IMG, Board Cert and Residency Questions

[docB]

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Hey guys. I was asked to post this for someone who would prefer to stay anonymous. We were discussing this via PM but hese questions are all way over my head. This student could use some quality answers. Please try to help them out. And don't hold it against them that the post reads like a Mad Libs story, that's my fault because of how I edited it.

Thanks everyone!

Hi DocB,

Thanks in advance for taking the time to answer these nuances, which I am sure you have been asked many times.

I'm a final year student at [US Institution Affiliated Medical School] in [a foreign country] (US School-affiliated, but still IMG). It looks like my chances of matching in the US are low - I am couples matching with a US citizen who is applying for Ortho. We only have 1 overlapping city which is [US City]. My backup is do to my residency here in [Foreign Country] in Internal Medicine. Whew, hard part over. Ok, so:

1. I plan to join my Significant Other in the US after I complete my residency here and do a fellowship. Question is, can I stay on in the US to practice?

-Sounds like I can get a state license to practice, but I can NEVER be Board Certified since I did not do my residency in the US.
- If I am employed by a big academic hospital, without a Board Certification, what are my limitations? What are the Delineation of Privileges that you talked about?

2. Will big academic hospitals employ me anyway even if I am NOT board certified?

3. If I do a Oncology/ID/Pulm fellowship in the US, how competitive is this and will I be able to take the Board Subspecialty exam? Will insurance cover my practice in the subspecialty without me being eligible for the General Internal Medicine Board Exam in the first place? We plan to get married next year so I will be a U.S. citizen by then.

REALLY SORRY for all the questions! But you sound like our go-to guy right now.. Thanks in advance and I really appreciate all the help. 🙂

 

[luCZky]

So you're telling me that they are willing to match into residency overseas (he) + US (SO) but they are not willing to match let say US east cost (he) + US west coast (SO), right? That they really believe that matching into overlapping fellowships will be easier with overseas+US residency instead of US+US residencies, right? That they really believe that anyone can tell them what the legislation will be in let say 6 or 7 or more years from now? I'm sorry I can't answer these questions but no one other can. They can change the rules in few weeks and then he may not be able to practice in the US ever so what's the added value of knowing how the situation looks like now? There can be only one advice.. if you want to live and practice in the US damn.. took whatever residency in the US that you can no matter where it is... there is no other safe way..

 

[hrandani]

You can't practice medicine independently at any level in the United States without doing graduate medical education here, in the United States.

There's been a few exceptions made, but they were for like, nobel prize winners.

 

[shiftingmirage]

1. I plan to join my Significant Other in the US after I complete my residency here and do a fellowship. Question is, can I stay on in the US to practice?
"-Sounds like I can get a state license to practice, but I can NEVER be Board Certified since I did not do my residency in the US."

Most states require IMG/FMG to complete 2-3 years of US training for a medical license. http://www.fsmb.org/usmle_eliinitial.html
Licensing is done at the state level so some states are more lenient than others. I believe some states will accept GME training completed at Canadian programs, but that is the only country I am aware of that they honor, and I'm not even sure that's every state.
Some states specify residency, while others just say training. I've heard stories, no first hand knowledge, of individuals who completed a fellowhsip in the US and applying that to the 2-3 year requirement and getting a license, but again, just rumors.

 

[Ronin786]

Unless this person has horrible board scores, I can't imagine doing a residency in a foreign country is going to be better than matching into any IM residency anywhere in the US.

 

[gutonc]

So, the long and short of this is that, the plan as it stands is a horrible idea. I agree with others that it's kind of ridiculous to be willing to do residency an ocean or two away but not an hour or two away from the SO. The chances of the OP matching somewhere in the US if s/he applies broadly enough is slightly >50% (I don't have the IM stats on hand but the overall IMG match rate is slightly north of 50% so let's just call it that). The chances of getting a fellowship in the US after completing a foreign IM residency is in the low single digit % and might actually come with a leading decimal point.

As for who will hire the OP if s/he does manage to get one of these unicorn fellowships, the answer is most likely NOT going to be a "big academic medical center" unless s/he is also a research superstar (like, 2 R01s and a couple of Nature/NEJM papers superstar). In fact, it's going to be hard to get hired at all, by any sizable group in any specialty since, most (?) contracts specify that you must be BC/BE which the OP will never be.

So the answer is that the OP needs to apply extensively in the US and take what s/he can get and move up from there.

If the OP would like to PM me I would be happy to answer further questions. Since this is an IM specific question, aPD might bee a good source as well.

 

[Raryn]

You can't practice medicine independently at any level in the United States without doing graduate medical education here, in the United States.

There's been a few exceptions made, but they were for like, nobel prize winners.

Several of the boards do have exemptions for people who didn't do residency here. But they're quite limited and require you to do an equivalent number of years of training here (4 years of radiology fellowships for example, to make up for the 4 years of residency you didn't do.)

As another example, I know a foreign trained orthopod now practicing in the states. He had to do 5 years worth of fellowships in the states (so 3 or 4 fellowships), then get a job at an academic medical center. After a certain number of years, the american board of orthopedics allows someone like that to take the exam. But that was all predicated on him getting into and completing those fellowships.

 

[gutonc]

I should point out also that many states have "foreign scholar" exemptions that allow academic centers to employ foreign trained docs who would otherwise be ineligible for licensure. This has been a back door (again, for superstars or people with connections) for IMGs to practice in the US. But, while I can't speak for other states, the Medical Board in my state recently put a 5 year limit on this pathway after which you must have completed all of the Steps and have the residency/fellowship program(s) at your institution testify that you're essentially board eligible material.

Just another reason to do it "right".

 

[BlondeDocteur]

It sounds like the country in question is Israel and the institution is either Sackler or Ben Gurion. The OP cannot obtain a medical license in any US state without completing at least 2-3 years of US GME. This is different from the requirements for US grads which are more lenient.

Her plan is dead in the water-- no license, no shot at privileges (no shot at privileges anyway without being BE/BC basically everywhere in the US now. Gone are the days of the GP being able to admit patients with his 1 year of internship under his belt).

The rules governing fellowships are different-- she can complete a fellowship (if she's admitted to one) but still can't practice that specialty here in the US without a license, and she won't be board-eligible for the subspecialty without the primary boards. Please correct me if I'm wrong but I think radiology is the only specialty where that's possible, right?

She's likely a US citizen. As others have said, she should just do it right-- if her boyfriend matches first, try to follow him and do research, etc until she can re-apply. Or delay graduation for a few more months of USCE.

 

[Raryn]

The rules governing fellowships are different-- she can complete a fellowship (if she's admitted to one) but still can't practice that specialty here in the US without a license, and she won't be board-eligible for the subspecialty without the primary boards. Please correct me if I'm wrong but I think radiology is the only specialty where that's possible, right?

A lot of the states will allow her to get a license as long as she has 2-3 years of post-graduate training (1 in WI or GA) AND passes step 1-3. So the fellowships will count for that. It doesn't necessarily have to be the PGY1-3 years that she does in the states.

But that assumes she can get into the fellowship(s). And it doesn't answer the BE/BC question.

 

[BlondeDocteur]

Oh sorry, I stand corrected. Thanks.

 

[K31]

It sounds like the country in question is Israel and the institution is either Sackler or Ben Gurion. The OP cannot obtain a medical license in any US state without completing at least 2-3 years of US GME. This is different from the requirements for US grads which are more lenient.

There are a few other possibilities too--the Cornell/Qatar and Duke/Singapore programs come to mind. But any way you cut it, still an IMG and subject to those licensing requirements.

 

[GasProspect]

IMG's can also apply for Green Card status sponsored by programs in underserved areas. I was on the interview trail with an Anes attending who practiced for numerous years in the midwest before deciding to pursue residency. It is possible but only if you're not picky.

 

[BlondeDocteur]

K31, have those programs graduated anyone yet?

 

[Winged Scapula]

There are a few other possibilities too--the Cornell/Qatar and Duke/Singapore programs come to mind. But any way you cut it, still an IMG and subject to those licensing requirements.

It also could be University of Queensland - Ochsner.

 

[luCZky]

IMG's can also apply for Green Card status sponsored by programs in underserved areas. I was on the interview trail with an Anes attending who practiced for numerous years in the midwest before deciding to pursue residency. It is possible but only if you're not picky.

Visa issues are absolutely different story. It doesn't matter what is his residency/visa status and he can get visa/GC by much more ways than the one you described. And beside that.. he will get a GC through marriage so it doesn't matter at all for him. With his GC he will be able to work wherever he wants and whatever he wants but he will not be able to be a physician b/c he will be ineligible for state license... that is the only thing which matters.. eligible/not eligible for state board license... nothing else.

 

[NotAProgDirector]

Don't forget that the ACGME recently decided that in order to qualify for an ACGME fellowship, all prior training must be ACGME. This means that the prior pathway where IMG's could do a basic residency in their home country and then come to the US for fellowship no longer exists starting in 2016. This rule was probably instrumental in bringing the AOA together with the ACGME (since it blocked AOA residents from ACGME fellowships), but it blocks IMG's as well. Unless the international program is ACGME-I.

Agree with everyone else here about the OP's issue. They should both do residencies in the US if they plan to practice here. If one plans to stay in their home country, then they will be seperated for several years anyway.

 

[rokshana]

what's an ACGME-I?

 

[NotAProgDirector]

http://www.acgme-i.org/web/index.html

 

[silver27]

so , i don´t know if this has been asked previously, i searched and i don´t seem to find accurate information, if i graduate from medical school outside the us and i want to be a cardiologist and i want to study cardiology in the us, what do i have to do ? i have already done residency in another country do i do it again ? what tests do i have to take in order for the medical school degree to be certified?
Thanks for the answers

 

[GasProspect]

Visa issues are absolutely different story. It doesn't matter what is his residency/visa status and he can get visa/GC by much more ways than the one you described. And beside that.. he will get a GC through marriage so it doesn't matter at all for him. With his GC he will be able to work wherever he wants and whatever he wants but he will not be able to be a physician b/c he will be ineligible for state license... that is the only thing which matters.. eligible/not eligible for state board license... nothing else.

If you read the quote thoroughly you would have seen where I said he was practicing already.

 

[IMPD]

Don't forget that the ACGME recently decided that in order to qualify for an ACGME fellowship, all prior training must be ACGME. This means that the prior pathway where IMG's could do a basic residency in their home country and then come to the US for fellowship no longer exists starting in 2016. This rule was probably instrumental in bringing the AOA together with the ACGME (since it blocked AOA residents from ACGME fellowships), but it blocks IMG's as well. Unless the international program is ACGME-I.

Agree with everyone else here about the OP's issue. They should both do residencies in the US if they plan to practice here. If one plans to stay in their home country, then they will be seperated for several years anyway.

I sat in on a discussion of this rule with the RRC (Resident Review Committee) for Internal Medicine last fall. It was fascinating to hear them explain this rule to a room full of IMPDs who had varied interests. The "exception" rule remains for what the RRC called "sub-sub-specialty" training. That is, if a training program has a procedure that they desire to teach to a superstar (usually an early-career attending) from a non-ACGME program, they can still bring that person into their fellowship. This exception rule is not designed or intended to apply to anyone else.

I totally agree with the role this rule played in the ACGME-AOA merger. Although the first rule of Fight Club is that you don't talk about Fight Club, the tandem moves by the AAMC to increase medical school graduation and the ACGME to shut the door on non-ACGME trained folks looks like a vision to create a more uniform experience (or exclusionary) for US medicine.

As a side note, the ABIM does (did?) offer an expidited training track for those with experience. We did this a few years ago (previous PD). Not sure what the current status of this is.

 

[luCZky]

If you read the quote thoroughly you would have seen where I said he was practicing already.

If you read the thread thoroughly you would have seen that this is not a visa issue but licensing issue. And you would find out that starting next year he is loosing possibility even to get any GME for licensing. It doesn't matter that anyone was able to do that before b/c it does't mean that anyone will be able to do that too anymore. You're post is not helping but harming...

 

[NotAProgDirector]

so , i don´t know if this has been asked previously, i searched and i don´t seem to find accurate information, if i graduate from medical school outside the us and i want to be a cardiologist and i want to study cardiology in the us, what do i have to do ? i have already done residency in another country do i do it again ? what tests do i have to take in order for the medical school degree to be certified?
Thanks for the answers

It's been asked a zillion times, but I'll answer it again:

1. You need to become ECFMG certified. To do so, you need to take USMLE Step 1, Step 2CK, and Step 2CS. Your medical school needs to be listed in IMED/FAIMER. Once you complete the application process, you'll get your ECFMG certificate.
2. You then will need to apply for an IM residency. You will get no credit for any prior training you have done, you will need to start from the beginning. IM Residency is 3 years. You will need good USMLE scores, and preferably some US experience to get a position. You will also need some sort of work visa if you're not a US citizen / legal immigrant.
3. You then would need to apply for a Cardiology fellowship. These are competitive, and whether or not you can get one will depend upon all of the above (where you do your residency, USMLE scores, etc) plus research experiences during and prior to residency plus cardiology experience. Cardiology fellowships are 3 years long.

Bottom line is that this is a long pathway, and there are no guarantees at any step.

Start here: http://www.ecfmg.org/forms/certfact.pdf

 

[rokshana]

http://www.acgme-i.org/web/index.html

thanks! i had no idea about this…interesting that they are in the countries (Qatar, UAE, and Singapore) that have US satellite medical schools…