More and more International medical graduates are joining fellowships in the US after completing their home country residency and getting their credentials verified. About half of the current fellows in nephrology and geriatrics underwent residency abroad. After years of struggle completing home country residency which is usually very competitive and joining ACGME fellowship in the USA the future of chances of staying and working in the USA for several doctors still looks bleak.
Options after fellowship:
The most common path in front of such doctors is to redo the residency in the US which is usually 3 years after which they get board eligible for the internal medicine/subspecialty field. Doing residency again is very challenging as they have to compete with applicants who are much younger with programs preferring those with a recent year of graduation.
The ideal option is to apply for jobs after fellowship which is associated with a lot of hurdles and is nearly impossible in the current situation even for those with a lot of experience in the field. The reasons for the difficulty to get the job are as follows:
Board eligibility/ Certification: The physician is not board-eligible/certified after the fellowship. As per ABIM guidelines, those candidates doing fellowship without US residency need to find a faculty position at the level of assistant professor or higher and work in the position for 3 years to be board eligible. Though this path seems reasonable it is met with a lot of difficulties. In the majority of cases, the hospital credentialing committees of the academic institutions will not accept the physician for a faculty position without board eligibility/certification.
State license requirements: Each state in the US has its criteria for physician licensing. Most physicians doing fellowship meet the criteria for licensing except one. The years of ACGME training required for licensure vary between 1-3 years among states with the majority of states needing 3 years which means those doing 1-year or 2-year fellowships are not eligible. Though there are provisions for waiver of such requirements in some states it is not clear.
J1 waiver: Another hurdle in this process is the inability to get a J1 waiver. The academic institutions that may accept such physicians are big, some of them in big cities which have a limited number of j1 waiver positions available under the Conrad 30 program. Here is a sample scenario: Dr. X is a fellow in nephrology looking for a faculty position in an academic institution to meet ABIM requirements. The majority of such institutions are located in places like New York, Chicago, California, Florida, and Texas where getting a waiver is extremely difficult with huge competition.
Do these experienced doctors need to go through residency again to prove themselves after such a huge amount of home-country experience and ACGME fellowship in the USA? This is not ideal in the current situation where there is a huge scarcity of physicians and a growing number of residency applicants every year. Each residency position these fellowship-trained doctors acquire is a lost opportunity for another young residency aspirant.
Some suggestions to solve these problems:
Revise the state licensing requirements taking into consideration these exceptionally talented physicians and provide them a way to attain licensure after completion of the fellowship.
Advise regulations to the hospital credentialing committee to be able to recruit such fellowship-trained doctors as faculty.
Allot more J1 waiver slots for academic institutions recruiting doctors for faculty pathways.
Enhance awareness among healthcare communities about this pathway.
