as much as a fully trained BC physician would get (except some super-shady pill-mills you really should avoid), but it will be enough to put food on the table.

Good luck.

Are you saying the PD's word is final forever more? Who can I appeal to?

 

[Crazy8s]

What did you do that they are actively blocking your attempts to get a new position?

Actively blocking?! That's not what my LOR's say....

 

[Raryn]

Are you saying the PD's word is final forever more? Who can I appeal to?

The only person you could "appeal" to would be a program director at a new residency that would be willing to take you.

What I'm saying is that it is very, very unlikely that any program director will take a chance on accepting someone as a resident who is >10 years out from medical school, previously failed out of a residency, and doesn't have the support of their prior program. Even if you had the support of your prior program, it's still unlikely.

There's no centralized authority that can get you a spot, just an individual program director (and/or their committee). Given that there's several thousand programs in this country, it's possible you'd find one willing to take you... just I personally doubt it.

 

[NotAProgDirector]

I'm very confused.

You said:

I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer.

And then:

actively blocking?! That's not what my LOR's say....

If I understand your situation correctly, you were terminated from a residency 10+ years ago. Unclear what happened, all you've said is that messed up badly and repeatedly. Keeping your story private is completely fine. Now you're trying to find a new spot.

At this point, your biggest problem isn't your prior program "blocking" you. It's that you're 10+ years out from medical school. Most residency programs will be concerned that your skills have atrophied. They also will be interested in the issues / reasons you were terminated in the first place.

 

[deleted480308]

OP, have you tried looking around for all the "open" and off cycle slots that i'm assuming are advertised on various specialty websites?

 

[Crazy8s]

I'm very confused.

You said:


And then:


If I understand your situation correctly, you were terminated from a residency 10+ years ago. Unclear what happened, all you've said is that messed up badly and repeatedly. Keeping your story private is completely fine. Now you're trying to find a new spot.

At this point, your biggest problem isn't your prior program "blocking" you. It's that you're 10+ years out from medical school. Most residency programs will be concerned that your skills have atrophied. They also will be interested in the issues / reasons you were terminated in the first place.

Thank you for your answer. With all respect, I am confused also. I have several LOR's written over several years saying they "recommend me for a first year position." However, when I have applied, they call my previous pd and the pd tells him/her only over the phone, never written, that they don't recommend me (yes, I have proof). What do you think?

 

[Crazy8s]

OP, have you tried looking around for all the "open" and off cycle slots that i'm assuming are advertised on various specialty websites?

No, I haven't tried this year. The last time I tried, I was interviewed and actually received a verbal offer from a residency. They called my previous residency the next week and suddenly, "all their positions are filled." I am happy to apply; there seems to be no point in wasting the time and $$ only to be blocked by my previous residency.

The only person you could "appeal" to would be a program director at a new residency that would be willing to take you.

What I'm saying is that it is very, very unlikely that any program director will take a chance on accepting someone as a resident who is >10 years out from medical school, previously failed out of a residency, and doesn't have the support of their prior program. Even if you had the support of your prior program, it's still unlikely.

There's no centralized authority that can get you a spot, just an individual program director (and/or their committee). Given that there's several thousand programs in this country, it's possible you'd find one willing to take you... just I personally doubt it.

Actually, you would be surprised. With the internet, you can see the application criteria on all of the websites of all GME programs. Some residencies (very, very few) don't have a graduation year requirement, or will overlook that requirement in the face of current clinical experience. Admittedly, performing H&P's are a long way from working without supervision. However, it does involve current direct patient contact that is, as you've said, putting food on the table.

 

[mcl]

No, I haven't tried this year. The last time I tried, I was interviewed and actually received a verbal offer from a residency. They called my previous residency the next week and suddenly, "all their positions are filled." I am happy to apply; there seems to be no point in wasting the time and $$ only to be blocked by my previous residency.


Actually, you would be surprised. With the internet, you can see the application criteria on all of the websites of all GME programs. Some residencies (very, very few) don't have a graduation year requirement, or will overlook that requirement in the face of current clinical experience. Admittedly, performing H&P's are a long way from working without supervision. However, it does involve current direct patient contact that is, as you've said, putting food on the table.

I think best path at this point is to contact the PD at your old program and ask for his/her support. No program is going to take you without talking to your previous program, so you need to convince that PD that you have changed and grown and are ready for residency. The only other option I see is asking the physicians who supervise you to network with their own residency programs on your behalf. They might be able to convince a program that you have potential based on their experience with you, which might trump comments from a PD who hasn't worked with you in a number of years.

 

[mvenus929]

Thank you for your informative, realistic answer. I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer. Seems to me after a decade and several years of successful work experience they shouldn't care what I do. How can I minimize their damage if I decide to try to return to residency?

actively blocking?! That's not what my LOR's say....

This line of thought doesn't make sense.

Thank you for your answer. With all respect, I am confused also. I have several LOR's written over several years saying they "recommend me for a first year position." However, when I have applied, they call my previous pd and the pd tells him/her only over the phone, never written, that they don't recommend me (yes, I have proof). What do you think?

Are your LORs from your previous PD, or just attendings you have worked with? The PD is essentially the all seeing eye--they know everything that happens in the rest of the program, so even if a few attendings thought you did well, if you had a major enough mess-up that your PD is not recommending you, you're going to struggle. Not to mention being so far out of med school at this point...

 

[Crazy8s]

This line of thought doesn't make sense.



Are your LORs from your previous PD, or just attendings you have worked with? The PD is essentially the all seeing eye--they know everything that happens in the rest of the program, so even if a few attendings thought you did well, if you had a major enough mess-up that your PD is not recommending you, you're going to struggle. Not to mention being so far out of med school at this point...

they are from my previous pd.

 

[Crazy8s]

I think best path at this point is to contact the PD at your old program and ask for his/her support. No program is going to take you without talking to your previous program, so you need to convince that PD that you have changed and grown and are ready for residency. The only other option I see is asking the physicians who supervise you to network with their own residency programs on your behalf. They might be able to convince a program that you have potential based on their experience with you, which might trump comments from a PD who hasn't worked with you in a number of years.

Thank you for your considered suggestion. That's probably the path I'll need to take. One final question... Can a GP be certified to work without supervision?

 

[mvenus929]

Thank you for your considered suggestion. That's probably the path I'll need to take. One final question... Can a GP be certified to work without supervision?

If you can get a license to practice medicine independently, you can practice without supervision. The issue comes with getting hospital privileges, or getting approved by insurance companies, who may not want to approve someone who isn't board certified/eligible to treat their patients. But you can set up a fee-for-service practice without issue.

 

[Crazy8s]

If you can get a license to practice medicine independently, you can practice without supervision. The issue comes with getting hospital privileges, or getting approved by insurance companies, who may not want to approve someone who isn't board certified/eligible to treat their patients. But you can set up a fee-for-service practice without issue.

they are from my previous pd.

How can I can I obtain a copy of the LOR he is providing to other employers, agencies, etc.? Do I have a legal right to this information? I'm not interested in a lawsuit, a defamation suit, or anything like that. I just want to know what he's saying.

 

[psych md jd]

How can I can I obtain a copy of the LOR he is providing to other employers, agencies, etc.?

Have you asked the PD directly for a copy?

 

[Crazy8s]

Have you asked the PD directly for a copy?

many times.

 

[psych md jd]

Then, next try the GME office. If still no response, continue going up the chain.

 

[fantasty]

Thank you for your informative, realistic answer. I tried for years to get into another residency but was blocked by my previous residency. They blocked all my attempts, even one where I would merely be a house officer. Seems to me after a decade and several years of successful work experience they shouldn't care what I do. How can I minimize their damage if I decide to try to return to residency?

I think @Raryn provided a pretty accurate assessment of the residency and the types of jobs that you can get with an unrestricted license without being BE/BC.

I don't want to paint the picture that my specialty is a good "consolation price" for people who didn't complete their first residency. But, preventive medicine and occupational medicine *may* still be reasonable options for someone who has successfully completed at least PGY-1. To apply in these fields (they are under the same specialty board, along with Aerospace med), you have to have completed a clinical year (most will consider any clinical specialty), and it can lead to a fairly diverse set of career options (as a board-certified physician) that might be a good match for someone who, for one reason or another, weren't a good match for their first residency.

The length of time since training *may* still be a factor, but the best way to find out would be to contact programs directly.

Obligatory links anytime I give advice
ACPM: American College of Preventive Medicine
ABPM: https://www.theabpm.org/

Info / career paths (Med student section): Medical Student Section - American College of Preventive Medicine
Resources for residents: Resident Physician Section - American College of Preventive Medicine

 

[Hundy]

It also depends on whether you're a US grad or an IMG, the rules tend to be different.

All states will require some paperwork from your residency program, usually documenting the length of training and whether your work was satisfactory. It will also depend on whether you quit, or were fired. If you were fired for cause, then the residency program will likely be required to report that to the state licensing authority. That doesn't mean that you won't get licensed, but it certainly means there would be more scrutiny.

Since no one has linked to it yet, here is the list of all of the states and their basic licensing requirements:http://www.fsmb.org/usmle_eliinitial.html

You should check the specific link (on that list) to the state you're interested in.

 

[Crazy8s]

Then, next try the GME office. If still no response, continue going up the chain.

Thank you for this suggestion. It's clearly what I'm going to have to do.