Depends if you come from a program that is an excellence center for a technique that the fellowship program director has interest in - think Charite Disk. I know for a fact that there have been several German spine fellows in the UC system (UCSF, UCSD), for example. I'm sure they needed their ECFMG certificate (all steps) and were there on a J-1 visa. Not sure if any of that changed with advent of the PTAL. If any of these acronyms don't ring a bell, please do your own research as I probably won't be checking back here.
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