Residency Abroad

[FoxTrot12]

Hi All,

OK, I am sure this issue has been addressed before, but I haven't been able to find it, so if this is redundant please point me toward a some of the info...

It is still quite a ways away for me but I was wondering if it is possible to do a residency abroad? What does this mean for getting certified in the US or the country of residency? Pretty much I haven't heard much on this topic and I was just trying to get some basic info. Thanks for any help!!

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[NotAProgDirector]

Training abroad will not count at all towards working in the US. You would end up needing to start at the PGY-1 level regardless of your foreign training. There are few exceptions to this -- usually for people with "exceptional" or unique skills.

You should only train abroad if you plan to practice abroad and not in the US/Canada.

 

[FoxTrot12]

Thanks for the tip! Do these "exceptional, unique" skills include MD/PhDs?

 

[NotAProgDirector]

Thanks for the tip! Do these "exceptional, unique" skills include MD/PhDs?

Not unless your research skills are unique, and even in that case would be difficult. Don't count on an O visa. They are designed for "world experts". I'm sure some clever immigration lawyer has gotten them for a more "run of the mill" person, but it's a longshot.

 

[200984]

Have you heard of an internship done outside the US recognized as a pgy1 in the US?

 

[NotAProgDirector]

Have you heard of an internship done outside the US recognized as a pgy1 in the US?

Some boards will CONSIDER 1 year of credit for 3 years of training outside the US. I would not count on it. You will not get any credit for just an internship outside the US/Canada.

 

[200984]

what do you mean boards? isnt it the job of the acgme to recognize that pgy1?
do u mean the state boards? who should i ask about it?
I have been working as a physician for 3 years after the internship - do you think this will count?

 

[Winged Scapula]

what do you mean boards?

He means the entity that recognizes training and board eligibility. For Surgery, its the American Board of Surgery (ABS), for IM its the American Board of Internal Medicine (ABIM), etc.

isnt it the job of the acgme to recognize that pgy1?

No. While residency programs obviously have requirements from the ACGME that must be met, they also have requirements by the relevant board in regards to scope of training and training requirements. The ACGME is not in the business of telling specialties what they have to train residents in but rather oversee things like work conditions, Core Competencies, requirements for training facilities, faculty, etc.

For example, ABS specifies the number of weeks that must be spent in doing certain surgical areas (core defined specialties) and what training can be accepted. Only this year has the ABS decided that credit *may* be awarded to training obtained abroad and only after you are in a US training program (ie, you cannot start a PGY-2 surgical residency in the US having been given credit for an intern year done abroad. You must start as an intern and you may be given credit somewhere along the line, usually not for the entire year, and it may shorten your training).

The ACGME is not responsible for dictating what is considered Board Eligible. Programs will not accept someone into training who can never be Board Eligible (for certification) therefore it behooves you to know what the Board's stance is on the issue of training abroad.

do u mean the state boards? who should i ask about it?

Google the Board for the relevant specialty and see what their requirements are for training abroad, whether or not credit can be given.

Once you know you may get credit, then it is up to the individual program as to whether or not they offer it to you. Just because the Board says it is allowed does not mean that residency programs have to approve it.

I have been working as a physician for 3 years after the internship - do you think this will count?

No. "Real world" experience is not given credit for GME in the US. You may or may not be given training credit for the intern year (do not expect to get a full year of credit) but as I and aProgDirector noted above, its first up to the relevant specialty board and then to the individual program. I would advise you to go into this expecting to get no credit and having to start from scratch.

 

[shan564]

What if somebody were to do a residency at an American university abroad... like Duke-NUS, Weill Cornell-Qatar, or Harvard Dubai?

 

[NotAProgDirector]

What if somebody were to do a residency at an American university abroad... like Duke-NUS, Weill Cornell-Qatar, or Harvard Dubai?

These are not ACGME accredited programs. They will not count toward US training. They will likely teach you good medicine, and allow you to practice in NUS/Qatar/Dubai, but not the US.

 

[shan564]

If a person does a residency at a reputable international school (i.e. Oxford, Melbourne, etc.), can they usually get academic (non-clinical) positions in the US?

 

[NotAProgDirector]

If a person does a residency at a reputable international school (i.e. Oxford, Melbourne, etc.), can they usually get academic (non-clinical) positions in the US?

Non-clinical academic job = research position, I assume.

In that case, a clinical residency will be of little value. You'd be competing with the MD/PhD's for research spots, better to focus on a research career if this is your planned pathway.

 

[shan564]

Non-clinical academic job = research position, I assume.

In that case, a clinical residency will be of little value. You'd be competing with the MD/PhD's for research spots, better to focus on a research career if this is your planned pathway.

I've run into a lot of professors who don't directly do clinical work, but need a strong clinical background for the kind of research that they do. I guess the bottom line is that I'll have to do my residency in the US.

 

[Winged Scapula]

I've run into a lot of professors who don't directly do clinical work, but need a strong clinical background for the kind of research that they do. I guess the bottom line is that I'll have to do my residency in the US.

I know you've stated that one of your professors at U of Mo states that they have a lot of FMGs and don't look down on training abroad, you have to realize that its hard to speculate/extrapolate that statement to your situation and years in advance. What he/she perceives to be true may not necessarily be (ie, Missouri is not, for most people, a desirable geographic area, and the reason for lots of FMGs there may not be because they don't discriminate against them but because they don't get enough apps from AMGs so HAVE to take FMGs because that's what they can get) and it may not be true at programs elsewhere in the US.

So yes, bottom line is that it is fine to spend a year abroad as an undergrad but do not go to medical school or residency abroad unless you are planning on staying in that country to practice or have no other options.

 

[shan564]

I know you've stated that one of your professors at U of Mo states that they have a lot of FMGs and don't look down on training abroad, you have to realize that its hard to speculate/extrapolate that statement to your situation and years in advance.

Not just any professor, but the residency director.

What he/she perceives to be true may not necessarily be (ie, Missouri is not, for most people, a desirable geographic area, and the reason for lots of FMGs there may not be because they don't discriminate against them but because they don't get enough apps from AMGs so HAVE to take FMGs because that's what they can get) and it may not be true at programs elsewhere in the US.

If you look at the average USMLE scores for FMGs and American graduates, it takes the same score to get into the same residency on average (nationwide). Of course, it is definitely an advantage to go to school here in the US... but I don't think it's as big of a difference as people make it seem. I know scores of FMGs who didn't have much trouble coming here after they scored well on the USMLE.

 

[Winged Scapula]

Not just any professor, but the residency director.

Thank you for the correction, but it doesn't affect my comment above either way.

If you look at the average USMLE scores for FMGs and American graduates, it takes the same score to get into the same residency on average (nationwide). Of course, it is definitely an advantage to go to school here in the US... but I don't think it's as big of a difference as people make it seem. I know scores of FMGs who didn't have much trouble coming here after they scored well on the USMLE.

And for every FMG you can show me who found a US position, I can show you one who couldn't.

I appreciate that from your vantage point its not a disadvantage to train abroad, but considering that I did go to school outside the US and I have many years of experience as a resident, fellow and now attending in the US, I'll venture that I have a tad more insider knowledge about this than you, your "scores" of FMGs or your PD.

If you have to do residency abroad, that's fine, but its foolish to assume that you might not face stigma or have trouble matching. All you need to do is spend about 5 minutes reading SDN and see lots of FMGs and IMGs who fail to match year after year, despite being told that it was "no problem". The US has been inundated with trainees from the UK, and the competition is getting more fierce with no plans to increase the number of positions any time in the near future.

 

[NotAProgDirector]

I have a serious question. I'm not interested in working or living in the United States (I mean this sincerely). I attend a US medical school but am interested in doing residency and then practicing abroad. This is both for personal reasons and also because of my choosen residency/subspeciality (ID). I've already lived/worked abroad (in Asia, Africa, etc.) and would like to pursue that in my career. Thus, there's actually no point whatsoever in completing residency in the US, except that perhaps it's treated prestigiously by other countries (except that actually other countries I'm considering working/living in like China, Japan, Korea, Singapore, Scandinavia, Australia, etc. may not accept US residents the same way US does not accept foreign residencies). So I'm wondering how one goes about applying to a residency program in, say, Singapore or Hong Kong. They obviously have residency programs, and the US even has a medical school in Singapore (Duke-NUS), so how does an American MD grad apply to one of those programs? Thanks.

There's no easy answer. It will be different for every country. You will need a work visa also. Most countries give first priority to their own graduates, so you may get what's "left over".

Remember that this decision is irreversible. Working overseas may look like fun now, but you will be unable to work in the US as a physician in the future unless the rules change, and I wouldn't count on that.

 

[Dr.Millisevert]

Another option would of course be specialty programs in Australia and New Zealand.

Specialty training in Australia/NZ is accepted in Canada, and many US ABMS specialty boards accept graduates of Australian and New Zealand training programs to be "board eligible".

Even Canadians have problems in some areas of the states though. Example.

In general though... outside the US the only countries that have programs that considered generally equivalent to US programs are in Canada, Australia, and New Zealand.

 

[killakiran]

I wanted to know the validity of the claim from some who say that those who have finished a DNB in India, can still come to the USA and forego base residency training and go straight to a fellowship program. For example, if you did MBBS and an internal medicine residency in India, that you could conceivably just do USMLE Steps 1-3 and come straight to the US for a cardiology fellowship. Is that true? From reading above seems this seems far fetched.

 

[Winged Scapula]

I wanted to know the validity of the claim from some who say that those who have finished a DNB in India, can still come to the USA and forego base residency training and go straight to a fellowship program. For example, if you did MBBS and an internal medicine residency in India, that you could conceivably just do USMLE Steps 1-3 and come straight to the US for a cardiology fellowship. Is that true? From reading above seems this seems far fetched.

It depends on the program. If they require that you graduate from an ACGME accredited IM residency, then you are not eligible. Since Cardiology is a competitive fellowship, they are probably less likely to waive this requirement. Less popular fellowships may not have these requirements.

 

[NotAProgDirector]

I wanted to know the validity of the claim from some who say that those who have finished a DNB in India, can still come to the USA and forego base residency training and go straight to a fellowship program. For example, if you did MBBS and an internal medicine residency in India, that you could conceivably just do USMLE Steps 1-3 and come straight to the US for a cardiology fellowship. Is that true? From reading above seems this seems far fetched.

You will not be eligible for the Cardiology Boards unless you are ABIM board certified, which means you'd need a full medicine residency first. So, I'd say that this almost never happens, and even if it did you'd have severe trouble practicing afterwards. Perhaps if you were internationally famous first this might be waived, but other than that the answer to your question is never.

 

[Domperidon]

I wanted to know the validity of the claim from some who say that those who have finished a DNB in India, can still come to the USA and forego base residency training and go straight to a fellowship program. For example, if you did MBBS and an internal medicine residency in India, that you could conceivably just do USMLE Steps 1-3 and come straight to the US for a cardiology fellowship. Is that true? From reading above seems this seems far fetched.

I hear this often happens in rads...they come here to do a fellowship, then they work in that same department (as assistant prof?) for a number of years (4 i believe) and that's it, they are eligible to sit for the board exam, without having to repeat the whole radiology residency. But it's the only specialty I know of that has it theorized. You should look for this on the boards web pages.

 

[dmh15]

These are not ACGME accredited programs. They will not count toward US training. They will likely teach you good medicine, and allow you to practice in NUS/Qatar/Dubai, but not the US.

Dr, please check your inbox.

 

[priyaaaaaaa]

so reading through this thread I am a little confused. i'm Australian and plan to go medschool and do my residency in Australia. Would I be eligible for registration in the States? If no, why not? Thx

 

[gyngyn]

so reading through this thread I am a little confused. i'm Australian and plan to go medschool and do my residency in Australia. Would I be eligible for registration in the States? If no, why not? Thx

To practice in the US, one must do a residency in the US.
You can find outcomes for IMG's here: http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

 

[Mad Jack]

so reading through this thread I am a little confused. i'm Australian and plan to go medschool and do my residency in Australia. Would I be eligible for registration in the States? If no, why not? Thx

To practice in the US, one must do a residency in the US.
You can find outcomes for IMG's here: http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

There are a few exceptions to the rules, mostly in family medicine
ABFM | Reciprocity Agreements

 

[Mad Jack]

One quirk of this, however, is that you will still have to meet state licensing requirements, so you could be boarded in FM after completing a residency in Australia, but in most states you would need between one and three years of graduate medical education.

 

[Mad Jack]

FSMB | State-Specific Requirements for Initial Medical Licensure