Foreign Trained MD's options in US??? Advice please?

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hi, i´m planning to move to tha states soon, im in my 2nd residence year almost begining third in surgery... i know i have to take the ECFMG/USMLE exam to work in the states... but i dont want to repeat the 4 residence years again...

is there any way possible that i dont have to do the residence years again??
im planning to make my speciality in plastic or maxillofacial surgery ...

please, let me know everything i need to do. thank you


You need to complete a US surgery residency to be eligible to practice independently. There is no way around this. As others have said, certain applicants can have 2 years waived, but the criteria is vague at best.

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those 2 years ... are given if i completed the 4 years residency in my country?
and... how can i get sure that where im applying they can give me just those 2 years?
 
those 2 years ... are given if i completed the 4 years residency in my country?
and... how can i get sure that where im applying they can give me just those 2 years?

Those "2 years" aren't "given". Your US residency program has to apply for the waiver from the American Board of Surgery (ABS), and ABS has to approve them. US residency programs do not have the independent power to offer a waiver; it is up to the ABS.

There is no way of knowing whether programs you are applying to would even be interested in applying for the waiver. I would venture most would not unless you were a stellar resident (which they won't know until you start residency), with impeccable credentials from a well regarded foreign school.

The above information given to you is correct: if you want to work in the US as a surgeon, be prepared to complete the ENTIRE 5+ years of US surgical residency, regardless of how many years you have completed in your country. Do NOT count on being offered or given a waiver for UP to 2 years (the ABS only notes that 2 years is the max; it does not guarantee that if a waiver is offered it will be for a full 2 years). Sorry, but those are the rules.

BTW, Plastic surgery is extremely competitive in the US and is, in most cases, completed after a full 5 year general surgery residency. OMFS requires dental training/degree as well as your medical degree.
 
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Thank you so much for the information... you were just great!
=D have a good year
 
Hi there, my brother is a non U.S medical graduate and he is a U.S perminant resident, he just completed a master of emergency medicine in Malaysia which is a 4 years program. My question is what are the best options for him basically on doing fellowship or any training over there coz he is not planning to go through d USMLE. So suggestions please!!!
 
Without the USMLE, he can't be a physician in the US. If his degree is an USMD-equivalent, then he can write the USMLE, apply for a US residency, manage to get a visa, convert that visa into a green card, and then be a US physician. Or, he can come to the US and be an EMT, or a nurse, etc, although he is likely to need to repeat all training here in the US (since most US licensing agencies don't recognize foreign training)
 
Thank u bro. He is already an emergency physician back home n at d same time he is aU.S green card holder. My qs is that is there any way to do fellowship over there without going through the long process of USMLE regardless intention to work in the U.S. thank u once again
 
Hi all, please answer to me if anyone know procedures with IMG anesthesiologists in USA.
I am an an anesthesiologist from Europe and I would like to get lisence to work in USA.I am already in USA and live in Washington State.
Please tell me all about my future effort to be an lisence anesthesiologist here:).Thank you!

same is my situation....
I am a MD anesthetist from India... now about to marry guy working in SF...
I am totally unaware of the procedure to adopt to get a liscence and start working...
I might have to stay there for life... but I am in no state to do all the residency or fight competitions...
what are the options available for a person like me...
 
same is my situation....
I am a MD anesthetist from India... now about to marry guy working in SF...
I am totally unaware of the procedure to adopt to get a liscence and start working...
I might have to stay there for life... but I am in no state to do all the residency or fight competitions...
what are the options available for a person like me...
Honestly?

You will be unable to work in the US as a physician without completing a residency.

Getting an anesthesia residency as an IMG is quite challenging.
 
hi all!
i did MBBS in India and currently in the last year of MD in Obstetrics and Gynecology. I wanted to know what is the process of getting a job in US? Do I have to clear all the steps of USMLE to get a job? To get into a residency programme is it necessary to clear USMLE?
thanks again.
 
hi all!
i did MBBS in India and currently in the last year of MD in Obstetrics and Gynecology. I wanted to know what is the process of getting a job in US? Do I have to clear all the steps of USMLE to get a job? To get into a residency programme is it necessary to clear USMLE?
thanks again.
Yes you need to clear the USMLE all steps. To get into a residency program it is necessary to not just pass you need to score the highest you can score because higher scores make it more likely to get in.
 
Yes you need to clear the USMLE all steps. To get into a residency program it is necessary to not just pass you need to score the highest you can score because higher scores make it more likely to get in.
thanks a lot for clearing my doubt.
 
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Greetings

I studied medicine in Greece and I am now in the last year of my residency in Ob/Gyn in Greece.

I want to ask you some things

1. Is there a chance when I become specialist to work in US without making any residency again? Is there another way like achieving in exams or something like that?

2. If cannot work in US without residency is there a chance to come to US for specialized training in Gynecologic Cancer for a couple of years and then come back to Greece?
 
1. No. Foreign training other than Canada is not recognized in the US. You will need to repeat some or all of your training. There are rare exceptions for "experts" in your field, but clearly as a new graduate of a residency program that will not apply.

2. Yes, sort of. Instead of applying for a baseline / core residency such as OB/GYN or medicine, you could apply for an Oncology fellowship or even a Gyn Onc fellowship if such a thing exists. Most programs will heavily favor US trained physicians though, and new ACGME rules are scheduled to go into effect shortly which will end this possibility. Should you do this before the rules change (2016 I think?), you still are likely to be unable to work in the US or you will find your options limited, as you will not be Board Eligible as you will not have completed a core residency. But you might be able to complete some training, and then return to Greece. Whether Greece would recognize US training I cannot comment. However, this type of pathway will be very difficult to obtain.
 
Greeting
I am a general surgeon with over 20 yrs experience, My wife is a pediatrician,me and my family have just received our US visas & PR so we are leaving our country, I appreciate you tell me what can I do, now I am 52 & my wife is 50 and so late for ECFMG. How we can find jobs or related fields corresponding our situation.
with regards
 
Hi. I am a swiss MD with swiss BC in anaesthesiology and in intensive care medicine. I am ECFMG certified (Steps 1, 2CK and 2 CS done) and plan to come to the US to do some research and maybe apply for a fellowship for 1-2 years. I did not apply for USMLE Step 3 till now. As my Step 1 and Step 2 CK are more than 10 years old, I am limited in my choice for taking Step 3. Does it play a role for the state where I will be able to work afterwards or doesn't it make a difference? In other words, if I take Step 3 in Florida, will I still be able to look for a job in another state? My plan is NOT to work in the US for more than 1-2 years....

Thank you for your advice.
 
Greeting
I am a general surgeon with over 20 yrs experience, My wife is a pediatrician,me and my family have just received our US visas & PR so we are leaving our country, I appreciate you tell me what can I do, now I am 52 & my wife is 50 and so late for ECFMG. How we can find jobs or related fields corresponding our situation.
with regards

You won't be able to practice as a doctor. At your age I would honestly advise something like opening a small business. I believe this move will benefit your kids more than for you or your wife.
 
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Hello I am Otolaryngologist and Facial Plastic Surgeon from Colombia, I have 15 years of experince and come to live in USA because USCIS give to me Permanent Residency Visa for Alien for Extraordinary Ability. I present USMLE in two opportunity but don’t pass, I am tired and I want know if I have some option to me for job in USA?? but no research I am in Florida
 
Hello I am Otolaryngologist and Facial Plastic Surgeon from Colombia, I have 15 years of experince and come to live in USA because USCIS give to me Permanent Residency Visa for Alien for Extraordinary Ability. I present USMLE in two opportunity but don’t pass, I am tired and I want know if I have some option to me for job in USA?? but no research I am in Florida

If you don't pass USMLE you can't be a doctor. You can do research though.
 
Hello all

Just a general question if anyone can help.

What are the options for the foreign trained internal medicine physician in USA? Is there a way of not doing a residency in USA and still be able to practice medicine? Are there any other health related jobs that may be an option (with a decent salary)

I will appreciate your advice (considering time and costs factors as I am already in mid 30's)
 
This thread basically answers your question. You must take the USMLE and complete a residency or fellowship in the US. It used to be possible to complete just a fellowship -- although you had to be competitive enough to get one -- but starting in 2016 that will be more difficult due to changes in the ACGME rules. Other health related jobs (Nurse, PA, etc) need their own training. There is no easy solution.
 
.

What are the options for the foreign trained internal medicine physician in USA? Is there a way of not doing a residency in USA and still be able to practice medicine? Are there any other health related jobs that may be an option (with a decent salary)

There is a school in Florida that is admitting FMGs to their nurse practitioner school. Independent practice nurses are becoming more commonplace as our system seeks to cut costs in any way possible that doesn't involve lowering reimbursement for lawyers or administrators. I don't know where you are coming from but I would really think this through.

I am a us trained, boarded American citizen and my goal is to be practicing in Canada, practicing in New Zealand, or be out of medicine entirely by the end of 2015.

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Hi,
I am a Dermatologist from the University of London, retired associate professor of Medical Science of Iran University. Now I am permanent resident of US and living in this country. I like to work in my specialty and any related subject like Laser, Aesthetics dermatology or research in this field.

Would you please suggest what I can do with out attending any residency or examination?

Thanks
 
You can't work as a clinical physician without residency training. You can do "research" but you'd need to find someone to hire you, and they would only likely do so if you have some skills that they would find helpful in their work. You might be able to work in a dermatologist's office as a "tech", but I don't know what type of certification they need. The honest truth is that your options are limited, but perhaps someone from the Univ of London knows someone here and is willing to help -- connections can be very helpful.
 
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You can't work as a clinical physician without residency training. You can do "research" but you'd need to find someone to hire you, and they would only likely do so if you have some skills that they would find helpful in their work. You might be able to work in a dermatologist's office as a "tech", but I don't know what type of certification they need. The honest truth is that your options are limited, but perhaps someone from the Univ of London knows someone here and is willing to help -- connections can be very helpful.

aProgDirector you really deserve a medal for all the hardwork you are doing on this forum. Every person asks the same question and thinks the answer will be different for them.
 
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aProgDirector you really deserve a medal for all the hardwork you are doing on this forum. Every person asks the same question and thinks the answer will be different for them.

Agreed, I scanned through this thread and aProgDirector has been incredibly patient in answering these questions that most people would've gotten fed up with a long time ago.
 
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aProgDirector you really deserve a medal for all the hardwork you are doing on this forum. Every person asks the same question and thinks the answer will be different for them.

True, I think the problem is the landscape of medicine has changed drastically. 20-30 years ago, it wasn't nearly as difficult as today for an FMG to get a residency. A lot of people hear from family members and friends how it wasn't too difficult to set up shop here and tell them to come and thus they erroneously believe its still easy for an FMG to practice here. Reading online something that is contradictory to that makes them believe that it isn't true and if they knew someone that did it years ago, why can't they?
 
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It seems like the primary care shortage is not going to be solved with PA/NP because they are going into specialties just like AMG physicians... Maybe some states that have severe PCP shortage can accommodate some non US citizen IMGs who speak English and give them restricted medical license that they can only use to practice in underserved areas...
 
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It seems like the primary care shortage is not going to be solved with PA/NP because they are going into specialties just like AMG physicians... Maybe some states that have severe PCP shortage can accommodate some non US citizen IMGs who speak English and give them restricted medical license that they can only use to practice in underserved areas...

I would prefer more recruitment of bright students in PCP shortage areas into medical school instead.
 
For international physicians with outstanding credentials, there is usually a way around these requirements:

1) he should check with the California Board of Medicine regarding licensure. If he is not eligible for CA licensure, he cannot work in that state.

2) there are many fellowship programs which do not require BE in general surgery, and this has been a way, in the past, for foreign trained physicians to get into the US medical system. So he might look into training in critical care, burns, etc. (which are not very competitive and may be more open to his background)

Hi Winged Scapula,

You seem to be very knowledgable in this regard so i hope i can get an answer from you.
I am a Us Citizen who studied in Poland and now I am working as a doctor in Sweden (i learned the language while i was in medschool.

Now i am unsure if i want to continue working in sweden or stop what im doing and go back to the US to take the USMLE and begin the long journey of residency.

questions
1 - As a US citizen, who is also an IMG, does it help to have the passport?
2 - is there anytime at which (for example after specialization into emergency medicine) i can return to the US without completing residency again?
3 - what are your predictions on the regulations and rules that govern the residency, match, and licensing bodies? will it become easier in the future to come back to the US for me? or is this a pipe dream?
 
Hi Winged Scapula,

You seem to be very knowledgable in this regard so i hope i can get an answer from you.
I am a Us Citizen who studied in Poland and now I am working as a doctor in Sweden (i learned the language while i was in medschool.

Now i am unsure if i want to continue working in sweden or stop what im doing and go back to the US to take the USMLE and begin the long journey of residency.

questions
1 - As a US citizen, who is also an IMG, does it help to have the passport?

No. The form of government issued ID (whether passport or driver's license) plays absolutely no role in obtaining a US residency position for US citizens.

2 - is there anytime at which (for example after specialization into emergency medicine) i can return to the US without completing residency again?

In most cases the answer is "no". Most states require at least some US residency training to be eligible for a medical license. See the list here. In addition, for practical purposes such as hospital privileges, employment and insurance company roles you must generally be Board Eligible which requires training in the US. Some foreign training may be credited toward the residency requirement but this would vary by field and by country where you trained. Do not assume that any training done outside the US will be credited and expect to start with internship all over.

3 - what are your predictions on the regulations and rules that govern the residency, match, and licensing bodies? will it become easier in the future to come back to the US for me? or is this a pipe dream?

I believe the opposite will happen: that it will become more difficult to work in the US or at least to find a residency position. As the number of US citizen US educated grads approaches the number of positions available, foreign trained physicians will be increasingly squeezed out.
 
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Hello I am Otolaryngologist and Facial Plastic Surgeon from Colombia, I have 15 years of experince and come to live in USA because USCIS give to me Permanent Residency Visa for Alien for Extraordinary Ability. I present USMLE in two opportunity but don’t pass, I am tired and I want know if I have some option to me for job in USA?? but no research I am in Florida
Do a 3-year NP program for foreign physicians at Florida International University (FIU)... That's probably your best shot to practice medicine in the US.
 
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Hello, I am a resident in gastroenterology in Italy and would like to do a fellowship in US for experience (I'm not planning to live and practice in US). Do I still require USMLE? Thanks in advance
 
Hello, I am a resident in gastroenterology in Italy and would like to do a fellowship in US for experience (I'm not planning to live and practice in US). Do I still require USMLE? Thanks in advance

Yes. In order to get even a temporary / training license in most, if not all, states, you'll need steps 1, 2CK, and 2CS of the USMLE.
 
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Hello, I'm a Swedish citizen, 33yo and graduated med school 2 years ago (In Sweden). Haven't started studying for Step 1 yet, but assuming I do well, do I have realistic chance of getting a residency in the states? Most interested in ophta, but I also enjoy FM, IM, psych and neurology. Thanks in advance!
 
Ophthalmology might be hard even if you do well on step1 because it's very competitive even for US grads... FM/psych/IM/neurology are not too competitive, thus; you should have a shot assuming you get an average score in step 1...
 
Hello, I'm a Swedish citizen, 33yo and graduated med school 2 years ago (In Sweden). Haven't started studying for Step 1 yet, but assuming I do well, do I have realistic chance of getting a residency in the states? Most interested in ophta, but I also enjoy FM, IM, psych and neurology. Thanks in advance!
It's all going to come down to that Step score. And even then, it's a tight market for FMGs, but if you do well and apply very broadly, your chances are reasonably good.
 
True, I think the problem is the landscape of medicine has changed drastically. 20-30 years ago, it wasn't nearly as difficult as today for an FMG to get a residency. A lot of people hear from family members and friends how it wasn't too difficult to set up shop here and tell them to come and thus they erroneously believe its still easy for an FMG to practice here. Reading online something that is contradictory to that makes them believe that it isn't true and if they knew someone that did it years ago, why can't they?

I remember being told by an aged physician that being a FMG in the 70s was far easier due to the physician shortage in certain locations. He although said in the early 80s, it became harder to come over as an FMG. He stated that noticeably in the last 10 years, it has gotten very hard for FMGs to work here. This same physician said in 10 years, coming over from other countries as an FMG will become even more bleak.
 
Yes. In order to get even a temporary / training license in most, if not all, states, you'll need steps 1, 2CK, and 2CS of the USMLE.
Do you really have to do all the steps? I thought I recalled a upper year at my Canadian school say you just needed a pass for Step 1 in order to do a fellowship, good to know that you need all 3.
 
I remember being told by an aged physician that being a FMG in the 70s was far easier due to the physician shortage in certain locations. He although said in the early 80s, it became harder to come over as an FMG. He stated that noticeably in the last 10 years, it has gotten very hard for FMGs to work here. This same physician said in 10 years, coming over from other countries as an FMG will become even more bleak.

This graph from the recent NRMP article is helpful
upload_2016-1-4_17-24-51.png


You can see that the number of spots open at the end of the match has dropped, and unmatched IMG's have increased. It's still quite possible for IMG's to get spots in the US -- it's just a tighter market now.

Do you really have to do all the steps? I thought I recalled a upper year at my Canadian school say you just needed a pass for Step 1 in order to do a fellowship, good to know that you need all 3.

You don't need "all" the steps. You don't need Step 3, unless you need an H visa.

A general question for you all...

I have a Dermatology & Cosmetology MD from Russia and moved to Boston, MA in September 2014. I met my husband in Boston and now live with him in Andover, MA while studying for USMLE certification. I understand to practice as a Doctor I need to pass Step 1, 2 and complete residency. However, is there any other work opportunities in this country for an IMG with a green card?

Thank you.

There is little you can do with a foreign MD and no residency training. Most clinical jobs (Clinical Assistant, LPN, EMT etc) require their own certification -- you can pursue one of these in the short term, while prepping for a residency application. You can do "research" although these positions are often unpaid. Or you can get a non clinical job.

Just to be clear, your chances of getting a Derm spot here in the US are terribly small. If that's what you're looking for, you'll need to volunteer to do research with a derm group in the US, probably for several years, and get stellar USMLE scores, and still after that your chances aren't good.
 
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Hi all,
I am a cardiologist and Biophysics MD/PhD outside of US, also ECFMG certified IMG, and green card holder. I want to work as interventional cardiologist in US. What is the shortest way to do this? and other yours advices?

Best regards,
 
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Hi all,
I am a cardiologist and Biophysics MD/PhD outside of US, also ECFMG certified IMG, and green card holder. I want to work as interventional cardiologist in US. What is the shortest way to do this? and other yours advices?

Best regards,
Apply to and match at a US internal medicine residency program. Then a 3 year internal medicine residency, followed by a 3 year general cardiology fellowship, followed by a 1 year interventional cardiology sub-fellowship. All these must be done in the US.

And all this assumes your medical school is recognized by the state you want to live in. Even if you complete all this training, if your medical school isn't recognized you won't get a license. Individual states have slightly different lists of recognized foreign medical schools.
 
Thank you so much the argus,
However, it takes 7 years if all must be done regularly, Is there anyway without residency, ?
If I just do fellowship in subspeciality for cardiology etc. Heart failure and Transplantation. I m MD/PhD also, and greencard holder, Can I have a job in USA?

thank you
 
Essentially no.

The standard pathway is as above. 3 years IM, 3 years cardiology, and then Interventional Cards. Of note, although interventional is only one year at present, it is almost certainly going to convert to a two year training program shortly (EP is transitioning now).

Can you skip the IM residency and start in Cards directly? In general, no. However programs have the ability to rarely make exceptions. To do so, they would need to clear it with GME and the GMEC. In order to follow this pathway, you must be "exceptional". Honestly the chances of getting a spot this way are remote at best.
 
Dear Members and/or SDN advisors: Kindly advise -

1. Can a FMG (FEP) who is ECFMG certified from 15 years back, apply to residency positions with those same credentials? What would be residency/ candidacy boosters - Steps retake? Externships? Obviously the 7 year requirement of USMLE Steps is long over. Can the once cleared Steps be re - taken afresh - 1,2 and thus later to Step 3 like a fresh candidate? Validity is addressed for CS and TOEFL in the ECFMG website. These are still the same uncertain blind steps to get back just to the ERAS and interviews stages. What is the feasibility? With a tight economy/Medicare, supply& demand for residencies, age, lapse of time ... know anyone who does this or do I quit- just forget about it - why even contemplate it in the current American medical system?

2. Is there somewhere in the US that I can do clinical post graduate training like say a paid masters clinical graduate program? That tuition paid process than getting a GME stipend, if it would certify me as an MD in three years, would allow me to work in remote/ rural countries/ back home too. Why is this not conceivable - hospitals can generate income from students paying for their GME just like MS/MBA tuition fees.

If to convey my thoughts with my back story - I have Standard ECFMG certification from 2001 (also cleared though not required - the new kid in the bloc - back then called - CSA). In 2001 -02, I applied to several residency programs through the new format called ERAS and other electronic tools that were to soon change the residency application procedures (there were programs in 2002 not yet into ERAS - that I mailed 20 pages of application in a yellow manila envelope as well). I was at the wrong time/space - because FMG- ERAS opened up international applications, flooding the program directors files. I interviewed but did not make it that year even while living in the US and having clinical exposure here, fluency etc.,. In the years that followed, life caught up with me and that made it impossible to apply (divorce, etc.,) and I went on to be a productive US naturalized citizen in another career field. Having put my only kid through elite STEM college and into the workforce, my regret now is that I should have kept applying to residency openings. I sense flashback when I read other members questions - and surely they might be fast forwarding their thoughts too about their future 'back story' - but not to discourage anyone here. My life resume is excellent for resilience and strength of character - like the wild west pioneers but unrecognized for effort! So keep plugging kids :)
 
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BTW - I was reading some of the detailed answers from the moderators - I sense them to be patient, tolerant, emotionally intelligent, thoughtful and above all non-judgmental. Great job guys and kudos. I have been to the infant stage of this website too - for years looked for answers to solve my predicament. It is all over the world - lack of a standardized medical education set up like those computer IT careers. My American child does not see the unfairness either - just step into my shoes and try to reason.

In favor of founders pursuit of happiness and equality - I am mustering to re-enter the medical profession. (There are adults changing careers and older professionals that get GED and who go on to accomplish their dreams, so why not?). When I say to folks - I am a doctor but not a doctor, I get told that I am not trying hard enough. Computer science grads migrate to the USA and with no board exams to prove their training, get to maintain government websites. I am resiliently entering middle age - Yet one mission that I could not accomplish - is the completion of my education (was once my chosen path - if ever I could get past the 'even as of today' myopic 7 years/attempt rules, etc.,:grumpy:)

America is the only unique place that one can come to better their lot - the founding principle. If it were dog in the manger attitude at Ellis island, then we would not have been so enriched. The country needs more doctors, talent is available - yet the gatekeepers have bottle necked that - why?
 
BTW - I was reading some of the detailed answers from the moderators - I sense them to be patient, tolerant, emotionally intelligent, thoughtful and above all non-judgmental. Great job guys and kudos. I have been to the infant stage of this website too - for years looked for answers to solve my predicament. It is all over the world - lack of a standardized medical education set up like those computer IT careers. My American child does not see the unfairness either - just step into my shoes and try to reason.

In favor of founders pursuit of happiness and equality - I am mustering to re-enter the medical profession. (There are adults changing careers and older professionals that get GED and who go on to accomplish their dreams, so why not?). When I say to folks - I am a doctor but not a doctor, I get told that I am not trying hard enough. Computer science grads migrate to the USA and with no board exams to prove their training, get to maintain government websites. I am resiliently entering middle age - Yet one mission that I could not accomplish - is the completion of my education (was once my chosen path - if ever I could get past the 'even as of today' myopic 7 years/attempt rules, etc.,:grumpy:)

America is the only unique place that one can come to better their lot - the founding principle. If it were dog in the manger attitude at Ellis island, then we would not have been so enriched. The country needs more doctors, talent is available - yet the gatekeepers have bottle necked that - why?

The simple answer is they want to keep the money and status to themselves, Doctors are better paid than Computer scientists in part because of the rules and regulations set in place to keep the pool concentrated to only those who meet certain regulations. At the same time, the careers are different, CS can be transferred around the world and talent is the most important thing, if the US was to limit the kind of jobs CS immigrants could do, the US would not be leading the world in CS right now. With medicine it is a bit different, the resources required are different and at its core it is a service job.

Physicians a long time ago realized that they did not want to place the bottleneck for entering their profession at the immigration level so they placed their own rules and regulations for immigrants. Some of it is in part true, not every country in the world has such stringent regulations for medical education as those in the US, but much of it of course is to protect their own interests.

At the same time the argument is made that unless you follow these strict rules and regulations, patient care will suffer which in my opinion is probably only partially true.

Good luck to you though.
 
Dear Members and/or SDN advisors: Kindly advise -

1. Can a FMG (FEP) who is ECFMG certified from 15 years back, apply to residency positions with those same credentials? What would be residency/ candidacy boosters - Steps retake? Externships? Obviously the 7 year requirement of USMLE Steps is long over. Can the once cleared Steps be re - taken afresh - 1,2 and thus later to Step 3 like a fresh candidate? Validity is addressed for CS and TOEFL in the ECFMG website. These are still the same uncertain blind steps to get back just to the ERAS and interviews stages. What is the feasibility? With a tight economy/Medicare, supply& demand for residencies, age, lapse of time ... know anyone who does this or do I quit- just forget about it - why even contemplate it in the current American medical system?

2. Is there somewhere in the US that I can do clinical post graduate training like say a paid masters clinical graduate program? That tuition paid process than getting a GME stipend, if it would certify me as an MD in three years, would allow me to work in remote/ rural countries/ back home too. Why is this not conceivable - hospitals can generate income from students paying for their GME just like MS/MBA tuition fees.

If to convey my thoughts with my back story - I have Standard ECFMG certification from 2001 (also cleared though not required - the new kid in the bloc - back then called - CSA). In 2001 -02, I applied to several residency programs through the new format called ERAS and other electronic tools that were to soon change the residency application procedures (there were programs in 2002 not yet into ERAS - that I mailed 20 pages of application in a yellow manila envelope as well). I was at the wrong time/space - because FMG- ERAS opened up international applications, flooding the program directors files. I interviewed but did not make it that year even while living in the US and having clinical exposure here, fluency etc.,. In the years that followed, life caught up with me and that made it impossible to apply (divorce, etc.,) and I went on to be a productive US naturalized citizen in another career field. Having put my only kid through elite STEM college and into the workforce, my regret now is that I should have kept applying to residency openings. I sense flashback when I read other members questions - and surely they might be fast forwarding their thoughts too about their future 'back story' - but not to discourage anyone here. My life resume is excellent for resilience and strength of character - like the wild west pioneers but unrecognized for effort! So keep plugging kids :)

Lots of questions. The short answer to your question is: Yes, you can apply to programs, but no, you are unlikely to get a spot.

ECFMG certification mostly doesn't expire. The CSA exam does expire, and your ECFMG certificate may have an expiration date on it. If that date is after June 14, 2001, then you just need to contact ECFMG and they will give you a sticker to place on your certificate to make it valid indefinitely. If you took it before this date, then you would need to take Step 2 CS. They do not hold you to the 7 year limit for exams, so you will not need to retake the other steps.

You will likely end up needing to retake the steps, assuming you did not take Step 3. You would basically try to register for Step 3 in California, a state that does not have any GME requirement for Step 3. You will get rejected because your prior steps are outside the 10 year limit. Using that rejection notice, you can petition the USMLE to retake the steps. A few states have no USMLE time limit for licensure (CT for example), so it would be possible to complete GME training and then get licensed in one of those states.

But I worry that if you were not competitive enough to get a spot 15 years ago, the situation is worse now.

You cannot pay for GME training, and there is no training that is not under ACGME or AOA supervision.
 
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