Finding a job in the US as a educated specialist from Norway

[psychegots]

Hi!

I'm starting medical school this fall in Norway so I am asking this question pretty early. Still, I wonder about the possibility for me to get a job in the US after I finish my specialization? I heard that unlike "plain doctors" specialists could go straight to a US position without having to take extra courses etc, but I have not been able to verify this information anywhere. Also I do not know how difficult it is to obtain such a position. My main motivation is that doctors have way higher salaries than here, so I am mainly interested in the higher paying specialties (I am willing to choose a specialty that will improve my chances).

If it matters in any way my grandfather is a US citizen so I have a distant claim for US citizenship. But as long as your able to get a secure job-offer I think your good to go anyway as far as I could read from the immigration rules.

Appreciate any help figuring this out!

---

Members don't see this ad.

 

[Law2Doc]

Hi!

I'm starting medical school this fall in Norway so I am asking this question pretty early. Still, I wonder about the possibility for me to get a job in the US after I finish my specialization? I heard that unlike "plain doctors" specialists could go straight to a US position without having to take extra courses etc, but I have not been able to verify this information anywhere. Also I do not know how difficult it is to obtain such a position. My main motivation is that doctors have way higher salaries than here, so I am mainly interested in the higher paying specialties (I am willing to choose a specialty that will improve my chances).

If it matters in any way my grandfather is a US citizen so I have a distant claim for US citizenship. But as long as your able to get a secure job-offer I think your good to go anyway as far as I could read from the immigration rules.

Appreciate any help figuring this out!

Family nationality/citizenship isn't relevant. To practice any form of medicine in the US, you must Be licensed, which means successful completion if the Step exams, and some period of residency training, usually 2-3 years minimum for foreign educated people. To get into a residency, you are going to have to do 1 or more years of observorship to give you some equivalence of US med school rotations. And thats just to get a license -- to actually practice within a specialty, you need to satisfy the requirements of board certification, which generally means completing an entire residency in that specialization 3-7 years, and completing various examinations. It's thus very difficult for people from and educated in foreign countries to end up practicing in any of the higher paying specialties in the US these days. Looking at immigration rules won't help you -- our immigration laws and medical requirements are not integrated. So no, you aren't "good to go" just by finding a job. You probably have quite a Few years of tests and training to be able to practice, and that's if you are lucky enough to get your door in the door.

 

[psychegots]

But are you sure this applies for Norway? Do they not compare the education in the relevant country?Even though I have not been able to verify the "straight to a US position" it was in a a comment on a closed doctor-forum so I assume it should be some degree of truth in it.

By what you are saying it seems easier to do the specialist training in the US.

 

[Poetic Silence]

There are quicker and less painful ways to get rich.

Isn't Norway the richest country in the world, or at least in the top five?

 

[Law2Doc]

But are you sure this applies for Norway? Do they not compare the education in the relevant country?Even though I have not been able to verify the "straight to a US position" it was in a a comment on a closed doctor-forum so I assume it should be some degree of truth in it.

By what you are saying it seems easier to do the specialist training in the US.

Foreign is foreign. There is no Norway exception. Sorry. If anything the Caribbean programs are much better off because they do there rotations here, and their grads are largely US or Canadian citizens. If you can get into med school in the US, do so, because you will have a very low chance of matching here if you train elsewhere. I don't know what closed doctor forum you were on, but you either misunderstood or were misled.

 

[psychegots]

There are quicker and less painful ways to get rich.

Isn't Norway the richest country in the world, or at least in the top five?

Don't get me wrong. I will study medicine this fall after I worked really hard get accepted because that is where my interest lies. I just do not care if I live and work here or in the US, and when the US means 5 times the salary that does make a difference. (Norway is a rich country, partly because people like doctors pay 40% tax on a low salary compared to their education )

 

[psychegots]

Foreign is foreign. There is no Norway exception. Sorry. If anything the Caribbean programs are much better off because they do there rotations here, and their grads are largely US or Canadian citizens. If you can get into med school in the US, do so, because you will have a very low chance of matching here if you train elsewhere. I don't know what closed doctor forum you were on, but you either misunderstood or were misled.

Thanks for answering. I will have to go to med-school here but it is useful to know that it probably is better to take the specialization over there. I know some doctors go there to take the trauma-specialization since that does not exists here so I know I can do it, I am just looking for the path of least resistance.

 

[Law2Doc]

Thanks for answering. I will have to go to med-school here but it is useful to know that it probably is better to take the specialization over there. I know some doctors go there to take the trauma-specialization since that does not exists here so I know I can do it, I am just looking for the path of least resistance.

Again, odds of matching into a competitive specialty residency from a non-US med school are very low, and you would first have to complete the Step exams, do some sort of obsevorship, etc. I wouldn't bank on this. This is the path of most resistance. Staying in Norway is the path of least resistance.

 

[psychegots]

Again, odds of matching into a competitive specialty residency from a non-US med school are very low, and you would first have to complete the Step exams, do some sort of obsevorship, etc. I wouldn't bank on this. This is the path of most resistance. Staying in Norway is the path of least resistance.

Hmmm I just found information related to the claim I knew I had read. Geir Ivar Elgjo, MD PhD Assistant Professor University of Virginia Health System wrote in an open letter (dated back in 2005) that he criticizes the Norwegian government for not recognizing his American specialist education in anesthesiology, one of his points is that the US approves Norwegian specialist education (but you have to be directly invited from a chief medical officer of the hospital you will work at he says). He does say that some states require a 3-day written and oral exam, but that those are fewer and fewer.

Have a lot of things changed since 2005, because I am getting confused here.

 

[Law2Doc]

Hmmm I just found information related to the claim I knew I had read. Geir Ivar Elgjo, MD PhD Assistant Professor University of Virginia Health System wrote in an open letter (dated back in 2005) that he criticizes the Norwegian government for not recognizing his American specialist education in anesthesiology, one of his points is that the US approves Norwegian specialist education (but you have to be directly invited from a chief medical officer of the hospital you will work at he says). He does say that some states require a 3-day written and oral exam, but that those are fewer and fewer.

Have a lot of things changed since 2005, because I am getting confused here.

There is no such rule in any specialty I am aware of, nor would he be licensed to practice medicine in any of the 50 states without some US residency training. I don't think what you described was even true in 2005. But it sure isn't now.

 

[PlutoBoy]

Listen, it's not that hard to get in or as difficult to understand the process (especially when you compare our medicolegal/immigration system with those in Europe, Norway included).

This is what you need to understand:

1) You need to take exams for licensure, just like any American graduate. These tests are called USMLE, which stands for United States Medical Licensing Examination. There is four of them: USMLE STEP 1, STEP 2 CK, STEP 2 CS, STEP 3. The tests themselves won't grant you permission to practice, but will make you eligible to apply for license to practice in a state. See number 2.

2) To practice in America, you need to do residency here. There is almost no exceptions. You can get board certified in a subspecialty if you are world renowned for it or if you have been a top Academician in the US but this is practically unheard of. Basically, you need to do your residency and subspecialty training here. It doesn't matter if your previous education is from Algeria or Norway. If you complete your medical training here, then you will be able to sit for the boards in your specialty/subspecialty and get a license in the state you wish to practice.

Having said that, obtaining a residency in America as a foreign grad is easier said than done but thousands do come every year, although the number is expected to decline significantly in the near future (6-8 years).

3) Residency is a job and as such you would need some sort of permit that allows you to work here. I'm talking about a visa. If you can claim citizenship then that's another story, but you would still have to do 1 and 2. By the way, as a Norwegian citizen you can come to America to VISIT, not work. You still need a visa that allows you to work, a permanent residency permit ("green card"), or US citizenship. If you do get a residency spot here, that would make you eligible for a visa. Keep in mind that most top hospitals are not willing to go through the hassle of doing all of this paperwork.

4) Doing "observerships" help but they are not mandatory. You don't need to do a year of "observerships" to get a residency spot.

5) It is difficult but easier than in most other countries.

 

[Law2Doc]

...

4) Doing "observerships" help but they are not mandatory. You don't need to do a year of "observerships" to get a residency spot....

few places will look at a foreign applicant without some semblance of US hospital experience and without LORs from US doctors. So while these observorships are not mandatory, they are pretty frequently essential in securing a spot.

As mentioned, US med school grads are increasing while residency slots are stagnant. So in a given specialty, there could very easily be zero spots going to foreign educated people in just a few years. So which specialty we are talking about is kind of important. If it's something competitive, we are probably talking about a very long shot.

 

[Winged Scapula]

1) In regards to: Geir Ivar Elgjo, MD PhD
There are certain loopholes to practicing medicine in the US without US residency training. This comes exclusively in the form of either being an internationally recognized expert who will fulfill a need not available otherwise or someone who has completed a US fellowship (but residency training outside of the country). These very rare positions are awarded to individuals with the limited institutional license; that is, you can only practice at the institution that hires you and presumably assists with your visa.

This is not something you should plan on being able to obtain easily.

2) as noted above, the most common path to working in the US is to apply for post-graduate residency and complete at least enough training to get a US license (see here). Bear in mind that just having a medical license does not mean that you are employable. In most cases, employers want someone who is US Board Eligible and/or Board Certified. You must complete a residency to do that.

Currently, to apply for a US residency, you must be ECFMG certified (www.ecfmg.org) which requires US licensing exams (USMLE), amongst other requirements.

3) Observerships are virtually useless. What you want to do is to spend some time in the US as a final year medical student, doing electives. It is accurate that many programs require US clinical experience (USCE) to be eligible for a position.

Your best bet is to train in the country in which you want to practice. Unfortunately, you have been given some bad information by your original source.

 

[psychegots]

Ah that probably explains what Geir Ivar Elgjo, MD PhD wrote. I think he made it sound common, but that would give him a better argument when criticizing the government so I probably should not have taken everything so literary.

Thank you all for answering me! Even though it turned out to be harder than I expected to get a US license now I have a clear understanding of what I need to do to obtain one 👍

 

[Law2Doc]

...now I have a clear understanding of what I need to do to obtain one 👍

doubtful, but at least you have a better starting point.

 

[Law2Doc]

...

3) Observerships are virtually useless. What you want to do is to spend some time in the US as a final year medical student, doing electives. It is accurate that many programs require US clinical experience (USCE) to be eligible for a position....

I think we are using different terms to describe basically the same thing. Where I have worked, you can't be a foreign med student and "do electives." lots of local and hospital regulations which limit what the foreign med students are actually allowed to do as compared to US med students, in terms if HIPAA, access to the EMR, doing procedures. they would call it an observorship or similar term because it's not really the same as what a US student gets to rotate through. But you get a year if US "experience" on your CV, and hopefully sone good LORs.

I agree that in some fields there are pathways to becoming a physician after having completed a foreign residency through extended fellowship, often something along the lines of training for 4 years at the same institution before you can get boarded. I'm not sure this is a higher yield path than residency, and I don't know what kind of job prospects this would lead to as compared to the traditional resident.

At any rate we agree that there is no seamless way for OP to do school in Norway and just come here to practice. That is the take home message. It will take many more years if training, regardless of your starting point, and that's assuming you can get your foot in the door.

 

[Bostonredsox]

Man reading this whole thread post call nearly made my head explode.

It is quite simple.

If you want to practice medicine in the United states, apply to and train at an american MD or DO school. If you are unsuccessful in doing that, apply to and attend a Caribbean school. The latter only carries a 50/50 chance of getting a residency slot and eventully a licensce. However, going to school in norway is a 0% chance of ever practicing in this country. What they are explaining to us is it is a 0.01% chance. You should consider it 0. If you want to practice here, apply to school here.

 

[Winged Scapula]

I think we are using different terms to describe basically the same thing. Where I have worked, you can't be a foreign med student and "do electives." lots of local and hospital regulations which limit what the foreign med students are actually allowed to do as compared to US med students, in terms if HIPAA, access to the EMR, doing procedures. they would call it an observorship or similar term because it's not really the same as what a US student gets to rotate through. But you get a year if US "experience" on your CV, and hopefully sone good LORs.

Well, I speak from experience as a foreign student who came to the US and did electives. I had the same privileges as US students, including seeing patients independently, doing procedures, scrubbing in on cases, etc. I never sensed any different treatment, and at least one institution (UVA), I was liked better than the home 4th year student and was given the best cases and patients to round on. That was the case at several places I rotated.

You can speak to the legalities more than I, but if the foreign student has malpractice insurance and has passed the USMLE, is it even legal for the hospital/program to treat them different than the American students?

 

[Winged Scapula]

Man reading this whole thread post call nearly made my head explode.

It is quite simple.

If you want to practice medicine in the United states, apply to and train at an american MD or DO school.

The OP is not an American and has not gone to undergraduate school so is not eligible for an American medical school.

However, going to school in norway is a 0% chance of ever practicing in this country. What they are explaining to us is it is a 0.01% chance. You should consider it 0.

Why would you say that? I wouldn't necessarily encourage the OP that it was easy to get a US residency but its hardly 0% chance. A foreign national training in his home country who tries to get a position in the US for residency is not necessarily at that much of a disadvantage (all else being equal). It will get harder over time, but for the good candidate, Norway, Zimbabwe or Outer Mongolia does not equal a 0% chance.

 

[Bostonredsox]

The OP is not an American and has not gone to undergraduate school so is not eligible for an American medical school.

Why would you say that? I wouldn't necessarily encourage the OP that it was easy to get a US residency but its hardly 0% chance. A foreign national training in his home country who tries to get a position in the US for residency is not necessarily at that much of a disadvantage (all else being equal). It will get harder over time, but for the good candidate, Norway, Zimbabwe or Outer Mongolia does not equal a 0% chance.

I did not realise a US BS/BA was required to attend medical school. All I remember my school requiring was chemistry, bio, physics, calc, a degree, and the MCAT. Do not recall it requiring a US degree. we had kids in our class that were part of some physician emigree program who I am quite sure did their undergrad training in the middle east.


I misunderstood his original post. I assumed he meant he was doing all of his training in norway, MD + residency, and wanted to know if he would be permitted to practice here, which is essentially no. If he is planning med school there and then going to apply as an FMG to a US residency that is ok, chances are lower than a US grad obviously but spots in FM, IM, Psych are usually still quite easy to get.

 

[Winged Scapula]

I did not realise a US BS/BA was required to attend medical school. All I remember my school requiring was chemistry, bio, physics, calc, a degree, and the MCAT. Do not recall it requiring a US degree. we had kids in our class that were part of some physician emigree program who I am quite sure did their undergrad training in the middle east.

Many, if not most, US medical schools require at least 90 units from a US undergraduate degree to matriculate. There are exceptions - combined BA/BS/MD programs - of course.

There may be special programs and that would be up to the school's particular policies.

I misunderstood his original post. I assumed he meant he was doing all of his training in norway, MD + residency, and wanted to know if he would be permitted to practice here, which is essentially no. If he is planning med school there and then going to apply as an FMG to a US residency that is ok, chances are lower than a US grad obviously but spots in FM, IM, Psych are usually still quite easy to get.

No, I think you understood correctly. At least, you and I thought the same: that he was asking about getting a job in the US after training in Norway. I thought you were telling him that it would be impossible to get a job here at all.

I agree with you: pretty much impossible without US training but not 0% if he comes here and does a US residency (even if having already done training in Norway).

I was probably confused. 😛

 

[Law2Doc]

...

You can speak to the legalities more than I, but if the foreign student has malpractice insurance and has passed the USMLE, is it even legal for the hospital/program to treat them different than the American students?

of course it's legal. If you haven't been to an LCME accredited institution, it's totally reasonable for an institution to limit your status and permitted duties if they let you come learn. You didnt get admitted to US school, and didnt train at one. So you can be treated differently than everyone who did so, and there's nothing illegal about it. The USMLE has to do with licensing, not US med school qualifications (although most schools require Step 1 passage as a precondition to the wards in conjunction with other LCME requirements). Your Malpractice insurance isn't the issue because it won't really protect the hospital in the event of a negligent supervision claim, just you. Ive seen folks who were experienced attendings in foreign countries have their experiences limited to shadowing and research at programs in the US, not even allowed to look in the EMR or put their hands on an instrument. Why? Because the same educational and LCME hoops weren't jumped through. Your program may have allowed you to enroll in an elective or sub-I, but plenty of places term it observorship, externship, or just a shadowing visitor, and limit your experiences accordingly. And it's totally legal (and probably the safer course under the law, actually).

That being said, if you are trying to get into a US residency or fellowship, and need letters from US attendings who have "worked with you" and need some US experience on your CV, this could be your best shot. Saying, I'm just going to do a fourth year elective at X med school, simply might not be realistic unless there is some history between X school and your program.

 

[Winged Scapula]

I'm not sure whether or not YOU were using the term YOU to refer to me because if so, what you've written below is patently false. If you have a personal issue with me, please contact me via PM rather than attempting to insult me in this thread.

of course it's legal. If you haven't been to an LCME accredited institution, it's totally reasonable for an institution to limit your status and permitted duties if they let you come learn. You didnt get admitted to US school, and didnt train at one. So you can be treated differently than everyone who did so, and there's nothing illegal about it. The USMLE has to do with licensing, not US med school qualifications (although most schools require Step 1 passage as a precondition to the wards in conjunction with other LCME requirements). Your Malpractice insurance isn't the issue because it won't really protect the hospital in the event of a negligent supervision claim, just you.

Ive seen folks who were experienced attendings in foreign countries have their experiences limited to shadowing and research at programs in the US, not even allowed to look in the EMR or put their hands on an instrument. Why? Because the same educational and LCME hoops weren't jumped through.

That's a red herring and has nothing to do with the issue at hand. You have posted, ad nauseum, across SDN, that the reason attendings from other countries (or even our own country) are treated differently is because they are a physician, not a student. They are held to a different standard. I agree with you. But we are talking about students here, not practicing physicians.

Your program may have allowed you to enroll in an elective or sub-I, but plenty of places term it observorship, externship, or just a shadowing visitor, and limit your experiences accordingly. And it's totally legal (and probably the safer course under the law, actually).

Perhaps you have a different experience at your programs but I am rather sure that I have been at more hospitals and programs than you, and none of them required foreign students to just "shadow". All were fully integrated into the team and allowed the same experiences as US students. I know it is your practice to try and convince SDN that your experience reflects all of reality, but it just doesn't.

 

[psychegots]

Just to clarify; I were asking about full training including specialty in Norway, but only because I was led to believe that was the easiest path. I have no problem with taking the specialty in the US, but I have to take med-school here.

Thank you Winged scapula for objecting to the 0 % chance comment. I do not know if it's intentional Law2Doc but you come of as sort of aggressive in my opinion. Thank you for answering though.

 

[Winged Scapula]

Just to clarify; I were asking about full training including specialty in Norway, but only because I was led to believe that was the easiest path. I have no problem with taking the specialty in the US, but I have to take med-school here.

Thank you Winged scapula for objecting to the 0 % chance comment. I do not know if it's intentional Law2Doc but you come of as sort of aggressive in my opinion. Thank you for answering though.

Thank you for the clarification. It is actually harder for you to work in the United States if you train elsewhere. You should expect to repeat most of your specialty training, If not all, should you come here for employment.

The easiest thing to do if you cannot go to medical school in the US is to come here for residency training.

 

[Law2Doc]

I'm not sure whether or not YOU were using the term YOU to refer to me because if so, what you've written below is patently false. If you have a personal issue with me, please contact me via PM rather than attempting to insult me in this thread.

I have no issue with you, actually enjoy hearing your perspectives on this and other threads (even when, as here, I don't agree with them), and when I used "you" in the prior post I meant it generically, not directed at you personally. Sorry for the confusion.

 

[Winged Scapula]

I have no issue with you, actually enjoy hearing your perspectives on this and other threads (even when, as here, I don't agree with them), and when I used "you" in the prior post I meant it generically, not directed at you personally. Sorry for the confusion.

👍

My apologies for the misunderstanding.

 

[Medstart108]

Man reading this whole thread post call nearly made my head explode.

It is quite simple.

If you want to practice medicine in the United states, apply to and train at an american MD or DO school. If you are unsuccessful in doing that, apply to and attend a Caribbean school. The latter only carries a 50/50 chance of getting a residency slot and eventully a licensce. However, going to school in norway is a 0% chance of ever practicing in this country. What they are explaining to us is it is a 0.01% chance. You should consider it 0. If you want to practice here, apply to school here.

You have to remember this guy lives in Norway. You can't just snap your fingers and send him to the US. Internationals pay extra fees to study in the US. He would also have to come to the US and do a bachelor's and then apply for medical school. Not only that but many schools don't accept non US citizens while others discriminate against them. He could just as easily leave after 4 years with 150k in debt and no job.

At this point he has an acceptance in Norway. Who cares if he can't practice in the US, he's got many other options after he graduates from Norway.

 

[Law2Doc]

...Who cares if he can't practice in the US....

apparently he does -- that was his whole point in this thread. He was asking about the logistics of coming to the US after schooling and training in Norway.

So the answer is, it's hard. best to do schooling here if you can, some clinicals here if you can't, then a long shot for a residency, and not possible to just apply for a US job after training in Norway. So saying "who cares -- he has other options in Norway" isn't really responsive to his questions -- he already knows this, and apparently doesn't love those options.