Do you need residency?

Here’s advice I often get when I mention my struggle on whether to leave medical school for good:  It’s a once in a lifetime opportunity. Just finish! Then decide what you want to do.

There’s no denying that an MD has advantages in other jobs, whether or not they’re related to medicine. How much is a matter of opinion. But alternative careers are not frowned upon. The AAMC provides resources for it here. Projects like the Drop Out Club help connect those leaving medicine with jobs in similar fields (note: residency experience is highly encouraged). But if you think you might want to be a doctor one day, you may wonder if and when you can do residency.

Beware the suggestion that a medical degree leaves the door open to practice ‘one day.’ 

Let’s do an experiment. You leave medicine, and years from now decide to dust off the ol’ white jacket and hang that medical degree. Then what? You go to your state’s licensing board. We’ll look at North Carolina, where a physician must have (among other things):

• Active license within the past 5 years
• Specialty board certification within the past 10 years
• Been active in clinical practice, providing patient care for 20 hours or more per week for at least two years.

What’s the difference between board certification and a license? According to the American Board of Medical Specialities, a medical license meets minimum competency requirements to diagnose and treat patients. Board certification is a commitment to knowledge & skills in a chosen speciality, which you will maintain as the field evolves.

Tip 1: Complete an internship.

Let’s start with the first one – a license. Most people don’t realize that a MD/DO only qualifies you to begin the licensing and training process. Or that you’re classified as an ‘undergraduate’ in medical school. Many institutions (mine included) only require sitting the USMLE Step 1 and Step 2 CK for a degree. You don’t need to pass because ‘graduate education,’ a.k.a residency, is voluntary.What the heck are these ‘Steps’? If your family is not in medicine, you may be tearing your hair out trying to explain. They sounds like just another SAT or MCAT.

The United States Medical Licensing Examination (USMLE) was introduced in 1992. Students must pass Step 1, Step 2 CS + CK, and Step 3 to apply for a license.

• Step 1 ($600) is an 8-hour exam on clinical knoweledge. This ‘firehose assessment’ of memorization skills is often considered the most difficult of the three, requiring weeks to months of study. A jeopardy-style accumulation of medical facts you’ll probably never need again.
• Step 2 has two parts:
  • Step 2 CK – Clinical Knoweledge ($580) is a 9-hour multiple choice test based on clinical scenarios, treatment, and diagnoses.
  • Step 2 CS – Clinical Skills ($1275 + hotel/travel to one of the 5 testing centers) is an 8-hour assessment of examinees in a series of standardized patient encounters. CS was added in 2005, with ongoing controversy over the costs.
• Step 3 ($830) is 2 days of multiple choice and computer-based simulations. Covers clinical skills, diagnostic acumen, decision making, treatment guidelines, and follow up care.

Steps 1 and 2 CK+CS are required to enter most residency programs, and are almost always taken in med school. However, Step 3 can only be taken during or after an intern year.  So no internship, no license!  On the other hand, you can still have people call you Dr. Such and Such.

Question: Can I take time off and apply to internship later?
Answer: Yes, but you don’t have much time. You must take Step 3 within seven years of Step 1. There are some nuances – check post #15 in the “Mom returning to residency” link below.

Tip 2: Go back to residency within 5 years. 

Good thing I got my license before I took time off. Now, what about that other requirement, board certification?  Ugh! Even more requirements. ABMS Board Certification calls for:

1. D.O. or M.D. degree from a qualified medical school (Check!)
2.  U.S. or Canadian medical license (Check!)
3. Three to five years of full-time residency training in an Accreditation Council for Graduate Medical Education (ACGME) program.
4. Passing the ABMS Member Board examination.

It’s not uncommon to change residencies or take time off. But without extenuating circumstance like a personal or family illness, most programs have a five year limitation after leaving internship. For threads and advice on individuals in the process, here are some SDN links:

Reapplying to residency after time off
Coming back to residency after several years off
Mom returning to residency

And don’t forget to take that board exam, more time limits there! You have 3-7 years  (specifics here) to obtain certification after residency. Then you will maintain it through a continuous professional development program called the ABMS Program for MOC. Lots more requirements there.

Tip 3: Plan on time and money to get back in the game

OK.. phew. I graduated, did an internship, got my license, finished residency, and am board certified. Now I can go write my book, start a small business, spend time with my kids before they become angsty teenagers.

Not so fast. Remember that last requirement – 20 hours or more of patient care in the last 2 years? You missed your MOC renewal and your license expired, so you’ll need to take some tests and practice under supervision to re-qualify for both. With increasing demand for doctors, special programs have appeared that help bring back physicians who burned out or retired early. These can cost $3,000 – $7,000 … per month. And they only help you qualify for a supervised re-entry period with a hospital or university until you meet the 2-year requirement.

I’ve spoken with physicians who did the legwork and have taken five or more years off. Despite the struggle, they are happy they have the option to return if they choose. On the other hand, the physicians who left residency are also happy. Maybe it has something with an intriguing fact about science of happiness, which Dan Gilbert explains in the TED Talk below.

For another resource, check out Ask an Ex-Surgeonator blog about her decision to leave residency as a PGY4 in surgery.