5th Pathway

[madavis]

I am considering attending a Medical School outside of the US, and an admissions rep from another school told me that the worst case scenario would be having to complete an extra year of training before being allowed to practice in the US. What does this training consist of? Has anyone been down this path or know someone who has?
Any info is appreciated!

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[irisheyes]

I'm sorry...this is the first I have heard of it. I know of tons of grads from ross and SGU and they enter the residency match program on par ( some after 3.5 yrs, some after 4). the only thing I can think of is that your rep is talking about the pgy-1 year which is your internship year. This is required of most every residency anyway, even as a USMG. For instance I want to go into anesthesia. This will require a one year internship in either FP, IM, surgery etc. followed by a three year anesthesia residency. I really think your advisor is trying to scare you off the notion. When I told my "advisor" at UIC that I was contemplating Ross, she almost laughed at me. Needless to say I left, checked it out for myself, and will be starting in January. There is no extra year. Doing what?😕 Unless of course by " worst case scenario" she was implying that you might fail a year and have to repeat it. Other than that her claim is booooogus! 😀 😀

 

[dwstranger]

5th Pathway is a well-established program (initiated in the early '70s by the AMA). It allows American citizens or permanent residents who go to med school in a country that requires a year of internship and a year of social service after the 4 years of school before granting the MD degree. Since this year of "supervised clinical training" is the 5th year (replacing the 5th and 6th), it's called "Fifth Pathway." Most participants in 5PW are grads of UAG in Mexico, although there is one guy in it now whose school is in Hungary. I am currently in the program, and am a June 2003 UAG grad. After completion of the 5PW, we are eligible to enter a US residency program, and we do not have to be ECFMG certified. We enter the Match as "Independent Applicants."

There are plenty of posts on this site about it, many posted by yours truly. Do a search and you'll find a lot. You can also go to the AMA's site http://www.ama-assn.org/ama/pub/category/10255.html for info and to NYMC's site http://www.nymc.edu/depthome/fifth.asp . Currently, NYMC is the only school in the country to administer the program, but the CA legislature passed a bill last year to reinstitute it there. I don't know where they are in the process, though.

After you do your research, feel free to e-mail/PM me with any questions you might have, or post here.

Diana

 

[redleft123]

Originally posted by dwstranger
but the CA legislature passed a bill last year to reinstitute it there. I don't know where they are in the process, though.

No....the Calif legislature did not pass a bill to reinstitute the 5PW program.

The bill required the Medical Board, in conjunction with UC, to prepare a feasibility study. The Med Brd has completed their portion, and UC is still working on writing their portion. They are having fiscal concerns just dedicating staff to the project ... and none of the UC schools are interested or fiscally able to sponsor such a program. And the money certainly is not going to be freely given by the Legislature. I have spoken to a few people at the Med Board and they said, at best, it's not going to be operational for anyone who is now in med school ... probably, if it happens, in 7-10 years. There is no benefit for any of the UC schools to open such a program.

 

[dwstranger]

Hey, I never said it was a "done deal." Yeah, I know, it's splitting hairs, but I don't want to be accused of spreading mis-information!! But thanks for the update. I said that it had passed, and it has. As follows:

BILL NUMBER: AB 2872 CHAPTERED
BILL TEXT
CHAPTER 1136
FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2002
APPROVED BY GOVERNOR SEPTEMBER 30, 2002
PASSED THE ASSEMBLY AUGUST 21, 2002
PASSED THE SENATE AUGUST 19, 2002
AMENDED IN SENATE JUNE 29, 2002
INTRODUCED BY Assembly Member Thomson

Passed the Assembly, passed the Senate, means it passed the legislature. In case anyone's interested, here's the text of the bill.

------------
FEBRUARY 25, 2002
An act to add Section 2104.5 to the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST
AB 2872, Thomson. Healing arts: physicians and surgeons.
Existing law, the Medical Practice Act, establishes requirements that a graduate of a medical school located outside of the United States or Canada is required to satisfy for licensure by the Medical Board of California as a physician and surgeon. These requirements include the successful completion of one academic year of a supervised clinical training program that is under the direction of an approved medical school.

This bill would make various findings by the Legislature, including that medical schools located within California no longer offer this clinical training program, described as the "Fifth Pathway Program." The bill would require the board, in consultation with these medical schools, the Office of Statewide Health Planning and Development, and other designated persons to study methods to reactivate the Fifth Pathway Program in medical schools located in this state. The bill would require the board to report its findings to the Legislature on or before July 1, 2003.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares all of the following:
(1) The Fifth Pathway Program allows a citizen of the United States who attended medical school in a foreign country and completed one academic year of supervised clinical training in an approved medical school located in the United States and one year of a residency program, to apply for licensure as a physician and surgeon.

(2) The clinical training component of the Fifth Pathway Program is not currently offered in medical schools located in California.

(3) The Fifth Pathway Program is currently utilized successfully in New York, and has been utilized successfully in California in the past, to increase the number of physicians and surgeons who have an understanding of foreign cultures and a proficiency in a foreign language that they obtained while attending medical school in a foreign country.

(4) California is currently experiencing a shortage of health care providers with the cultural and linguistic competency to serve the state's diverse population, which has contributed to a lack of access to care in many immigrant communities.

(b) It is the intent of the Legislature to facilitate the establishment of one or more Fifth Pathway Programs at approved medical schools in California so that United States citizens who have graduated from a medical school in a foreign country can more easily obtain licensure in this state.

SEC. 2. Section 2104.5 is added to the Business and Professions Code, to read:
2104.5. The board, in consultation with various medical schools located in California, the Office of Statewide Health Planning and Development, and executive directors and medical directors of nonprofit community health centers, hospital administrators, and medical directors with experience hiring graduates of the Fifth Pathway Program or foreign medical school graduates shall study methods to reactivate the Fifth Pathway Program in medical schools located in this state. The executive directors and medical directors of nonprofit community health centers, the hospital administrators, and the medical directors should serve or work with underserved populations or in facilities located in medically underserved communities or in health professional shortage areas. The board shall submit a report to the Legislature on or before July 1, 2003, that shall include options for the Legislature to consider in order to facilitate the establishment of one or more Fifth Pathway Programs in medical schools located in California. The study shall focus on whether the Fifth Pathway Program can address the needs of areas where a shortage of providers exists, communities with a non-English speaking population in need of medical providers who speak their native language and understand their culture, and whether it can provide greater provider stability in these communities.
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I agree that it probably won't be available for anyone currently in med school, but at least it's on the way!

 

[trkd]

My understanding is that there is not much place for 5th pathway anymore. Look at the match results (http://www.nrmp.org/res_match/tables/table2_2003.pdf). Foreign grads (us and non-us IMGs) are matching higher than 5th pathways applicants. Furthermore, I don't think all states recognize 5th pathway. So why bother?

 

[dwstranger]

The table says this for active applicants (not counting the people who withdrew, etc.):

for 2003/2002/2001/2000:
5PW matched 51.2 / 58.8 / 67.6 / 58.3%
unmatched 48.8 / 41.2 / 32.4 / 41.7

USIMGs matched 54.6 / 53.8 / 52.4 / 51.4%
unmatched 45.4 / 46.2 / 47.6 / 48.6%

non-USIMGs matched 55.7 / 51.3 / 44.8 / 38.5%
unmatched 44.3 / 48.7 / 55.2 / 61.5%

Now maybe I'm interpreting the table wrong, but if you look at the numbers of 5PWs who matched in the last 4 Matches, only in 2003 was the percentage lower than USIMGs or FMGs. In 2000, 2001, and 2002, the percentage of 5PWs was higher than either of those other two groups. So your statement is largely incorrect.

To say "there's not much of a place for 5PW anymore" is also inaccurate, I believe. I chose to go to school in Mexico, where they require 6 years altogether and a professional exam before you get the MD degree. The main reason I chose Mexico over the Caribbean because I wanted to improve my Spanish. I was also able to drive there instead of flying (another plus for me). So the question then is: did I want to stay there for 6 years -- 4 of school, 1 of internship, 1 of social service -- before returning to the US with no US experience? The alternative to that is 5PW, because it replaced the 5th and 6th year with only a 5th year, and a year in the US at that. Granted, if one goes to a Carib school, one finishes in 4 years and does the last two years in the US. That's a definite plus. And until now, with the impending institution of the Step 2/CS and the dropping of the TOEFL requirement, 5PW was also held the advantage because we didn't have to take the TOEFL or the CSA, a savings of time, money, and hassle.

While it's also true that 5 or 6 states (and Guam!) do not recognize 5PW, in most of those states, 5PW grads have shown up at the state's medical board with a lawyer and petitioned for licensure, and it was granted. I personally know of people who did this in Utah.

I'm not trying to make the case for Mexico, or against anyone else. Applicants have to look at all the options before them -- the particular school, environment (a large city vs an island, etc.), cost of living, where you eventually want to practice, etc. -- and make their own choices. I was willing to do the extra year to be able to become fairly fluent in Spanish, which will definitely benefit me in my future practice.

 

[trkd]

Originally posted by dwstranger
The table says this for active applicants (not counting the people who withdrew, etc.):

for 2003/2002/2001/2000:
5PW matched 51.2 / 58.8 / 67.6 / 58.3%
unmatched 48.8 / 41.2 / 32.4 / 41.7

USIMGs matched 54.6 / 53.8 / 52.4 / 51.4%
unmatched 45.4 / 46.2 / 47.6 / 48.6%

non-USIMGs matched 55.7 / 51.3 / 44.8 / 38.5%
unmatched 44.3 / 48.7 / 55.2 / 61.5%

Now maybe I'm interpreting the table wrong, but if you look at the numbers of 5PWs who matched in the last 4 Matches, only in 2003 was the percentage lower than USIMGs or FMGs. In 2000, 2001, and 2002, the percentage of 5PWs was higher than either of those other two groups. So your statement is largely incorrect.

To say "there's not much of a place for 5PW anymore" is also inaccurate, I believe. I chose to go to school in Mexico, where they require 6 years altogether and a professional exam before you get the MD degree. The main reason I chose Mexico over the Caribbean because I wanted to improve my Spanish. I was also able to drive there instead of flying (another plus for me). So the question then is: did I want to stay there for 6 years -- 4 of school, 1 of internship, 1 of social service -- before returning to the US with no US experience? The alternative to that is 5PW, because it replaced the 5th and 6th year with only a 5th year, and a year in the US at that. Granted, if one goes to a Carib school, one finishes in 4 years and does the last two years in the US. That's a definite plus. And until now, with the impending institution of the Step 2/CS and the dropping of the TOEFL requirement, 5PW was also held the advantage because we didn't have to take the TOEFL or the CSA, a savings of time, money, and hassle.

While it's also true that 5 or 6 states (and Guam!) do not recognize 5PW, in most of those states, 5PW grads have shown up at the state's medical board with a lawyer and petitioned for licensure, and it was granted. I personally know of people who did this in Utah.

I'm not trying to make the case for Mexico, or against anyone else. Applicants have to look at all the options before them -- the particular school, environment (a large city vs an island, etc.), cost of living, where you eventually want to practice, etc. -- and make their own choices. I was willing to do the extra year to be able to become fairly fluent in Spanish, which will definitely benefit me in my future practice.

If you look at the trend in each of the match results, more and more USimgs and NonUSimgs are matching while less are matching from 5PW each year for the past 3. So my comment was based on the most recent results but you can look at what has happened in the past few years and see that it wasn't just by chance the 5PW mathched less.

As for the social service and all that bit, 5PW may be a better deal for you. I am not sure how all that works because I am not in that situation. I have 4 years to do, not 6. However, I stand by my comment that there is not much place left for it (except I suppose for people in your situation who can shorten your time). I assume that most people are not in a position to shorten their time overseas with 5PW so there would not be much point in doing it. As for the CSAs, I think everyone has to do that pretty soon (even US grads). True, I will have to do the TOEFL, but I just don't see it as much of a problem, having spoken English my whole life.

The thing is, there is no need to get defensive. I am not attacking your path to becoming a doc. I really don't care. I just didn't see the point in doing it. Just an opinion.

 

[busupshot83]

universtiy of west indies has a 5 year education

 

[redshifteffect]

Originally posted by trkd
True, I will have to do the TOEFL, but I just don't see it as much of a problem, having spoken English my whole life.

I thought the TOEFL was no longer a requirement as of 2004? Isn't this replaced with the Step 2 CSE?

 

[dwstranger]

TRKD,

I didn't really take offense (sorry if it came across that way). I guess I just read your post wrong. Like I said, for some people, I do believe it is still valid, to save time (from a 6 yr requirement) or if Spanish is your first language (many in my class come from Puerto Rico, and are more comfortable in Spanish than English, so Mexico was a natural place to study). You are right about the trend, which is disturbing for us, but I am confident that it should remain fairly level, at least for my class! 😉

As far as other places (e.g., in Europe), there's a guy in our 5PW class who goes to school in Hungary, and I believe neilc, who has posted on studentdoc before, is also in Hungary, was looking into 5PW (but I may be wrong about that).

Re: the TOEFL, yeah, that will be eliminated with the implementation of Step 2-CS, since you'll have to be able to communicate effectively (in English) with the "patients." But I think I mentioned that in my previous post. I think it's dropped as soon as the new test comes in. This is mid-2004, effective for the class of 2005 (according to the USMLE website).

 

[neilc]

Originally posted by dwstranger
As far as other places (e.g., in Europe), there's a guy in our 5PW class who goes to school in Hungary, and I believe neilc, who has posted on studentdoc before, is also in Hungary, was looking into 5PW (but I may be wrong about that).

yep, i considered it. looks like a good option to me! i decided against it, for a few reasons...

as far as i know, the only schools that qualify are those that have a final year "social service" requirement. i imagine that the qualification for the european model schools is that our sixth year is like a transitional year internship. so, i guess that qualifies as being required to practice for a year before getting your diploma.

so, it does shorten time for some of those that qualify. i think if you come from europe, you simply do your final year in the states, which has it's benifits....it is ideal for those students from mexico, though. gets you back in the states early and you save a year overall. carib grads don't qualify for it, so it can't and won't help them.