1-2 year training for Geriatric or functional medicine for foreign MD?

[queenki]

Hi,

I don't even know where to ask.
I am looking for some info on behalf of my aunt, who is a MD in South Korea, has been practicing Family Medicine past 30 years. She wants to take a break and get some training to reroute/refresh her career past 60. (She doesn't just want to retire, but also not looking for FORMAL complete re training to be licensed to practice in US) She just wants to get some training in US, and go back to South Korea and still practice there.

I have no idea how these kind of training works/or even exist...
Would it be just certificate program?

She want to focus on geriatrics or functional medicine (I don't even know what functional medicine is...)

If anyone has any information about these, please let me know.
All I could find was foreign national MD who has been trained in foreign medical schools will have to pass 2 board exams AND get into residency (2-3yrs) and pass the 3rd board to be eligible to practice in US.
(this isn't what my aunt wants, she just want to get some training and go back to SK...)

She is also trying to come to US, attend ESL classes to learn/advance conversational English, while observing/shadowing clinics time to time, and then get into such a program for 1-2 years.

I wish I knew better, but literally I have no idea...

Please share any relevant info if you have any

Thank you so much in advance!

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[gutonc]

She want to focus on geriatrics or functional medicine (I don't even know what functional medicine is...)

It's b***s***.

But lucky for her, I am currently offering a course in functional medicine that I'm sure she'd be a great candidate for. Cost is $25K, cash and there is a super sweet framed certificate that she'll get after completion of the course. Have her PM me for details.

 

[queenki]

It's b***s***.

But lucky for her, I am currently offering a course in functional medicine that I'm sure she'd be a great candidate for. Cost is $25K, cash and there is a super sweet framed certificate that she'll get after completion of the course. Have her PM me for details.

Ah haha. I see. I wasn't sure what that was. I've never heard before. I don't know where she gets these infos, but sounds like something she should be cautious. Thanks!

Is there any legit (sorry) geriatrics training program open for foreign MD?

 

[NotAProgDirector]

There are plenty of 1 year geriatrics fellowships. They are all "legit" = ACGME programs. But as a foreign MD, she's not going to qualify for any of them without baseline US training in IM or FM. In any case, to do any clinical work at all, she would need to take and pass the USMLE exams.

She could simply shadow someone in the US in a volunteer position -- but she won't be able to actually do anything.

 

[Winged Scapula]

Unfortunately, your aunt is a few years too late. It used to be relatively easy for foreign nationals to get an institution sponsored training license for fellowships, especially those not offered in their home country. The window is rapidly closing/closed to these; while I am sure there are non-accredited fellowships around, if @aProgDirector says that all the legit ACGME ones now require full license examination, the your aunt is out of luck for these.

I know Australia still offers some of these, if she meets their medical board requirements, and if that is a consideration for her.

 

[queenki]

There are plenty of 1 year geriatrics fellowships. They are all "legit" = ACGME programs. But as a foreign MD, she's not going to qualify for any of them without baseline US training in IM or FM. In any case, to do any clinical work at all, she would need to take and pass the USMLE exams.

She could simply shadow someone in the US in a volunteer position -- but she won't be able to actually do anything.

I see Thank you so much for the info!
So she just has to do the full board in order to get into any of those program!
I don't think she would/could do that at this point...hum.

 

[queenki]

Unfortunately, your aunt is a few years too late. It used to be relatively easy for foreign nationals to get an institution sponsored training license for fellowships, especially those not offered in their home country. The window is rapidly closing/closed to these; while I am sure there are non-accredited fellowships around, if @aProgDirector says that all the legit ACGME ones now require full license examination, the your aunt is out of luck for these.

I know Australia still offers some of these, if she meets their medical board requirements, and if that is a consideration for her.

I see. She's been talking about it for few years now, well too late.
I wonder if there is any way that I can get info for those program if there is any any left even if it is going to be really rural area?
How should I search for it? (like website or key words or official name for those programs...)
I am sorry, I just have no knowledge in these field, I don't even know what ACGME stands for. I can google though.

anyway... Thank you so much for the info and insights. I wish I could find a way for her if there is any left yet ;(

 

[queenki]

Unfortunately, your aunt is a few years too late. It used to be relatively easy for foreign nationals to get an institution sponsored training license for fellowships, especially those not offered in their home country. The window is rapidly closing/closed to these; while I am sure there are non-accredited fellowships around, if @aProgDirector says that all the legit ACGME ones now require full license examination, the your aunt is out of luck for these.

I know Australia still offers some of these, if she meets their medical board requirements, and if that is a consideration for her.

ECFMG | EVSP: J-1 Physician

I found this org and it seems like they are "sponsoring J-1" for international physicians for Graduate training in US?
Does she have to go through full board exam even with these?

I am reading the info but it is not making sense bc Iack so much background info about how medical license works ;( sorry...

 

[AdmiralChz]

I doubt she will qualify for any “ACGME” as her training won’t be recognized and she will require all the Steps completed. It is unlikely she will be able to do anything beyond an observership.

 

[IMGASMD]

I doubt she will qualify for any “ACGME” as her training won’t be recognized and she will require all the Steps completed. It is unlikely she will be able to do anything beyond an observership.

OP, observership, volunteering maybe the only things that she will be able to do. She won’t get any credits, but if her intention is to “show” that she did something, you may have to find a big academic program that may have someone to sponsor her or if she knows someone from her own institution that has connection in the states. The laws, institutional bylaws, may just preclude her from seeing any patients.

It really depends what she needs this experience for? Is it to advance her academic ranking or is it she just doesn’t want to “waste” her time while on vacation. I think for someone who’s in her late fifties learning a new language is more than enough while on leave. She’d also be here learning about a new culture. She can also find local practices with Korean physicians that she maybe able to shadow.

 

[queenki]

I doubt she will qualify for any “ACGME” as her training won’t be recognized and she will require all the Steps completed. It is unlikely she will be able to do anything beyond an observership.

I see. Thanks!

 

[queenki]

OP, observership, volunteering maybe the only things that she will be able to do. She won’t get any credits, but if her intention is to “show” that she did something, you may have to find a big academic program that may have someone to sponsor her or if she knows someone from her own institution that has connection in the states. The laws, institutional bylaws, may just preclude her from seeing any patients.

It really depends what she needs this experience for? Is it to advance her academic ranking or is it she just doesn’t want to “waste” her time while on vacation. I think for someone who’s in her late fifties learning a new language is more than enough while on leave. She’d also be here learning about a new culture. She can also find local practices with Korean physicians that she maybe able to shadow.

She doesn't need rank or anything. She just need training to shift her focus from family medicine to geriatrics.
I personally think it is her best interest to just come here advance her English, relax in suburb and enjoy nature (She lives/practices in big city), and some observation and volunteering. But she wants training......I don't know why.

I feel like I will end up telling her to just relax and enjoy time being here haha.

She has been to US numerous times, her step son is US citizen, her husband is US permeant resident.
Her English is not like native, but she can do casual conversation with somewhat limited speed. For her age and the fact that she never lived here, it is impressive.

Anyway thank you so much for all infos.

I guess she has a friend who did those kind of program long time ago in US.

 

[Raryn]

ACGME accredited fellowships can take people who did not do prior residency in the states - the graduate just won't be eligible for the boards when they finish. This is occasionally seen with Middle Eastern countries who pay a fellowship to expand an extra slot and train one of their doctors (with the intention that person go back).

That said, the trainee still needs to be eligible for a training license in the states, which means at the very least Step 1, CK, and CS passed. Also, finding one of these programs to take you without you coming with your own source of funding is probably difficult.

 

[NotAProgDirector]

ACGME accredited fellowships can take people who did not do prior residency in the states - the graduate just won't be eligible for the boards when they finish.

As mentioned above, in Internal Medicine, this is no longer allowed. It's part of the subspecialty program requirements that all fellows need to complete an ACGME IM residency first (or canadian, and DO will probably be OK with the merger). There's an exception for ACGME-I programs, and you can ask for a waiver for an exceptional candidate.

This might be possible for non-IM fellowships.

 

[queenki]

ACGME accredited fellowships can take people who did not do prior residency in the states - the graduate just won't be eligible for the boards when they finish. This is occasionally seen with Middle Eastern countries who pay a fellowship to expand an extra slot and train one of their doctors (with the intention that person go back).

That said, the trainee still needs to be eligible for a training license in the states, which means at the very least Step 1, CK, and CS passed. Also, finding one of these programs to take you without you coming with your own source of funding is probably difficult.

Oh she will fund herself of course. I don't think she is expecting to gain any financial support or any income during the training (which will probably already very competitive). She does Not need to be eligible for any board in US after the program. and also she does absolutely plan to go back to South Korea, she got no relative except a step son. (We have a huge family in SK and she has no interest in immigration at all.)

I think she just want some legit training while she is in US, take some refreshing time, live new life past 60.

I wish she would have considered this maybe 5 years ago or something....sigh.

 

[Raryn]

As mentioned above, in Internal Medicine, this is no longer allowed. It's part of the subspecialty program requirements that all fellows need to complete an ACGME IM residency first (or canadian, and DO will probably be OK with the merger). There's an exception for ACGME-I programs, and you can ask for a waiver for an exceptional candidate.

This might be possible for non-IM fellowships.

You are correct and my information was from an older iteration of the rules. I went and checked, it is not possible for any ACGME accredited fellowship without an explicit exemption for "exceptional candidates" that may or may not be allowed by the individual RRC. That said, the exemptions do exist, so I looked up for what that means.

From the common program requirements: (bold is mine)

III.A.2. Eligibility Requirements – Fellowship Programs
All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in an RCPSC-accredited or CFPC- accredited residency program located in Canada. (Core)
III.A.2.a) Fellowship programs must receive verification of each entering fellow’s level of competency in the required field using ACGME or CanMEDS Milestones assessments from the core residency program. (Core)
III.A.2.b) Fellow Eligibility Exception A Review Committee may grant the following exception to the fellowship eligibility requirements: An ACGME-accredited fellowship program may accept an exceptionally qualified applicant**, who does not satisfy the eligibility requirements listed in Sections III.A.2. and III.A.2.a), but who does meet all of the following additional qualifications and conditions: (Core)
III.A.2.b).(1) Assessment by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of training in the core specialty; and (Core)
III.A.2.b).(2) Review and approval of the applicant’s exceptional qualifications by the GMEC or a subcommittee of the GMEC; and (Core)
III.A.2.b).(3) Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3, and; (Core)
III.A.2.b).(4) For an international graduate, verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification; and, (Core)
III.A.2.b).(5) Applicants accepted by this exception must complete fellowship Milestones evaluation (for the purposes of establishment of baseline performance by the Clinical Competency Committee), conducted by the receiving fellowship program within six weeks of matriculation. This evaluation may be waived for an applicant who has completed an ACGME International-accredited residency based on the applicant’s Milestones evaluation conducted at the conclusion of the residency program. (Core)
III.A.2.b).(5).(a) If the trainee does not meet the expected level of Milestones competency following entry into the fellowship program, the trainee must undergo a period of remediation, overseen by the Clinical Competency Committee and monitored by the GMEC or a subcommittee of the GMEC. This period of remediation must not count toward time in fellowship training. (Core)
** An exceptionally qualified applicant has (1) completed a nonACGME-accredited residency program in the core specialty, and (2) demonstrated clinical excellence, in comparison to peers, throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following: (a) participation in additional clinical or research training in the specialty or subspecialty; (b) demonstrated scholarship in the specialty or subspecialty; (c) demonstrated leadership during or after residency training; (d) completion of an ACGME International-accredited residency program. [Each Review Committee will decide no later than December 31, 2013 whether the exception specified above will be permitted. If the Review Committee will not allow this exception, the program requirements will include the following statement]:
III.A.2.c) The Review Committee for _____ does not allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A.2. (Core)

So I pulled up the first IM fellowship requirements that came to mind (Endocrinology) and scrolled down to III.A.2.c).

The Review Committee for Internal Medicine does allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A.2. (Core)

Then I pulled up the one explicitly for Geriatrics (since this is OP's question)

III.A.3. The Review Committees for Family Medicine and Internal Medicine allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A. (Core)

Now, does it mean that OP's aunt can meet the requirements to be an "exceptionally qualified applicant"? Likely not. But if she can demonstrate evidence of scholarship or leadership experience, it may be possible. And even if she did, the USMLEs would be required.

 

[Raryn]

Oh she will fund herself of course. I don't think she is expecting to gain any financial support or any income during the training (which will probably already very competitive). She does Not need to be eligible for any board in US after the program. and also she does absolutely plan to go back to South Korea, she got no relative except a step son. (We have a huge family in SK and she has no interest in immigration at all.)

I think she just want some legit training while she is in US, take some refreshing time, live new life past 60.

I wish she would have considered this maybe 5 years ago or something....sigh.

This popped up while I was typing my last post.

She's actually not able to fund herself. There's mechanisms by which a third party (such as say, the Saudi government) can provide funding for a specific spot - but there is no mechanism by which a resident/fellow can forego a salary or pay in for it. That's actually forbidden in the current iteration of the rules (I think somewhere in the institutional requirements, but I'd have to dig for it again).

 

[Winged Scapula]

ECFMG | EVSP: J-1 Physician

I found this org and it seems like they are "sponsoring J-1" for international physicians for Graduate training in US?
Does she have to go through full board exam even with these?

I am reading the info but it is not making sense bc Iack so much background info about how medical license works ;( sorry...

As noted above, this program refers to visa status. It does not negate the need for your aunt to complete the US licensing exams to be eligible for a US ACGME fellowship.

 

[queenki]

You are correct and my information was from an older iteration of the rules. I went and checked, it is not possible for any ACGME accredited fellowship without an explicit exemption for "exceptional candidates" that may or may not be allowed by the individual RRC. That said, the exemptions do exist, so I looked up for what that means.

From the common program requirements: (bold is mine)



So I pulled up the first IM fellowship requirements that came to mind (Endocrinology) and scrolled down to III.A.2.c).

The Review Committee for Internal Medicine does allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A.2. (Core)

Then I pulled up the one explicitly for Geriatrics (since this is OP's question)

III.A.3. The Review Committees for Family Medicine and Internal Medicine allow exceptions to the Eligibility Requirements for Fellowship Programs in Section III.A. (Core)

Now, does it mean that OP's aunt can meet the requirements to be an "exceptionally qualified applicant"? Likely not. But if she can demonstrate evidence of scholarship or leadership experience, it may be possible. And even if she did, the USMLEs would be required.

Thank you so much for taking time to help me out. So, it sounds like there is no way to attend accredited training without the USMLE.
If she can pass the step 1 and 2 of USMLE, then she can apply for the accredited residency/fellowship as like any other medical school graduates in US. and the USMLE step 1 and 2 is.... almost impossible to pass as foreign MD? or... if she prepare for about a year or so, is it attemptable?

What do you think about the "a nonACGME-accredited residency program in the core specialty," mentioned above?
does it still require to pass the USMLE?

Sorry for lack of background knowledge regarding any of this system...

 

[queenki]

This popped up while I was typing my last post.

She's actually not able to fund herself. There's mechanisms by which a third party (such as say, the Saudi government) can provide funding for a specific spot - but there is no mechanism by which a resident/fellow can forego a salary or pay in for it. That's actually forbidden in the current iteration of the rules (I think somewhere in the institutional requirements, but I'd have to dig for it again).

Oh, I see. Only via gov funded program. and that is also closing up opportunity I guess.
I'll ask my aunt if she can find any info about gov funded fellowship opportunity abroad. (but I think if I was the gov, I would choose someone young to train so that she can contribute back to society longer, so I don't think she will stand out for this rout)

So, it sounds like she just has to pass the USMLE step 1 and 2 otherwise no way to get any training in US.

Thank you so much....!

 

[queenki]

As noted above, this program refers to visa status. It does not negate the need for your aunt to complete the US licensing exams to be eligible for a US ACGME fellowship.

I see thank you, this just sponsors the visa, so that the individual clinic/hospital/school does not have to go through the visa processing work.

What do you think about the "a nonACGME-accredited residency program in the core specialty," mentioned above?
does it still require to pass the USMLE?

 

[Winged Scapula]

I see thank you, this just sponsors the visa, so that the individual clinic/hospital/school does not have to go through the visa processing work.

What do you think about the "a nonACGME-accredited residency program in the core specialty," mentioned above?
does it still require to pass the USMLE?

Let's start with some basic information.

ACGME is the Accreditation Council for Graduate Medical Education. They are the body responsible for accrediting the majority of residency and fellowship programs in the US. There are "non-ACGME accredited" residency and fellowship programs but they are much less common. In some cases, especially with residency (less so with fellowship), they may be considered to be of questionable quality (if they do not have an organized body doing oversight).

To practice medicine in the US, you are required to have a medical license. As a resident, you may have a training license which is provided through the training institution. The training license is only good within the confines of the training program (ie, you cannot go out and start a practice with it). More senior residents and fellows often have an unrestricted license which allows them to practice. Most training programs require eligibility for a state medical license to be eligible for training.

Thus, to obtain an license in the US, your aunt must take the USMLE Steps 1-3 (assuming the fellowship requires an unrestricted license which many do). The ACGME is not involved in this; this is a state medical license issue. Even non accredited programs may require a license otherwise you could not practice medicine and only observe.

ACGME: accredits training programs
Programs (ACGME or not): must be eligible for a US medical license
USMLE: examinations required to be eligible for a license

It was not uncommon in the not so distant past, for foreign grads to secure a non-ACGME or even ACGME fellowship without having US residency training and then use that to enter practice in the US. This window is almost all but closed.

So bottom line is that while you may find an unaccredited program for your aunt that does not require prior US training or a license, but this is likely to be no different than an observership. She needs to take the USMLEs.

 

[NotAProgDirector]

If all she wants is some US experience and then go back to SK, she should just volunteer in a doc's office here.

 

[queenki]

Let's start with some basic information.

ACGME is the Accreditation Council for Graduate Medical Education. They are the body responsible for accrediting the majority of residency and fellowship programs in the US. There are "non-ACGME accredited" residency and fellowship programs but they are much less common. In some cases, especially with residency (less so with fellowship), they may be considered to be of questionable quality (if they do not have an organized body doing oversight).

To practice medicine in the US, you are required to have a medical license. As a resident, you may have a training license which is provided through the training institution. The training license is only good within the confines of the training program (ie, you cannot go out and start a practice with it). More senior residents and fellows often have an unrestricted license which allows them to practice. Most training programs require eligibility for a state medical license to be eligible for training.

Thus, to obtain an license in the US, your aunt must take the USMLE Steps 1-3 (assuming the fellowship requires an unrestricted license which many do). The ACGME is not involved in this; this is a state medical license issue. Even non accredited programs may require a license otherwise you could not practice medicine and only observe.

ACGME: accredits training programs
Programs (ACGME or not): must be eligible for a US medical license
USMLE: examinations required to be eligible for a license

It was not uncommon in the not so distant past, for foreign grads to secure a non-ACGME or even ACGME fellowship without having US residency training and then use that to enter practice in the US. This window is almost all but closed.

So bottom line is that while you may find an unaccredited program for your aunt that does not require prior US training or a license, but this is likely to be no different than an observership. She needs to take the USMLEs.

Ohhh....I see it is much clear now.
Thank you so much for taking time to let me know.
At this point, I think it is just best idea for her to just come, advance English, do observation in skilled nursing facility and learn how they treat patients. I am not sure if Dr.s will accept longterm observation, but we can try. She could try a couple of different clinic/facility and rate around.

Thank you!

 

[queenki]

If all she wants is some US experience and then go back to SK, she should just volunteer in a doc's office here.

yes, I think I arrived to the conclusion now.
There is no point for her to take the step 1,2, just to get into the training when she doesn't want to practice in US.

Thanks!!!!!

 

[Winged Scapula]

Ohhh....I see it is much clear now.
Thank you so much for taking time to let me know.
At this point, I think it is just best idea for her to just come, advance English, do observation in skilled nursing facility and learn how they treat patients. I am not sure if Dr.s will accept longterm observation, but we can try. She could try a couple of different clinic/facility and rate around.

Thank you!

I'm not sure observing nursing staff will be useful to your physician aunt. She would be better off asking several physicians about observerships: she could include Family Medicine with a large geriatric population/geriatric fellowship trained, Geriatric Psychiatry, etc.

 

[queenki]

I'm not sure observing nursing staff will be useful to your physician aunt. She would be better off asking several physicians about observerships: she could include Family Medicine with a large geriatric population/geriatric fellowship trained, Geriatric Psychiatry, etc.

I see. That might be better idea.
I will look for those kind of physicians around

Thank you!!