Does an IMG have to do residency in non-USA country?

[rocker]

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I understand that most, if not all, state licensing boards have the minimum requirement that a physician, who wishes to practice medicine in the USA, must be eligible to practice medicine in the country in which the medical school is located. Exactly, what does this mean, "must be eligible to practice medicine in the country in which the medical school is located"??? Does it mean that the physician who graduates from a non-American country must do residency in that country?

Basically, as an example... for a student who is attending a medical school in the UK. Would this student be required to do residency in the UK in order to become "eligible" to practice medicine in the UK? And therby satisy this American minimum requirement?

 

[Winged Scapula]

I understand that most, if not all, state licensing boards have the minimum requirement that a physician, who wishes to practice medicine in the USA, must be eligible to practice medicine in the country in which the medical school is located. Exactly, what does this mean, "must be eligible to practice medicine in the country in which the medical school is located"??? Does it mean that the physician who graduates from a non-American country must do residency in that country?

Basically, as an example... for a student who is attending a medical school in the UK. Would this student be required to do residency in the UK in order to become "eligible" to practice medicine in the UK? And therby satisy this American minimum requirement?

Depends on what is required to be eligible to practice medicine in that country (how's that for double speak?). Remember in the US at least, residency is not required to be ELIGIBLE or even licensed to practice medicine - only graduation from an approved medical school (and passing Step 3 to be licensed is) is. The situation is the same in most foreign countries although some (Mexico comes to mind) do require either an intern year or some government service to become eligible.

If you are contemplating attending school in the UK, you need not do any more schooling there to obtain a residency in the US than graduate from medical school.

 

[rocker]

Depends on what is required to be eligible to practice medicine in that country (how's that for double speak?). Remember in the US at least, residency is not required to be ELIGIBLE or even licensed to practice medicine - only graduation from an approved medical school (and passing Step 3 to be licensed is) is. The situation is the same in most foreign countries although some (Mexico comes to mind) do require either an intern year or some government service to become eligible.

If you are contemplating attending school in the UK, you need not do any more schooling there to obtain a residency in the US than graduate from medical school.

Thanks for explaining, but now I'm doubly confused. I assumed that, like all other docs, UK doctors had to complete med school AND residency to be able to practice medicine in the UK. They don't?! 😕

 

[Winged Scapula]

I cannot speak for the current licensing situation in the UK, but in the US you do not have to complete a residency to practice medicine.

You only need to be licensed which requires completion of the USMLE Steps 1-3 and approval from a state licensing board. As recently as 40 years ago, residencies simply consisted of 1 year internship and no more for most general practitioners. The era of extended residencies and fellowships for medicine physicians is relatively recent.

Granted, getting hired by a practice, hospital or to be paid by Medicare or Insurance companies for your care without having completed a residency is getting increasingly difficult.

Some states do require that you complete a certain amount of training, especially as an IMG, before they will allow you to take Step 3, but completion of a residency is not technically necessary (although everyone does it for the reasons above and the fact that a General practitioner in the US does not really exist anymore - ie, as a distinct entity from FP).

Hope this helps.

 

[rocker]

I cannot speak for the current licensing situation in the UK, but in the US you do not have to complete a residency to practice medicine.

You only need to be licensed which requires completion of the USMLE Steps 1-3 and approval from a state licensing board. As recently as 40 years ago, residencies simply consisted of 1 year internship and no more for most general practitioners. The era of extended residencies and fellowships for medicine physicians is relatively recent.

Hope this helps.

Too bad it's not like 40 years ago and all you had to do was a 1 year internship. Makes things a lot easier. Thanks for clarifying.

I am still a bit confused about the terms residency and internship. Like you were saying about 40 years ago, you only had to do 1 year of internship to become licensed. Is this true in non-USA countries, that you must do some sort of internship to get licensed?

And just so that I know what I'm talking about...
- A residency program is a paid post-graduate program done AFTER you get an MD.
- An internship is a non-paid program done BEFORE you get an MD (or MB ChB, MBBS, etc).
Am I right on those two things? In that a residency is done after attaining an MD. While a internship must be done in order to attain an MD (or MBBS, Mb ChB, etc).

 

[OzDDS]

Too bad it's not like 40 years ago and all you had to do was a 1 year internship. Makes things a lot easier. Thanks for clarifying.

I am still a bit confused about the terms residency and internship. Like you were saying about 40 years ago, you only had to do 1 year of internship to become licensed. Is this true in non-USA countries, that you must do some sort of internship to get licensed?

And just so that I know what I'm talking about...
- A residency program is a paid post-graduate program done AFTER you get an MD.
- An internship is a non-paid program done BEFORE you get an MD (or MB ChB, MBBS, etc).
Am I right on those two things? In that a residency is done after attaining an MD. While a internship must be done in order to attain an MD (or MBBS, Mb ChB, etc).

I believe an internship is the 1st year of post MD, MBBS, MBChB. And yes, it is paid (not much mind you).

I think what you might be wondering is, if you do your medical degree abroad the US requires you to be a "registerable" physician in the country from which you recieved your degree. Some countries require you to do a 1-year internship after you recieve your medical degree before you are "fully licensed". But I think even if you did not do the internship, you would still be "registerable" in that country.

 

[rocker]

I believe an internship is the 1st year of post MD, MBBS, MBChB. And yes, it is paid (not much mind you).

I think what you might be wondering is, if you do your medical degree abroad the US requires you to be a "registerable" physician in the country from which you recieved your degree. Some countries require you to do a 1-year internship after you recieve your medical degree before you are "fully licensed". But I think even if you did not do the internship, you would still be "registerable" in that country.

That makes sense and yes, I have also read that many US State licensing boards require you do be "eligible" or "registerable" as a physician in the country in which you received your medical degree if you want to come back and practice in the USA.

Does the US system even offer internships? I thought that they don't do that anymore. US med schools mostly are structured in that you do 4 years of study (2 Basic Science years + 2 Clinical Science years) in order to receive the MD. Then, you apply for and do a multiyear residency program. Where is the internship portion in the US system? It doesn't seem that there is one. 😕

 

[Winged Scapula]

Too bad it's not like 40 years ago and all you had to do was a 1 year internship. Makes things a lot easier. Thanks for clarifying.

I am still a bit confused about the terms residency and internship. Like you were saying about 40 years ago, you only had to do 1 year of internship to become licensed. Is this true in non-USA countries, that you must do some sort of internship to get licensed?

And just so that I know what I'm talking about...
- A residency program is a paid post-graduate program done AFTER you get an MD.
- An internship is a non-paid program done BEFORE you get an MD (or MB ChB, MBBS, etc).
Am I right on those two things? In that a residency is done after attaining an MD. While a internship must be done in order to attain an MD (or MBBS, Mb ChB, etc).

IN THE US, internship is simply the first year of residency. It is an old term and can also be referred to as PGY1 or Post Graduate Year 1, the first year in training after medical school. Internships are paid just as residencies are and it will perhaps relieve some of the confusion if you just understand that in the US, internship is simply the first year of residency and is otherwise no different.

US medical schools do not require that you do anything other than the standard 4 years of medical education and pass the USMLE exams to enter internship. Internship is generally followed by residency because as I stated in an earlier post, without completion of a full residency program in the US you will find it difficult to practice. While it was easier 40 years ago, the degree of skill and detailed knowledge was likely much less than it is now.

As another posted noted, some countries require a year internship after completion of the undergraduate medical degree before you are eligible to become registered or licensed in that country. Again, in the US this is not always the case, but will vary from state to state (ie, how many years you have to complete in residency training before they will allow you to apply for a full and unrestricted license and further, a DEA number. For example, Pennsylvania requires IMGs to complete 3 years of residency training before doing so.).

Hope this clarifies things for you.

 

[OzDDS]

So basically, if you go to the UK or Australia for medical school and attend a 4-year graduate program similar to the US/Canada. You could.. Immediatly fter getting your degree and passing your Boards and getting your ECMFG cert then yes.. you could apply for US residency... the first year of which would be your internship year. or conversly, if you decided to remain in UK or Australia after recieveing your degree you would enter into your internship year there.

 

[leorl]

So basically, if you go to the UK or Australia for medical school and attend a 4-year graduate program similar to the US/Canada. You could.. Immediatly fter getting your degree and passing your Boards and getting your ECMFG cert then yes.. you could apply for US residency... the first year of which would be your internship year. or conversly, if you decided to remain in UK or Australia after recieveing your degree you would enter into your internship year there.

Yes, that's it 🙂. Should you then decide after doing your internship in Uk/Oz that you want to complete post-graduate training (i.e. residency) in the US, you would most probably have to repeat your internship in the US. The same would go for those from the US who want to practice elsewhere - most likely, they would have to repeat internship in that country and also complete that country's licensing exams (i.e. PLAB).

To echo Kim, what you need to do to enter residency in the US (of which internship is the 1st year) is 1) graduate from an IMED accredited medical school 2) USMLE 1, USMLE 2 CK, USMLE 2 CS - these will give you ECFMG certification. To me, there's not much point in practicing if you don't do a residency...you won't get anywhere. So these requirements will enable you to go through the NBME Match to find a residency program that suits you, or in some cases, get a residency outside the match. Once in residency, you will do USMLE 3 in order to gain state licensure. It can be a very confusing process.

Where there's confusion, is that there are a few medical schools (UAG in Guadelajara) that require a year of internship and a year of social service BEFORE you can earn your MD. US citizens who go there can bypass this by going through the Fifth Pathway program. But this structure seems to be just in that region. The European schools don't follow that structure, and all internship/residency is post-graduate.

 

[Arb]

Remember you have to do Step 3 for a H1b visa if you are not American.

 

[rocker]

leorl's info on internships and UAG is quite interesting. I just looked at UAG's website, in particular the page http://www.uag.edu/medicine/med7.htm and it looks like UAG students have to complete the internship year and then something called a social service year even before they are allowed to become ECFMG certified and apply for a US residency program!

So, how is it that IMGs from countries (eg Ireland, UK, Australia, Poland, Czech Rep, Hungary, etc) are able to get ECFMG certified and go straight to a US residency without even completing the internship year in the country in which they did their med studies???

 

[londoc]

Attempting to shed some light on the initial question of eligilbility timing for UK grads:

Certainly, here (UK) once one has the degree they are eligible to provisionally register with the General Medical Council (GMC) (I assume akin to limited licence in the States) and after satisfactorily completing one year, receives full registration. At this point, we are able to apply for SHO posts (more akin to residency, although not quite a speciality-specific initially).

Whether provisional registration (i.e just completing UK med school) means one is eligible in the States, I'm not sure - I would assume so. Having said that, most people would complete their year of house jobs since having left the system it would be much harder to get back in. Additionally, most medical schools have a local 'matching scheme' with various close hopsitals which favours both parties, encouraging posts to be filled and a degree of certainly for the first year. These schemes may not be open to returning grads.

This is changing slightly however with the new foundation year system which is much more similar to the US residency system. I am less clear on this as it is relatively new and hasn't affected myself or my colleagues. One would have two years of initial training in various generic specialities and then would immiediately apply for a specific speciality-based rotation. Currently, UK junior docs finish house jobs and traditionally do a six month ED job before doing perhaps one or two more 'stand-alone' posts and then applying for an SHO rotation which takes you up to around the time that you're expected to get your chosen post-graduate exam (MRCP, MRCS, FRCA etc).

I digress.... bascially the question is whether provisional or full GMC registration is needed - I would intuitively think provisional only.... but am unsure since I qualified some years ago and the question never arose in my case.... I, and many others, would warn against leaving 'prematurely' since although the thought of return improbable now, it may prove more difficult to come back easily to house jobs, especially those within teaching hospitals.

However, if completely sure that a UK return is out of the question, crack on asap, especially in view that pretty much regardless of length of training in the UK, everyone has to go back and start at the intern level since little or no credit will be given for overseas training (some caveats do exist)...

perhaps that helps, perhaps not...

 

[Dr.Millisevert]

Attempting to shed some light on the initial question of eligilbility timing for UK grads:

Certainly, here (UK) once one has the degree they are eligible to provisionally register with the General Medical Council (GMC) (I assume akin to limited licence in the States) and after satisfactorily completing one year, receives full registration. At this point, we are able to apply for SHO posts (more akin to residency, although not quite a speciality-specific initially).

Whether provisional registration (i.e just completing UK med school) means one is eligible in the States, I'm not sure - I would assume so. Having said that, most people would complete their year of house jobs since having left the system it would be much harder to get back in. Additionally, most medical schools have a local 'matching scheme' with various close hopsitals which favours both parties, encouraging posts to be filled and a degree of certainly for the first year. These schemes may not be open to returning grads.

This is changing slightly however with the new foundation year system which is much more similar to the US residency system. I am less clear on this as it is relatively new and hasn't affected myself or my colleagues. One would have two years of initial training in various generic specialities and then would immiediately apply for a specific speciality-based rotation. Currently, UK junior docs finish house jobs and traditionally do a six month ED job before doing perhaps one or two more 'stand-alone' posts and then applying for an SHO rotation which takes you up to around the time that you're expected to get your chosen post-graduate exam (MRCP, MRCS, FRCA etc).

I digress.... bascially the question is whether provisional or full GMC registration is needed - I would intuitively think provisional only.... but am unsure since I qualified some years ago and the question never arose in my case.... I, and many others, would warn against leaving 'prematurely' since although the thought of return improbable now, it may prove more difficult to come back easily to house jobs, especially those within teaching hospitals.

However, if completely sure that a UK return is out of the question, crack on asap, especially in view that pretty much regardless of length of training in the UK, everyone has to go back and start at the intern level since little or no credit will be given for overseas training (some caveats do exist)...

perhaps that helps, perhaps not...

What about if say an american recieved his/her degree in the UK and then skipped the house registration year. Then completed their residency training in the US, then returned to complete a fellowship year in the UK and/or wrote the FRCS exam. Would they then be able to practice in the UK even though they did not complete their internship there?

 

[londoc]

What about if say an american recieved his/her degree in the UK and then skipped the house registration year. Then completed their residency training in the US, then returned to complete a fellowship year in the UK and/or wrote the FRCS exam. Would they then be able to practice in the UK even though they did not complete their internship there?

Interesting question... not my field of expertise (intensivist).... as with many of my american counterparts on these fora, I am only familiar with a set path (namely UK qualification and subsequent training) and anything deviating from this I am sadly lacking in meaningful advice....

there are a few differences between the UK and US systems and therefore it is often dangerous and misleading to equate the two.

There are, however, some problems and assumptions with the above scenario:

1. there is no such thing as fellowship in the American sense, i.e. a completely separate entity between resident and attending offering increasing complexity and autonomy. The closest equivalent is a specialist registrar (SpR) which is not really the same. This is a complicated issue which is related to fundamental transatlantic differences in length and method of training and I think I would confuse the issue by attempting the explain it here...

2. in order to take the MRCS (equivalent of FRCS - changed a few years ago) there are certain criteria that you must fulfill - off the bat 22 months of 'basic surgical training' within a combination of specialities. Whether American/ Australian training jobs would count - I really don't know enough...

I know that for anaesthesia - a maximum of 12 months of substantive posts abroad can count towards the 30 months requisite to sit the final FRCA... so common sense does prevail (at least with anaesthetists)...

3. In order to get the above 22 months and indeed any other SHO / registrar jobs you would need to be fully registered with the GMC - this may well involve taking the PLAB examination (something I know very little about) which is designed to show competency. This way you would avoid house jobs but apparently the whole GMC/ PLAB/ job application process may well not be a smooter alternative....

I'm sure there are many more doctors on the forum who have had to painstakingly go through American/ English hoops in order to be able to continue their chosen careers - I would invite them to make a much more educated contribution....

my apologies....

in the meantime:
http://www.gmc-uk.org/register/default.htm (General Medical Council)
http://www.rcseng.ac.uk/ (Royal College of Surgeons)
http://www.britishcouncil.org/goverance-health-nacpme-faqs.doc (looks very helpful)

are good starting points

 

[leorl]

So, how is it that IMGs from countries (eg Ireland, UK, Australia, Poland, Czech Rep, Hungary, etc) are able to get ECFMG certified and go straight to a US residency without even completing the internship year in the country in which they did their med studies???

Because in those countries, it's like the US...you complete internship AFTER graduation. The internship year is part of your post-graduate training as the first year of your residency. The fifth pathway program is set in place only for those who attend countries/universities where internship + social year is required pre-graduation (as in, they need it to earn an MD). In more western countries, an intern year is not required to gain the MD.

 

[Miklos]

So, how is it that IMGs from countries (eg Ireland, UK, Australia, Poland, Czech Rep, Hungary, etc) are able to get ECFMG certified and go straight to a US residency without even completing the internship year in the country in which they did their med studies???

At least when it comes to Hungary, leorl is misinformed.

This is because the 6th year of a 6 year program in Hungary is an "internship" for Hungarian purposes (the equivalent of a PRHO year in the British isles.) The diploma therefore includes the internship.

So, The Fifth pathway therefore can be used to meet the sixth year requirements or the student/grad can go on to ECFMG certification with diploma in hand after completing the 6th year.

Miklos

 

[leorl]

Oh, didn't see Hungary in the list. Regardless, 5PW can be used for places requiring an internship year pre-graduation. Got it?

 

[erichaj]

You DO NEED TO DO RESIDENCY IN THE UNITED STATES TO PRACTICE MEDICINE.

YOU CAN'T GET A LICENSE IF YOU DON'T DO RESIDENCY.

GOOD LUCK

EH.