Now, a cautionary tale...

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tennischamp822 said:
Wait, I thought they did that already when I signed up for Step.

The decision won't be final until late May, so would I be able to take it before they come to a decision?
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See if you can appeal so you can buy more time to study for it because once they take a final decision, they might let NBME know that you are no longer eligible to take it.
 
tennischamp822 said:
Hey guys, I was wondering if anyone had advice for my situation.
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Even if you are allowed to sit for Step 1, do well on it, successfully transfer into a Caribbean school, and do well on Step 2 CK/CS, you will still have to disclose that you were dismissed from a previous school on your ERAS application for residency. This will come up in your interviews, guaranteed, and many programs will treat a professionalism violation much more severely than a failed Step exam. You would need to show tangible proof that you've addressed the issue, and either way you're most likely not going to get competitive programs. It would be a big risk. It would be much better for you to work within your current program to appeal the dismissal.
 
tartesos said:
I'm actually happy for him,hopefully he can pay those loans. He could work in any federal position( va, Indian health, corrections ) and some states as well.



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He should have no issues paying off his student loan after finishing that internship and securing a job in the mainland... Physicians with restricted license are doing ok in state like FL etc...
 
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Skip Intro said:
I'm not terribly familiar with such "internado" programs in Puerto Rico. Anyone have any specific information?

-Skip
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Based on what my friend who did the 'internado' and is working in the US mainland told me: An 'internado' (translation for internship or intern year) is like 1-year of paid or unpaid (depending of the hospital) preliminary medicine... After that 1 year, you are eligible to have PR license in which you can function as a PCP in PR... The majority of PCP in PR are GP because there is a severe shortage of PCP there... Most PR physicians who complete residency usually leave or don't return to the island due to a multitude of reasons (salary, security , not a great environment to raise children etc... ).

He told me some mainlanders who go there choose to do 2-year since many states in the mainland will not give you a license if you don't have a 2-year postgrad training as an IMG... and these hospitals are happy to renew your contract after that first year because they are essentially getting free labor from a licensed MD... They make sure you apply for a license after your 1st year so you can function as a regular MD.

My friend is basically making the salary of a FM doc (180k/year + crazy benefits--even partially subsidized housing) working for a subsidiary of the US government... 8am-5pm M-F seeing <10 patients/day...

He also said it's getting difficult to get these 'internado' because a lot Puerto Ricans are going abroad to study medicine, then come back and apply for these positions... since you don't need step 1/2/3 to be a licensed MD in PR... You just have to take some PR version of USMLE, which is only one exam...

I worked with some of these GP in FL in 'area of critical need' and I believed they were good physicians (at least better than the PA/NP who were working at the clinic).

There is always some stupid loopholes in the system for people to use...
 
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W19 said:
Based on what my friend who did the 'internado' and is working in the US mainland told me: An 'internado' (translation for internship or intern year) is like 1-year of paid or unpaid (depending of the hospital) preliminary medicine... After that 1 year, you are eligible to have PR license in which you can function as a PCP in PR... The majority of PCP in PR are GP because there is a severe shortage of PCP there... Most PR physicians who complete residency usually leave or don't return to the island due to a multitude of reasons (salary, security , not a great environment to raise children etc... ).

He told me some mainlanders who go there choose to do 2-year since many states in the mainland will not give you a license if you don't have a 2-year postgrad training as an IMG... and these hospitals are happy to renew your contract after that first year because they are essentially getting free labor from a licensed MD... They make sure you apply for a license after your 1st year so you can function as a regular MD.

My friend is basically making the salary of a FM doc (180k/year + crazy benefits--even partially subsidized housing) working for a subsidiary of the US government... 8am-5pm M-F seeing <10 patients/day...

He also said it's getting difficult to get these 'internado' because a lot Puerto Ricans are going abroad to study medicine, then come back and apply for these positions... since you don't need step 1/2/3 to be a licensed MD in PR... You just have to take some PR version of USMLE, which is only one exam...

I worked with some of these GP in FL in 'area of critical need' and I believed they were good physicians (at least better than the PA/NP who were working at the clinic).

There is always some stupid loopholes in the system for people to use...
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This should just be the standard all over the US. Do one or two years as an intern and then become a GP even if restricted to work these federal or state jobs or areas of high need. Hell, even charge tuition like hundreds of dental residency programs do. This model makes sense over allowing midlevels to take over entire fields of medicine.

Where can one find out more about these internados in PR, @W19?
 
OutRun said:
This should just be the standard all over the US. Do one or two years as an intern and then become a GP even if restricted to work these federal or state jobs or areas of high need. Hell, even charge tuition like hundreds of dental residency programs do. This model makes sense over allowing midlevels to take over entire fields of medicine.

Where can one find out more about these internados in PR, @W19?
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It's hard to find out about these internado according to what he told me..He said he had to travel to PR, and directly went to a bunch of hospitals until he found a few that told him they have the program... Crazy process!

I agree with you that this should be the standard in all US states, but I disagree that they should charge tuition... However, the problem is that you have a bunch of elitists MD/DO and med students that disagree with us because they have to protect their brand :rolleyes:.

By the way, my friend told me there are no NP/PA in PR...
 
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There is no ACGME-accredited program at the institution he lists:

ACGME - Accreditation Data System (ADS)

I'm not sure that this "match" is nothing more than an Internado. Working? Maybe. Paying? Not sure. Leading to board-certification? Doubtful.

I'm dubious that he is calliing this a "match".

-Skip
 
Skip Intro said:
There is no ACGME-accredited program at the institution he lists:

ACGME - Accreditation Data System (ADS)

I'm not sure that this "match" is nothing more than an Internado. Working? Maybe. Paying? Not sure. Leading to board-certification? Doubtful.

I'm dubious that he is calliing this a "match".

-Skip
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I had the exact same thoughts reading his post. I always try to maintain optimism in cases like this, but man this is just a bad situation all around. I maintain strongly that this not who I would want treating my loved ones.
 
bedevilled ben said:
I had the exact same thoughts reading his post. I always try to maintain optimism in cases like this, but man this is just a bad situation all around. I maintain strongly that this not who I would want treating my loved ones.
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Well, but you would not mind having a NP treating your love ones...
 
W19 said:
Well, but you would not mind having a NP treating your love ones...
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That so? Depends heavily on what they're being treated for, and on the NP/PA. Lack of standardized education is exactly why I'm wary of midlevel providers. I've worked with plenty that ran circles around me. I work with a few now that have clinical acumen well below a 4th year medical student. Lack of standardization in education is exactly the problem.

Precisely why I wouldn't want Dr. Bill treating them. The minimum standard was set, and he failed to meet it.
 
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nidusiamnot said:
If you fail, try and try again. I guess he finally matched! Kudos to him for not giving up.

Southern Doc (Caribbean Style): WOW after 6 years MATCHED
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He didn't actually match.

Skip Intro said:
There is no ACGME-accredited program at the institution he lists:

ACGME - Accreditation Data System (ADS)

I'm not sure that this "match" is nothing more than an Internado. Working? Maybe. Paying? Not sure. Leading to board-certification? Doubtful.

I'm dubious that he is calliing this a "match".

-Skip
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That's the most important part, no? He really can't practice in the US but would he be able to practice independently in Puerto Rico?
 
The Wobblie said:
He didn't actually match.
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Correct. Confirmed here:

Southern Doc (Caribbean Style): July 2017

The Wobblie said:
That's the most important part, no? He really can't practice in the US but would he be able to practice independently in Puerto Rico?
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I'm not sure of the legality of an "Internado" with regards to permanent licensure. It may help him re-apply to a full residency somewhere. But, he's 53-years-old... already... just how much more of a hit can the bank account take? I don't get the impression this guy lives on top of a bottomless pit of money. I suppose one can always follow their dream all the way to the poor house, if one desires. Always have a back-up plan.

-Skip
 
On top of that, Puerto Rico is a disaster now with most hospitals shut down. Looks like the place he's at was close to a direct hit by the eye of the storm. Hopefully they are OK.

Because PR is considered part of the US, PR internships are usually considered US experience. The programs are not ACGME certified, so he won't be board eligible. But if he completes enough years of training to satisfy a licensing board, he should/may be able to get a medical license.
 
aProgDirector said:
On top of that, Puerto Rico is a disaster now with most hospitals shut down. Looks like the place he's at was close to a direct hit by the eye of the storm. Hopefully they are OK.
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Yeah, wow. Good point.

aProgDirector said:
Because PR is considered part of the US, PR internships are usually considered US experience. The programs are not ACGME certified, so he won't be board eligible. But if he completes enough years of training to satisfy a licensing board, he should/may be able to get a medical license.
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This may be true. But, every medical staff I have been a member of has required either board eligibility or board certification in specialty to be a member (which I, of course, am). Likewise, all private insurers have also required this for me to bill for service on their plans. Without a board certification, he is going to be significantly limited in his ability to pursue meaningful employment.

I imagine this is just a stepping stone. Perhaps a full residency is in his future... as the clock continues to tick, tick, tick.

-Skip
 
bedevilled ben said:
That so? Depends heavily on what they're being treated for, and on the NP/PA. Lack of standardized education is exactly why I'm wary of midlevel providers. I've worked with plenty that ran circles around me. I work with a few now that have clinical acumen well below a 4th year medical student. Lack of standardization in education is exactly the problem.

Precisely why I wouldn't want Dr. Bill treating them. The minimum standard was set, and he failed to meet it.
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Do you think that if he got an NP degree and worked in a hospital (with a residency program he is interested in) on the floor as NP for a year would help him to obtain a residency? Would program directors be willing to overlook the time gap after med school graduation if they liked his performance as an NP on the wards? If I were him, I would have chosen this approach to obtain a residency - would like to hear everyone's opinions.
 
spudbunny said:
Do you think that if he got an NP degree and worked in a hospital (with a residency program he is interested in) on the floor as NP for a year would help him to obtain a residency? Would program directors be willing to overlook the time gap after med school graduation if they liked his performance as an NP on the wards? If I were him, I would have chosen this approach to obtain a residency - would like to hear everyone's opinions.
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Year of graduation is a filter for PD's.
If they do not employ a YoG filter, his NP employment might be seen. It would require an extremely weak pool for this to make much difference, though.
 
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gyngyn said:
Year of graduation is a filter for PD's.
If they do not employ a YoG filter, his NP employment might be seen. It would require an extremely weak pool for this to make much difference, though.
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Thank you for replying. What I meant was if Dr. Bill worked as an NP in a department with a residency program (i.e. a residency program that he would apply to in the future), do you think that the networking/personal contacts and direct observation of his work could overcome time from graduation and low test scores? It seems that might be the only way to overcome the YoG filter.
 
spudbunny said:
Thank you for replying. What I meant was if Dr. Bill worked as an NP in a department with a residency program (i.e. a residency program that he would apply to in the future), do you think that the networking/personal contacts and direct observation of his work could overcome time from graduation and low test scores? It seems that might be the only way to overcome the YoG filter.
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I see.
This would only work if the program had a very weak applicant pool.
 
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spudbunny said:
Thank you for replying. What I meant was if Dr. Bill worked as an NP in a department with a residency program (i.e. a residency program that he would apply to in the future), do you think that the networking/personal contacts and direct observation of his work could overcome time from graduation and low test scores? It seems that might be the only way to overcome the YoG filter.
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Gyngyn answered your previous question better than I could have. Based only on what I've read from his blog, Dr. Bill tried to network by attending conferences year after year after year, and tried to sell himself directly to PD's at those conferences. I think a better approach overall (and I have some Caribbean colleagues that are doing precisely this) would have been to work in a low-paying/volunteer research position at a community-based hospital after he failed to Match the first time. Doing that gives you access to faculty, and an opportunity to really sell yourself as a likable and hardworking resident. Strong letters of recommendation and an email from a faculty member can get you quite far, especially in the less competitive specialties in a community hospital setting. Either way, after failing to Match 2-3 times, one really has to step back and evaluate their approach. Doing the same thing over and over and expecting different results is not an actionable plan.

My heart goes out to this guy, but I maintain firmly that he does not represent a failure of the system. He has shown time and again that he does not meet the minimum requirements for practicing medicine safely. Additionally, he's shown remarkably poor insight, judgment, and planning. Based on the evidence he's posted on his blog, this is not someone that should be overseeing the medical care of others.
 
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