how to you work in the usa if you're from the eu?

[europeman]

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with european citizenship, how does one work as a surgeon in the USA? do you have to re-complete a residency, or can i simply take the steps and pass? are there any countries which can transfer and work in the usa? Canada, Israel, Puerto Rico?

 

[Winged Scapula]

The answer is a bit complicated.

Without having completed a residency in the US or Canada, you are not Board Eligible. Many, if not most jobs as a surgeon in the US require that you be Board Eligible, if not Board Certified. To do so, you must complete a surgical residency in the US. Recently, the American Board of Surgery has announced that they will offer partial credit to those who have done some surgical training abroad...but you have to be already in a US residency program in good standing and your PD must apply for the credit. Up to 2 years credit can be claimed if approved by the ABS.

However, there are a few situations in which either a surgeon is recognized as an international expert in their field and is recruited by an institution or accepts a job which does not require BE/BC. These are generally pretty rare and are not to be considered as a route for *most* surgeons who have trained abroad.

Passing the USMLE Steps 1-3 only confers upon you the possibility of obtaining a medical license in the US. It does not replace doing a residency and most states require a certain amount of graduate medical training before you are eligible for a license (in addition to passing Steps 1-3).

So, the short answer is that if you can obtain a US medical license and find a job which does not require you to be BE (and remember, that many insurance companies are now requiring you to be BE as are many hospital credentialing boards), then you do not have to repeat a residency here in the US. But for all intent and purposes, most find that it is very difficult to do (ie, find a job) without the US training.

Finally, Puerto Rico is a US territory and as such, many of its schools are ACGME accredited, as are many of the Canadian programs. For graduates of these, they are treated as if they were trained in the mainland 48 states. You've mentioned Israel in a couple of posts; while Sackler and Ben Gurion students have obtained residencies in the US, they are still considered foreign medical grads and as such, subject to ECFMG certification and the same requirements for BE as if they had trained anywhere else outside of the US and Canada.

As always, the best advice is to train in the country where you want to work...if you want to be a surgeon in the US, do your residency here. If you wish to stay in the EU, then train there.

For further information, go to the American Board of Surgery site: http://www.absurgery.org

 

[Blade28]

KC, we need to put this in the FAQ. 🙂

 

[Winged Scapula]

You're probably right...I know both you and I've answered this question multiple times. I was just too lazy to look for the threads.

 

[amc123]

The Student BMJ (studentbmj.com) publishes articles on this regularly. Here is one from August 2003, volume 11, p 282: "Training in the United States."
student.bmj.com/issues/03/08/careers/282.php

 

[core0]

snip
So, the short answer is that if you can obtain a US medical license and find a job which does not require you to be BE (and remember, that many insurance companies are now requiring you to be BE as are many hospital credentialing boards), then you do not have to repeat a residency here in the US. But for all intent and purposes, most find that it is very difficult to do (ie, find a job) without the US training.

I know that I am cutting out a lot of stuff, but besides being BC/BE don't most states require either a year of internship or a residency to even get a post graduate license? I was under the impression that pretty much everyone who was not a US/Canadian grad had to complete a residency with the special physician exception.

David Carpenter, PA-C

 

[Winged Scapula]

I know that I am cutting out a lot of stuff, but besides being BC/BE don't most states require either a year of internship or a residency to even get a post graduate license? I was under the impression that pretty much everyone who was not a US/Canadian grad had to complete a residency with the special physician exception.

David Carpenter, PA-C

Yes, in most states, you have do a year or more of post-graduate training to be eligible for a license.

However, this requirement can be waived in the case of:

1) "international expert in field" (rare reason)
2) no clinical duties, ie, only research

In all cases, its best to check with the state licensing body where you will be practicing to see if they will give you a license without having had US or Canadian residency training. Thanks for bringing that up as I did forget to include it in my answer above.

 

[core0]

Yes, in most states, you have do a year or more of post-graduate training to be eligible for a license.

However, this requirement can be waived in the case of:

1) "international expert in field" (rare reason)
2) no clinical duties, ie, only research

In all cases, its best to check with the state licensing body where you will be practicing to see if they will give you a license without having had US or Canadian residency training. Thanks for bringing that up as I did forget to include it in my answer above.

I have always wondered about this. I worked with a physician that was a pediatric surgeon in Europe but chose an anesthesiology residency in the states. Is there anything to prevent someone from going back into say pediatric surgery once they get their US license. I know that there are tremendous bureaucratic problems with this (BC/BE insurance etc). But from a credentialling standpoint they would have a case log (a bit dated to be sure) that shows they are qualified. Also if I am not mistaken US licenses are an unrestricted license to practice medicine and surgery so there is no restriction here. Just a thought.

David Carpenter, PA-C

 

[Winged Scapula]

I have always wondered about this. I worked with a physician that was a pediatric surgeon in Europe but chose an anesthesiology residency in the states. Is there anything to prevent someone from going back into say pediatric surgery once they get their US license. I know that there are tremendous bureaucratic problems with this (BC/BE insurance etc). But from a credentialling standpoint they would have a case log (a bit dated to be sure) that shows they are qualified. Also if I am not mistaken US licenses are an unrestricted license to practice medicine and surgery so there is no restriction here. Just a thought.

David Carpenter, PA-C

Well, then it does come down to being BE/BC. Obviously getting the medical license is the first step, but in your case the European Pediatric Surgeon would not be Board Eligible so it would be tough, if not impossible, to find a hospital or insurance companies that would take him on.

Most of the credentialing apps I'm filling out want to see your case logs from the last two years (this is a new requirement, I'm told) so, I'm not sure the above surgeon would be able to provide those. I don't know what they do about people whose case logs are not current.

Since the license is unrestricted he could technically open a private practice and advertise himself as a pediatric surgeon, but it might be hard, as I noted above, to get a hospital to allow him to admit and operate and to get insurance companies to reimburse him for those procedures.

 

[core0]

Well, then it does come down to being BE/BC. Obviously getting the medical license is the first step, but in your case the European Pediatric Surgeon would not be Board Eligible so it would be tough, if not impossible, to find a hospital or insurance companies that would take him on.

Most of the credentialing apps I'm filling out want to see your case logs from the last two years (this is a new requirement, I'm told) so, I'm not sure the above surgeon would be able to provide those. I don't know what they do about people whose case logs are not current.

Since the license is unrestricted he could technically open a private practice and advertise himself as a pediatric surgeon, but it might be hard, as I noted above, to get a hospital to allow him to admit and operate and to get insurance companies to reimburse him for those procedures.

My thought was that if someone really wanted to come to the land of the brave and the home of the big mac they could use this. Obviously you couldn't use this to get on staff at Best Medical Center. But out in the hinterland credentialling and other things are much different.

Now with the change in American Board of Surgery things have changed. However say you have someone that is working in surgery in another country. Get into a FM residency. Use your one month of vacation to go back and keep your hand in. Complete your FM residency. Go to a very small hospital that absolutely can't find a surgeon. Open a surgical practice. I know of one person that did this with anesthesia. Not sure if it was done with surgery. With the American Board of Surgery change it would still be three years either way and doing it through a residency means that you can be board certified. I would be curious if the American Board of Surgery change is in response to this?

David Carpenter, PA-C