Fellowship Program for Foreign Doctors

[Dragon Scorpion]

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Hello! I'm a second year Internal Medicine resident from the Philippines. It's been my dream to train for fellowship abroad like in US, Europe or Australia. I am currently interested in the field of cardiology or nephrology. What are the requirements in applying for fellowship for foreign doctors like me? I want to prepare as early as now. All your comments/replies will be highly appreciated.

 

[Thrombophlebitis]

You should have started yesterday.
You need to pass/do well on the USMLE step 1, Step 2CK and Step 2CS.
You need to have hands on U.S. clinical experience and letters of recommendation from practicing physicians in the U.S.
You also need to have around 5000-10000$ to spend on applying to programs and for traveling to and from interviews.

 

[SmartySmurf]

Hello nice people!!!!
I would like to extend "Dragon Scorpion" question.
I just received my medical degree (not in the US and I am not an american citizen)
I finished step 1 and step 2 ck.
I would like very much to do a fellowship in the US in the future.

Now I need to decide whether to do CS or not.
why to do it? ----> because I would like to do a fellowship in USA after doing my residency in my home country.
why not?------> there are rumors that doctors how did not finish residency in the USA can not do fellowship in the USA.

So my question is, are those rumors have any truth in them?????

 

[chessknt]

It isn't a rumor--you cannot apply for any fellowship of any subspecialty of medicine without first completing a residency in the base specialty. You need to start over and do residency here first if that is really what you want.

 

[IMreshopeful]

Hello nice people!!!!
I would like to extend "Dragon Scorpion" question.
I just received my medical degree (not in the US and I am not an american citizen)
I finished step 1 and step 2 ck.
I would like very much to do a fellowship in the US in the future.

Now I need to decide whether to do CS or not.
why to do it? ----> because I would like to do a fellowship in USA after doing my residency in my home country.
why not?------> there are rumors that doctors how did not finish residency in the USA can not do fellowship in the USA.

So my question is, are those rumors have any truth in them?????

Yes. You absolutely have to do residency in the Unites States prior to any fellowship here. You can pretty much 100% guarantee not being able to do fellowship in the US if you do your residency elsewhere.

I don't even understand that line of reasoning. As an IMG you NEED all of the step exams to even apply for residency here. So you not only have to take CS you also need to take step 3.

 

[Animalcules]

Yes. You absolutely have to do residency in the Unites States prior to any fellowship here. You can pretty much 100% guarantee not being able to do fellowship in the US if you do your residency elsewhere.

I don't even understand that line of reasoning. As an IMG you NEED all of the step exams to even apply for residency here. So you not only have to take CS you also need to take step 3.

You need CS, Step 3 is optional for you.


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[Psai]

Hello nice people!!!!
I would like to extend "Dragon Scorpion" question.
I just received my medical degree (not in the US and I am not an american citizen)
I finished step 1 and step 2 ck.
I would like very much to do a fellowship in the US in the future.

Now I need to decide whether to do CS or not.
why to do it? ----> because I would like to do a fellowship in USA after doing my residency in my home country.
why not?------> there are rumors that doctors how did not finish residency in the USA can not do fellowship in the USA.

So my question is, are those rumors have any truth in them?????

It's funny that the guy that cs is designed for doesn't want to do cs

 

[Animalcules]

It's funny that the guy that cs is designed for doesn't want to do cs

Nobody in the US wants to take CS, why would this be different for him? It's much more of a pain for an IMG: getting a travel visa, paying for the flight, hotel, and CS, jet lag and then having an actual chance of failing due to language barriers, unfamiliarity with the format, etc. It's much more understandable than the hesitation amongst AMGs. I understand that people claim the test is useless and only exists to make revenue. I think this is not incorrect, yet 5% of AMGs fail it. So you can argue it serves some purpose if these students fail for legitimate reasons. Nobody wants to fail after putting so much money and effort into their training, whether you trained here or abroad.


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[IMreshopeful]

You need CS, Step 3 is optional for you.


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For IMGs it's highly recommended in general for residency applications

 

[Animalcules]

For IMGs it's highly recommended in general for residency applications

Sure, but I know many IMGs that matched into top-30 IM programs without taking Step 3. No clue about other specialties. My point is that you cannot expect to get interviews without CS, but you can comfortably match without Step 3.

 

[rokshana]

Yes. You absolutely have to do residency in the Unites States prior to any fellowship here. You can pretty much 100% guarantee not being able to do fellowship in the US if you do your residency elsewhere.

I don't even understand that line of reasoning. As an IMG you NEED all of the step exams to even apply for residency here. So you not only have to take CS you also need to take step 3.

No step 3 is not required unless it's needed for a visa

 

[rokshana]

For IMGs it's highly recommended in general for residency applications

Not,sorry, it's not

 

[SmartySmurf]

Hello everybody!!!
thank you very much for answering!!!

unfortunately i think most of you didn't understand my question 🙁

I don't want to match for residency in the USA.
I want to do my residency in my home country, and after i finish to go to the USA to do a 2 year fellowship.

my concern is whether it is possible to do fellow if i didnt do my residency in the US.

i have no problem doing CS , i have already did the first steps , but it will be waste of money and time to do CS if i wont be allowed to do fellowship anyway.

thank you so much for your answers , i appreciate it very much!!!

 

[IMreshopeful]

Hello everybody!!!
thank you very much for answering!!!

unfortunately i think most of you didn't understand my question 🙁

I don't want to match for residency in the USA.
I want to do my residency in my home country, and after i finish to go to the USA to do a 2 year fellowship.

my concern is whether it is possible to do fellow if i didnt do my residency in the US.

i have no problem doing CS , i have already did the first steps , but it will be waste of money and time to do CS if i wont be allowed to do fellowship anyway.

thank you so much for your answers , i appreciate it very much!!!

I directly answered your question. You cannot do fellowship in the US if you do not do residency here.

 

[SmartySmurf]

I directly answered your question. You cannot do fellowship in the US if you do not do residency here.

Thank you very much for answering!!!

 

[SmartySmurf]

I directly answered your question. You cannot do fellowship in the US if you do not do residency here.

One last question;
How do you explain it, that many MDs's from my country made their residency in their home country (Israel) and their fellow in the US .
Is it related to new rules made by "ACGME"?

 

[NotAProgDirector]

Yes, the ACGME changed the rules. This used to be allowed, and now it is not.

To be fair -- it is still allowed, but you need to ask for specific exemption to do it from the institution. But in practical terms it's unlikely.

 

[SmartySmurf]

Yes, the ACGME changed the rules. This used to be allowed, and now it is not.

To be fair -- it is still allowed, but you need to ask for specific exemption to do it from the institution. But in practical terms it's unlikely.

Thank you very much for answering!!!

 

[Psai]

Nobody in the US wants to take CS, why would this be different for him? It's much more of a pain for an IMG: getting a travel visa, paying for the flight, hotel, and CS, jet lag and then having an actual chance of failing due to language barriers, unfamiliarity with the format, etc. It's much more understandable than the hesitation amongst AMGs. I understand that people claim the test is useless and only exists to make revenue. I think this is not incorrect, yet 5% of AMGs fail it. So you can argue it serves some purpose if these students fail for legitimate reasons. Nobody wants to fail after putting so much money and effort into their training, whether you trained here or abroad.


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Except the whole point of cs is to test language skills for imgs. It's to make sure that a foreign physician can actually talk to patients here. So how is it a hassle for you? Are you being forced to come to America to practice? We owe you nothing. It's much more of a hassle for us grads for whom the test is useless and adds nothing except anxiety and debt. And having it set up so that an arbitrary percentage of people fail proves what exactly?

 

[Animalcules]

Except the whole point of cs is to test language skills for imgs. It's to make sure that a foreign physician can actually talk to patients here. So how is it a hassle for you? Are you being forced to come to America to practice? We owe you nothing. It's much more of a hassle for us grads for whom the test is useless and adds nothing except anxiety and debt. And having it set up so that an arbitrary percentage of people fail proves what exactly?

I am glad you feel the need to speak for America as a whole. I don't think anybody, including me, here ever implied that "America" would owe her/him anything. But I am very amused by your reaction. Does America owe you? It certainly sounds like it. If so, is this because you were born in the US? Because you went to school here? Or are you going straight to a taxpayer argument? I can assure you, I pay taxes here as well. And yet I don't feel the country owes me.

If the point of the CS is language assessment, this could be done in a more efficient way. Last I checked, spoken English proficiency is only one out of three parts scored in the CS. All US grads pretty much pass this part. AMGs fail the knowledge/ documentation part (ICE), if anything. I am not sure how you know that AMGs failing the CS this is arbitrary. Please elaborate if you have data.

It's funny that the guy that cs is designed for doesn't want to do cs

Again, not sure why I offended you.

 

[Psai]

I'm an American. You're not. Don't let it upset you

 

[rokshana]

I'm an American. You're not. Don't let it upset you

you do know that the rationale for USMD students to take CS was because of concerns that US students' clinical skills and the ability to interact with people were not up to par (its also the reason schools started using simulated patients in the basic science years)...the CSA was given to I/FMGs for years before it was decided to change it to CS and administered to all students...though i'm sure the fact that it is a big money maker made this seem like a good idea.

 

[Siggy]

Nobody in the US wants to take CS, why would this be different for him? It's much more of a pain for an IMG: getting a travel visa, paying for the flight, hotel, and CS, jet lag and then having an actual chance of failing due to language barriers, unfamiliarity with the format, etc. It's much more understandable than the hesitation amongst AMGs. I understand that people claim the test is useless and only exists to make revenue. I think this is not incorrect, yet 5% of AMGs fail it. So you can argue it serves some purpose if these students fail for legitimate reasons. Nobody wants to fail after putting so much money and effort into their training, whether you trained here or abroad.

Except the quoted reason is the reason that Step 2 CS (and it's prequel, the ECFMG Clinical Skills Assessment) exists. It was meant to insure that IMGs coming to the US could adequately communicate with patients and that their communication skills, or lack there of, would not hinder patient care.

Hence while virtually all US graduates pass the CS.

Hence why no one is going to feel sorry that someone from the group of people that caused the exam to be created... and then spread to everyone (because... revenue generation) is complaining about having to take the exam.

 

[Animalcules]

Except the quoted reason is the reason that Step 2 CS (and it's prequel, the ECFMG Clinical Skills Assessment) exists. It was meant to insure that IMGs coming to the US could adequately communicate with patients and that their communication skills, or lack there of, would not hinder patient care.

I do not think this is true. The test was introduced in 2004 as a clinical skills assessment for all medical students, not a language test. Interestingly, there seems to be little correlation between the CS results and OSCE performance in med school, so both cannot be valid or they test different things. Maybe the CS is too easy. Would a lower pass rate for AMGs make you feel better?

 

[Siggy]

I do not think this is true. The test was introduced in 2004 as a clinical skills assessment for all medical students, not a language test. Interestingly, there seems to be little correlation between the CS results and OSCE performance in med school, so both cannot be valid or they test different things. Maybe the CS is too easy. Would a lower pass rate for AMGs make you feel better?

"For students and graduates of international medical schools, Step 2 CS will replace the ECFMG Clinical Skills Assessment (CSA®) for purposes of ECFMG certification."
http://medicine.osu.edu/orgs/clinicalskills/spresources/pages/step2csinfo.aspx

The ECFMG Clinical Skills Assessment (CSA) evaluates your ability to gather and interpret clinical patient data and communicate effectively in the English language.
...
The CSA assesses whether you can obtain a relevant medical history, perform a focused physical exam and compose a written record of the patient encounter. The CSA requires that you demonstrate proficiency in spoken English, which will be evaluated by the standardized patients you encounter in the test stations. The CSA is administered only in English.
http://www.pages.drexel.edu/~dmd42/csa/


Would a lower pass rate make me feel better? No. The exam shouldn't be changed in order to fail an arbitrary number of people. If, by and large, everyone is passing a certifying exam like this, and doing so from the start, then the better option would be to scrap it.

 

[drk]

I'm pretty sure you can do a fellowship here without having completed IM residency in the USA. You have to have obviously completed an IM residency in your home country. This is probably heavily program dependent and rarely done. You will however not be allowed to practice in the USA.

We had a guy do his fellowship in our hospital then he decided he wanted to stay so he did his IM after doing his fellowship 😛

 

[FrisbeeDocIM]

I'm pretty sure you can do a fellowship here without having completed IM residency in the USA. You have to have obviously completed an IM residency in your home country. This is probably heavily program dependent and rarely done. You will however not be allowed to practice in the USA.

We had a guy do his fellowship in our hospital then he decided he wanted to stay so he did his IM after doing his fellowship 😛

Yes, the ACGME changed the rules. This used to be allowed, and now it is not.

To be fair -- it is still allowed, but you need to ask for specific exemption to do it from the institution. But in practical terms it's unlikely.

As aPD said, it's no longer allowed (for the most part).

 

[SmartySmurf]

Thank you to everyone that answered my question 🙂 ,
I now realize that there is this new rule that does not allow people who finished residency in a non ACGME accredited institute , to do a fellowship in an ACGME hospital.
However it seems to me that there are ways to bypass this rule, and honestly i believe it would change in a few years, since it has no logic.
so the smart step is to do the CS exam to have my ECFMG certificate. and when the time comes to do a fellowship i will find the way 🙂.
Thanks again everybody!
Yours,
Smartysmurf

 

[gutonc]

Thank you to everyone that answered my question 🙂 ,
I now realize that there is this new rule that does not allow people who finished residency in a non ACGME accredited institute , to do a fellowship in an ACGME hospital.
However it seems to me that there are ways to bypass this rule, and honestly i believe it would change in a few years, since it has no logic.
so the smart step is to do the CS exam to have my ECFMG certificate. and when the time comes to do a fellowship i will find the way 🙂.
Thanks again everybody!
Yours,
Smartysmurf

Whether you think it makes sense or not, somebody does...and that somebody's opinion is much more relevant than yours. The likelihood that it will change back to the old way is virtually nil. Feel free to prepare for it, but don't count on it.

 

[rokshana]

, and honestly i believe it would change in a few years, since it has no logic.

how is there no logic in having those that do ACGME fellowships to also do ACGME residencies? IF DO residents (AOA) are not allowed to do ACGME fellowships, then why would be make sense to let someone from outside the country to do so?

 

[SmartySmurf]

To whom who question my logic, apparently you haven't lived enough years to understand that things change in life. esp. when it concerns money. and US hospitals get paid a lot of money from foreigners doing fellowships there.
And another thing, its highly arrogant to believe that a resident from a non ACGME hospital is not good enough to do fellowship in an ACGME hospital.
This is why my logic tells me this rule wont last, feel free to believe otherwise!, time will tell whose logic is more accurate 😉

 

[gutonc]

Dude...you don't get it. Things do change in life. We know that. And the rules were the way that they were for a long time. ACGME recently decided that, if you didn't do your residency in a program that they certify, you can't do a fellowship in a program that they certify. If things are going to change going forward, it's more likely that they will get more restrictive, not less.
Nobody is saying that a non-ACGME trained doctor couldn't do well in an ACGME fellowship. But the rules are what they are.

And I don't know why you think hospitals make a ton of money training foreign physicians. There are a few spots in a few specialties that are held for citizens of Gulf Oil States that are paid for by their governments. But even they are subject to the ACGME rules.

 

[rokshana]

To whom who question my logic, apparently you haven't lived enough years to understand that things change in life. esp. when it concerns money. and US hospitals get paid a lot of money from foreigners doing fellowships there.
And another thing, its highly arrogant to believe that a resident from a non ACGME hospital is not good enough to do fellowship in an ACGME hospital.
This is why my logic tells me this rule wont last, feel free to believe otherwise!, time will tell whose logic is more accurate 😉

yes things do change and since that rule was just implemented the conventional wisdom here is that changes are going towards more restriction not less...

and what with more US MD as well as DO schools opening and increasing in enrollment, the restrictions towards IMGs and FMGs requiring visas will become more restrictive, and less available not the other way around.

you can do whatever you want, but don't come crying here a few years from now when that plan backfires.

and as for it being arrogant to think that a resident from a non acgme program is not good enough...welcome to america...

 

[buonassezia]

Yes, things change in life, but it is the direction of the change that matters. Things will change towards you being ineligible for US medical training by expiration of your USMLE's before they change towards waiving all the rules for you.

The validity of your passed USMLE exams only lasts a few years total. So taking CS would be a bad idea if you don't intend to apply for training in the US within a few years, max. That's not a long time for systemic change. I would not be willing to bet thousands of dollars for CS and a lot of wasted time on the hope that a very entrenched formal system would change for you within that brief timeframe. Now that /is/ arrogance.