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This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I had to move from Britain to the US for family reasons, and spent 2 years researching the pathway of least resistance. I could not find reliable information to guide me. It was very stressful and time consuming, and I hope no one has to go through what I endured.

This post summarizes my experience and recommendations. I did this myself and talked to a few others who did it also.

*** First of sort your immigration situation; whether a visa, green card, or other. At least have a plan ready because you will need this when you apply for a state license or board certification.

*** You need to have completed at least 3 years of residency training in the UK, New Zeeland, Australia, or Ireland. You need to have proof of completion of training (CCT if from the UK).

*** Do ECFMG primary source verification and take all USMLEs.
  • I used UWorld Qbank only and cleared all of them in 6 months.
  • You just need to pass, no need to score high.
  • For Step 2CS, I recommend Ximedus workshop in Florida to orient you about the exam.
  • It does not matter where you did medical school as long as ECFMG is OK with it (I know doctors who did medical school in Africa and residency in the UK, and were able to peruse this pathway successfully/practice in the US).

*** Apply for a state license without US-residency training (Maine or Oklahoma): this is the bottle neck!
  • These 2 states accept your non-US residency training as a waiver for US-residency training requirement.
  • For UK and Ireland trained doctors I recommend Maine (took me 3 months to get my license). Everyone else have no other choice but Oklahoma.
  • Make sure that you are within 2 years of clinical practice, preferably within 1 year. If needed, you can go back home and practice for a few months to restart the 2 year licensing requirement.
  • For Maine, FCVS will verify your UK training. Make sure to provide them with the contact info for your program once you submit your application (this is a must, although they do not ask you for it). Follow up with FCVS aggressively. For UK training: FCVS does not verify foundation years, only core training in your specialty.
  • You do not need a DEA number for Maine application purposes.
  • You MUST get FCVS.

*** Once you have a state license, you can practice in that state. I talked to a cardiologist and a surgeon who are practicing without board certification in Maine. Your options of employment are community hospitals and private practices. Academic centers require American Board certification. Without board certification, you will do some extra paperwork with insurance companies and have to get letters from your chairman, but it will be fine in the end.


*** I recommend doing a 1 year fellowship before practicing solo:
  • This is OPTIONAL. Some people did not do this and they feel perfectly fine practicing in the US.
  • The science is the same but logistics are different between systems.
  • ACGME accredited fellowships can take you although you did not finish an ACGME-accredited residency in most cases (at the discretion of program director).
  • You will be using a training state license while during fellowship, not a full license.
  • For family medicine or internal medicine getting a geriatrics fellowship is easy (all geriatrics fellowships are ACGME accredited). Refer to ACGME fellowship-specific manual if you need to know which fellowship programs take non-ACGME trained applicants.
  • I will be doing a 1 year ACGME-accredited fellowship this summer to orient myself before practicing solo. I applied broadly and got multiple offers.
  • ACGME accredited fellowships help you get licenses in other states. Some states require 2 years of ACGME accredited training (residency or fellowship). Other states require 3 years.
  • Non-ACGME fellowships are not worth it in my opinion.

*** Get Board Certified:
  • This will open doors for employment.
  • This will make all insurance companies accept you as a provider, no questions asked or extra paperwork needed.
  • This will open licensing in many other states. Some states waive US-residency training requirement if you are US-board certified.
  • American Board of Family Medicine has a reciprocity agreement. American Board of Internal Medicine has an alternative certification pathway. American Board of Radiology has an IMG pathway. Other boards may have pathways for you to get certified based on your overseas qualifications/training or cumulative practice in the US after a while. Please contact specific boards for info. Be patient and read the fine print on their websites. Many customer service operators might not even know about it as this is not common. Dig deep and be meticulous.
  • On my end, I am a GP. I applied for the American Board of Family Medicine Reciprocity Agreement pathway. I took the ABFM certifying test and I am now ABFM certified!
  • I talked to internists who got certified via the alternative pathway of the ABIM.

*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.
  • Once you become Board Certified, this will open other states for you. You need to read the fine print for state licensure application instructions. Current states that accept ABFM as a waiver for US residency training are CT, GA, OR, TN, NC, NV and a few others.
  • Michigan has reciprocity if you practiced in any other state for 3 years.
  • After becoming Board Certified, I advise getting a job in a teaching hospital (community or academic). All other state accept working as a faculty training residents for 3 years as a waiver for US residency training requirement.

I hope my post enlightens your path and spare you the hassle.

Good luck everyone!
 
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Hey, Spartacus thanks for the really detailed response. I am happy you broke the ice finally for the US. So happy for you. One thing of course that was on my mind was about the visa. I see you mentioned that you already have a visa. What about those without a green card? How to go about that barrier?
 
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Hey, Spartacus thanks for the really detailed response. I am happy you broke the ice finally for the US. So happy for you. One thing of course that was on my mind was about the visa. I see you mentioned that you already have a visa. What about those without a green card? How to go about that barrier?
I am on a family based green card. I do not have any information about immigration and visas.
 
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So when I discussed this with the person at abfm they mentioned that it aint a requirement for the exam. You mention that it is needed at the time of certification. Can you elaborate? Can it not be done at the time with a visit visa?
 
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So when I discussed this with the person at abfm they mentioned that it aint a requirement for the exam. You mention that it is needed at the time of certification. Can you elaborate? Can it not be done at the time with a visit visa?
Needed for state license. Have no info about visa or immigration. Sorry
 
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I would try to contact the boards as well though. Since many img doctors are without a green card and they do start to work as attendings or hospitalists
 

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*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.


Good luck everyone!

Great post.

Please add an asterisk or additional info to this point that working for the VA requires federal clearance, and as such these jobs are open to US Citizens only (there are rare instances that they'll take non-citizen, LPRs as I have a friend who did), but majority will get filtered out. So if you're on a visa (which I can't see how you'd be on?), the VA is not an option.
 

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It would be interesting in knowing if UK dermatologists can practice in US without further training...or if the American Board of Dermatologists can accept that like the other boards.
 
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This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I had to move from Britain to the US for family reasons, and spent 2 years researching the pathway of least resistance. I could not find reliable information to guide me. It was very stressful and time consuming, and I hope no one has to go through what I endured.

This post summarizes my experience and recommendations. I did this myself and talked to a few others who did it also.

*** First of sort your immigration situation; whether a visa, green card, or other. At least have a plan ready because you will need this when you apply for a state license or board certification.

*** You need to have completed at least 3 years of residency training in the UK, New Zeeland, Australia, or Ireland. You need to have proof of completion of training (CCT if from the UK).

*** Do ECFMG primary source verification and take all USMLEs.
  • I used UWorld Qbank only and cleared all of them in 6 months.
  • You just need to pass, no need to score high.
  • For Step 2CS, I recommend Ximedus workshop in Florida to orient you about the exam.
  • It does not matter where you did medical school as long as ECFMG is OK with it (I know doctors who did medical school in Africa and residency in the UK, and were able to peruse this pathway successfully/practice in the US).

*** Apply for a state license without US-residency training (Maine or Oklahoma): this is the bottle neck!
  • These 2 states accept your non-US residency training as a waiver for US-residency training requirement.
  • For UK and Ireland trained doctors I recommend Maine (took me 3 months to get my license). Everyone else have no other choice but Oklahoma.
  • Make sure that you are within 2 years of clinical practice, preferably within 1 year. If needed, you can go back home and practice for a few months to restart the 2 year licensing requirement.
  • For Maine, FCVS will verify your UK training. Make sure to provide them with the contact info for your program once you submit your application (this is a must, although they do not ask you for it). Follow up with FCVS aggressively. For UK training: FCVS does not verify foundation years, only core training in your specialty.
  • You do not need a DEA number for Maine application purposes.
  • You MUST get FCVS.

*** Once you have a state license, you can practice in that state. I talked to a cardiologist and a surgeon who are practicing without board certification in Maine. Your options of employment are community hospitals and private practices. Academic centers require American Board certification. Without board certification, you will do some extra paperwork with insurance companies and have to get letters from your chairman, but it will be fine in the end.


*** I recommend doing a 1 year fellowship before practicing solo:
  • This is OPTIONAL. Some people did not do this and they feel perfectly fine practicing in the US.
  • The science is the same but logistics are different between systems.
  • ACGME accredited fellowships can take you although you did not finish an ACGME-accredited residency in most cases (at the discretion of program director).
  • You will be using a training state license while during fellowship, not a full license.
  • For family medicine or internal medicine getting a geriatrics fellowship is easy (all geriatrics fellowships are ACGME accredited). Refer to ACGME fellowship-specific manual if you need to know which fellowship programs take non-ACGME trained applicants.
  • I will be doing a 1 year ACGME-accredited fellowship this summer to orient myself before practicing solo. I applied broadly and got multiple offers.
  • ACGME accredited fellowships help you get licenses in other states. Some states require 2 years of ACGME accredited training (residency or fellowship). Other states require 3 years.
  • Non-ACGME fellowships are not worth it in my opinion.

*** Get Board Certified:
  • This will open doors for employment.
  • This will make all insurance companies accept you as a provider, no questions asked or extra paperwork needed.
  • This will open licensing in many other states. Some states waive US-residency training requirement if you are US-board certified.
  • American Board of Family Medicine has a reciprocity agreement. American Board of Internal Medicine has an alternative certification pathway. American Board of Radiology has an IMG pathway. Other boards may have pathways for you to get certified based on your overseas qualifications/training or cumulative practice in the US after a while. Please contact specific boards for info. Be patient and read the fine print on their websites. Many customer service operators might not even know about it as this is not common. Dig deep and be meticulous.
  • On my end, I am a GP. I applied for the American Board of Family Medicine Reciprocity Agreement pathway. Last week I was notified that I have satisfied the requirements and will take my ABFM certifying exam in November 2020!
  • I talked to internists who got certified via the alternative pathway of the ABIM.

*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.
  • Once you become Board Certified, this will open other states for you. You need to read the fine print for state licensure application instructions.
  • Michigan has reciprocity if you practiced in any other state for 3 years.
  • After becoming Board Certified, I advised getting a job in a teaching hospital in Oklahoma or Maine (community or academic). Most other state accept working as a faculty training residents for 3 years as a waiver for US residency training requirement.

I will try to answer any questions you may have. I hope my post enlightens your path and spare you the hassle.

Good luck everyone!


You mention about doing fellowships. So would a 2 fellowships help in recognition to practice in other states considering most of the geriatrics fellowships are one year? Also can you specifiy about where to ask about information related to acgme fellowships and whether they accept british training?
 
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txm88

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Thanks for sharing your journey - very interesting highlighting a non-traditional route.

I found it interesting that some ACGME fellowship programs allow people who have not completed an ACGME residency
-I was wondering how common this was and how program directors view this. I assume that following completion of a ACGME approved fellowship one would able to be able to complete the board exam and hence become certified in that sub-specialty? Hence solving the problem of not being able to be board certified despite having a medical licence of a certain state
 
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txm88

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thanks @braineddetermined i'm actually asking on behalf of a non-radiology colleague who will hopefully finish their training in Aus this year and is considering going overseas for a fellowship
 

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thanks @braineddetermined i'm actually asking on behalf of a non-radiology colleague who will hopefully finish their training in Aus this year and is considering going overseas for a fellowship

Oh, I see. Well if they’re in IM there a few fellowships that always stay open like nephrology, ID, geriatrics, palliative medicine..etc.
 

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Thanks for sharing your journey - very interesting highlighting a non-traditional route.

I found it interesting that some ACGME fellowship programs allow people who have not completed an ACGME residency
-I was wondering how common this was and how program directors view this. I assume that following completion of a ACGME approved fellowship one would able to be able to complete the board exam and hence become certified in that sub-specialty? Hence solving the problem of not being able to be board certified despite having a medical licence of a certain state
For INternal Medicine, you can not take the board exam after completing a fellowship. You must first be ABIM certified, which usually requires completing an IM residency. There is an alternative pathway in IM but it's very complicated -- you need to be sponsored by a Dean/Chair, which means you must be hired at an academic place, which isn't easy if you have no board certification to start with.
 
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@NotAProgDirector

But on their site it isn’t written that you have to be BC...only this:
  • Certification in Internal Medicine from ABIM for certification in a subspecialty.

Here are the requirements for the A pathway


A full-time faculty member at an LCME- or Canadian-accredited medical school, or at an ACGME- or Canadian-accredited residency or fellowship program, who has successfully completed training in internal medicine and/or a subspecialty abroad, may become eligible to achieve ABIM Board Certification in Internal Medicine and/or a subspecialty as a candidate for special consideration.

The candidate may not propose him/herself for consideration in this pathway, but must be proposed by the Chair of the Department of Medicine, or the internal medicine and/or the subspecialty program director at the institution where the candidate holds a current full-time faculty appointment.

Who is Eligible?

Eligible faculty will have:

  • Completed three or more years of verified graduate medical education training in internal medicine and/or a subspecialty abroad.
  • Certification in Internal Medicine from ABIM for certification in a subspecialty.
  • An academic rank of Assistant Professor or higher.
  • A full-time faculty appointment for a minimum of three (3) immediately prior and consecutive years at the same institution.
  • Full-time faculty members are those who supervise and teach trainees (students, residents or fellows) in clinical settings that include direct patient care.
  • The appointment must be at an LCME- or Canadian-accredited medical school or at an ACGME- or Canadian-accredited internal medicine residency or subspecialty fellowship training program.
  • A valid, unrestricted and unchallenged medical license to practice medicine in the United States, its territories or Canada

Link
 
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- Having an unrestricted state license is like having your GMC full registration. Having American Board Certification in a specialty is like having Royal College Membership (ABFM to MRCGP analogy). You can definitely practice medicine with a state license only but your employment options are relatively limited. Getting board certified will give you freedom and flexibility.

- To know which fellowships take IMGs without US residency, use ACGME fellowship-specific manuals. ACGME has a detailed PDF with rules for each fellowship program. Read the fine print please and be patient.
 
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It's theoretically possible, yet practically looks impossible.

You'd need to first get a fellowship position without an IM residency first. This will require approval of the GMEC.

Then, you'd complete the fellowship.

Then, you'd need to be hired by an academic program and work there for three years. So the institution would need to hire you while you are not board certified. Since you're not board certified I don't believe you can supervise residents or fellows, so how's that supposed to work?

So it's possible. I've never actually seen it done.
 
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It's theoretically possible, yet practically looks impossible.

You'd need to first get a fellowship position without an IM residency first. This will require approval of the GMEC.

Then, you'd complete the fellowship.

Then, you'd need to be hired by an academic program and work there for three years. So the institution would need to hire you while you are not board certified. Since you're not board certified I don't believe you can supervise residents or fellows, so how's that supposed to work?

So it's possible. I've never actually seen it done.
It depends on the specialty. For family medicine it is very doable as the ABFM reciprocity board certification process is straight forward once you get a state license. Again, each case is unique and I personally know 6 people who did this successfully.
 

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I've seen it done several times in Anesthesiology as well.

Of course, programs are limited as to how many faculty they can sponsor for alternative board certification with the ABA.

So generally only foreign faculty with significant research output/other accomplishments have a chance to approach said pathway, as the Dept. Chair won't offer it to others.
 
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This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I completed UK medical school in England and finished FY1 to receive full GMC registration. Training as a GP in Germany right now. Does this ruling only affect above named countries which completed training such as CCT in the UK? Would love to know if german FM training is somewhere in there.

PS: Can't direct message you due to settings chosen but would love to exchange some ideas with you.
 
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I completed UK medical school in England and finished FY1 to receive full GMC registration. Training as a GP in Germany right now. Does this ruling only affect above named countries which completed training such as CCT in the UK? Would love to know if german FM training is somewhere in there.

PS: Can't direct message you due to settings chosen but would love to exchange some ideas with you.
German training is not recognized in the US. Sorry.
 
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I was wondering about the average salaries for family physicians in the US? Is it true that they are one of the lowest paid in the US?
 

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I was wondering about the average salaries for family physicians in the US? Is it true that they are one of the lowest paid in the US?

I think these 2 threads can help as well


 
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This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I had to move from Britain to the US for family reasons, and spent 2 years researching the pathway of least resistance. I could not find reliable information to guide me. It was very stressful and time consuming, and I hope no one has to go through what I endured.

This post summarizes my experience and recommendations. I did this myself and talked to a few others who did it also.

*** First of sort your immigration situation; whether a visa, green card, or other. At least have a plan ready because you will need this when you apply for a state license or board certification.

*** You need to have completed at least 3 years of residency training in the UK, New Zeeland, Australia, or Ireland. You need to have proof of completion of training (CCT if from the UK).

*** Do ECFMG primary source verification and take all USMLEs.
  • I used UWorld Qbank only and cleared all of them in 6 months.
  • You just need to pass, no need to score high.
  • For Step 2CS, I recommend Ximedus workshop in Florida to orient you about the exam.
  • It does not matter where you did medical school as long as ECFMG is OK with it (I know doctors who did medical school in Africa and residency in the UK, and were able to peruse this pathway successfully/practice in the US).

*** Apply for a state license without US-residency training (Maine or Oklahoma): this is the bottle neck!
  • These 2 states accept your non-US residency training as a waiver for US-residency training requirement.
  • For UK and Ireland trained doctors I recommend Maine (took me 3 months to get my license). Everyone else have no other choice but Oklahoma.
  • Make sure that you are within 2 years of clinical practice, preferably within 1 year. If needed, you can go back home and practice for a few months to restart the 2 year licensing requirement.
  • For Maine, FCVS will verify your UK training. Make sure to provide them with the contact info for your program once you submit your application (this is a must, although they do not ask you for it). Follow up with FCVS aggressively. For UK training: FCVS does not verify foundation years, only core training in your specialty.
  • You do not need a DEA number for Maine application purposes.
  • You MUST get FCVS.

*** Once you have a state license, you can practice in that state. I talked to a cardiologist and a surgeon who are practicing without board certification in Maine. Your options of employment are community hospitals and private practices. Academic centers require American Board certification. Without board certification, you will do some extra paperwork with insurance companies and have to get letters from your chairman, but it will be fine in the end.


*** I recommend doing a 1 year fellowship before practicing solo:
  • This is OPTIONAL. Some people did not do this and they feel perfectly fine practicing in the US.
  • The science is the same but logistics are different between systems.
  • ACGME accredited fellowships can take you although you did not finish an ACGME-accredited residency in most cases (at the discretion of program director).
  • You will be using a training state license while during fellowship, not a full license.
  • For family medicine or internal medicine getting a geriatrics fellowship is easy (all geriatrics fellowships are ACGME accredited). Refer to ACGME fellowship-specific manual if you need to know which fellowship programs take non-ACGME trained applicants.
  • I will be doing a 1 year ACGME-accredited fellowship this summer to orient myself before practicing solo. I applied broadly and got multiple offers.
  • ACGME accredited fellowships help you get licenses in other states. Some states require 2 years of ACGME accredited training (residency or fellowship). Other states require 3 years.
  • Non-ACGME fellowships are not worth it in my opinion.

*** Get Board Certified:
  • This will open doors for employment.
  • This will make all insurance companies accept you as a provider, no questions asked or extra paperwork needed.
  • This will open licensing in many other states. Some states waive US-residency training requirement if you are US-board certified.
  • American Board of Family Medicine has a reciprocity agreement. American Board of Internal Medicine has an alternative certification pathway. American Board of Radiology has an IMG pathway. Other boards may have pathways for you to get certified based on your overseas qualifications/training or cumulative practice in the US after a while. Please contact specific boards for info. Be patient and read the fine print on their websites. Many customer service operators might not even know about it as this is not common. Dig deep and be meticulous.
  • On my end, I am a GP. I applied for the American Board of Family Medicine Reciprocity Agreement pathway. Last week I was notified that I have satisfied the requirements and will take my ABFM certifying exam in November 2020!
  • I talked to internists who got certified via the alternative pathway of the ABIM.

*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.
  • Once you become Board Certified, this will open other states for you. You need to read the fine print for state licensure application instructions.
  • Michigan has reciprocity if you practiced in any other state for 3 years.
  • After becoming Board Certified, I advised getting a job in a teaching hospital in Oklahoma or Maine (community or academic). Most other state accept working as a faculty training residents for 3 years as a waiver for US residency training requirement.

I hope my post enlightens your path and spare you the hassle.

Good luck everyone!

Correct me if I'm wrong but if an IMG has no greencard, the only way to apply for a ACGME-fellowship is via a J1 Visa, as almost no hospitals support fellowships on H1B visas. The J1 visa stipulates that without a waiver you must return to your home country for 2 years, before you can return to the US to work on a H1B Visa. Therefore, is is probably advisable to start practising on a H1B with a state license in either Maine/Oklamoha/North Dakota before starting an ACGME Fellowship and wait until one has earned the employment based greencard. However, an Indian or chinese national will have significant issues, due to greencard waiting times, to receive an employment based greencard.

The alternative option is to do an ACGME Fellowship on a J1 Visa and apply to a J1-waiver such as the Conrad-30 J-1 waiver program, which obligates (for a few years) you to work in an underserved area in that specific state you did your fellowship in. But here you have to be careful that you will qualify for licensing in the state following your fellowship. For example: Some states require 2 or 3 years US based residency/fellowship training before a state license can be issued. Even though you can apply for the J1 wisa waiver through the Conrad 30 program in that one state, your visa home requirements will be waived for this state but you will not be able to practise in that state as you are not fulfilling licensing requirements. I believe there is no way to do fellowship in one state and apply to a J1 waiver program in another state. Also, if you are not a FM or IM trained physician, you will have increased difficulty for fulfilling J1 visa waiver requirements as primary care docs are usually most needed in underserved areas.

Once you have earned an employment based greencard, you could apply to a ACGME-Fellowship and earn state licensure across other states that have the US based residency/fellowship training requirement. In these cases, doing an ACGME Fellowship to get to know the american system makes little sense, as you will most likely have already practised for at least a year in the country. I wonder if in those cases it makes sense, other than personal reasons, to do a ACGME Fellowship at all.

You could just get board certified (if reciprocity agreement exists in that speciality) in one of the states you can get a state license in (Oklahoma/Maine/North Dakota) and then work in a teaching hospital as faculty for 3 years. As I understand this way you fulfill the waiver requirement for US based residency training to work in most other states, without needing to have done an ACGME-Fellowship.

Did I get it right?

In my case as a GP trainee in Germany but UK graduate with full GMC registration, I do not qualify for this pathway. Since I'm at the beginning of my training, I'm going to give the USMLEs 1/2CK/2CS/3 and the match cycle for 2022 a shot. As US residency would start in 07/2022, I'm actually applying to GPST now (FM training in the UK) and I'm hoping to start GPST training at the beginning of 08/2021, which means I have time until 08/2021 for all USMLE exams, US clinical experience, the UK SRA exam/Selection centre exam. If I match into the US system for 2022, I can resign my UK post after working close to 12 months. If I dont match, I can try my luck in ST2 and ST3 again, although at this point it would make more sense to do MRCGP, earn CCT and follow Spartacus above described pathway = State licensing, board certification and employment in the US.
 
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Correct me if I'm wrong but if an IMG has no greencard, the only way to apply for a ACGME-fellowship is via a J1 Visa, as almost no hospitals support fellowships on H1B visas. The J1 visa stipulates that without a waiver you must return to your home country for 2 years, before you can return to the US to work on a H1B Visa. Therefore, is is probably advisable to start practising on a H1B with a state license in either Maine/Oklamoha/North Dakota before starting an ACGME Fellowship and wait until one has earned the employment based greencard. However, an Indian or chinese national will have significant issues, due to greencard waiting times, to receive an employment based greencard.

The alternative option is to do an ACGME Fellowship on a J1 Visa and apply to a J1-waiver such as the Conrad-30 J-1 waiver program, which obligates (for a few years) you to work in an underserved area in that specific state you did your fellowship in. But here you have to be careful that you will qualify for licensing in the state following your fellowship. For example: Some states require 2 or 3 years US based residency/fellowship training before a state license can be issued. Even though you can apply for the J1 wisa waiver through the Conrad 30 program in that one state, your visa home requirements will be waived for this state but you will not be able to practise in that state as you are not fulfilling licensing requirements. I believe there is no way to do fellowship in one state and apply to a J1 waiver program in another state. Also, if you are not a FM or IM trained physician, you will have increased difficulty for fulfilling J1 visa waiver requirements as primary care docs are usually most needed in underserved areas.

Once you have earned an employment based greencard, you could apply to a ACGME-Fellowship and earn state licensure across other states that have the US based residency/fellowship training requirement. In these cases, doing an ACGME Fellowship to get to know the american system makes little sense, as you will most likely have already practised for at least a year in the country. I wonder if in those cases it makes sense, other than personal reasons, to do a ACGME Fellowship at all.

You could just get board certified (if reciprocity agreement exists in that speciality) in one of the states you can get a state license in (Oklahoma/Maine/North Dakota) and then work in a teaching hospital as faculty for 3 years. As I understand this way you fulfill the waiver requirement for US based residency training to work in most other states, without needing to have done an ACGME-Fellowship.

Did I get it right?

In my case as a GP trainee in Germany but UK graduate with full GMC registration, I do not qualify for this pathway. Since I'm at the beginning of my training, I'm going to give the USMLEs 1/2CK/2CS/3 and the match cycle for 2022 a shot. As US residency would start in 07/2022, I'm actually applying to GPST now (FM training in the UK) and I'm hoping to start GPST training at the beginning of 08/2021, which means I have time until 08/2021 for all USMLE exams, US clinical experience, the UK SRA exam/Selection centre exam. If I match into the US system for 2022, I can resign my UK post after working close to 12 months. If I dont match, I can try my luck in ST2 and ST3 again, although at this point it would make more sense to do MRCGP, earn CCT and follow Spartacus above described pathway = State licensing, board certification and employment in the US.


The employment-based green card would take awhile isn't it? You can always do a 1-year fellowship and use that as a means to apply for residency. Which would make it more straight forward?
The USMLE exams require pretty rigorous studying. Yes for the route mentioned above you might not need good scores as the candidate already has green card, but in the case of IMGs without a green card we might need to have average to good scores at least above 220, in a case if we might have to apply for residency after fellowship. With UK training I hope it becomes easy to prepare for the USMLEs but for me it wasn't. I took them before coming to the UK
Any particular reason you considered Germany over the UK for Gp training? German training is not recognized in any of the anglophile countries
 
Jun 29, 2020
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0
The employment-based green card would take awhile isn't it? You can always do a 1-year fellowship and use that as a means to apply for residency. Which would make it more straight forward?
The USMLE exams require pretty rigorous studying. Yes for the route mentioned above you might not need good scores as the candidate already has green card, but in the case of IMGs without a green card we might need to have average to good scores at least above 220, in a case if we might have to apply for residency after fellowship. With UK training I hope it becomes easy to prepare for the USMLEs but for me it wasn't. I took them before coming to the UK
Any particular reason you considered Germany over the UK for Gp training? German training is not recognized in any of the anglophile countries

There is a chance we are not on the same page here.

Almost all non-us foreign physicians will have to go through a greencard process (employment vs. family) eventually, if they want to stay and continue practising in the US. As a foreign non-us physician you can either work on a J-1/H1b or O-1 Visa.

1) The J-1 Visa is for a maximum of 7 years, can be used in residency and fellowship training ONLY and has the 2 year home requirement following training. Note: Fellowships only accept J-1 Visas. Most IMGs are on a J-1 Visa. The spouse can work on a J-2 Visa. But you are not allowed to apply for other visas until you completed the 2 year home requirement/or fulfilled the waiver requirement which obligates you to work in an underserved area under a H1B visa.
-If you want Fellowship training, you have to take this visa
-If you want US training and dont mind going home for 2 years, or never want to work in the US after completing training, you should take this visa.
-If you are Indian or chinese, a J-1 Visa is better in the longterm as you can exhaust the 7 year limit before beginning to exhaust the 6 year H1b limit. These guys have horrendous greencard processing times. (I'm not sure if greencard applications extend the limits on a H1b; This is the case in Germany)
-If you want your spouse to be able to work, you should take this visa. J-2 allow you to work EVERYWHERE. H4 (H1B spouses) are not allowed to work.
-If you are in an IM/FM residency or fellowship program, this visa is a good option, as its easy to waive the J-1 requirements after.
-This visa has limited options after training/fellowship, as you most likely have to work in underserved areas for a few years
-The visa-waiver process is quite complicated and not 100% bulletproof.
-You cannot moonlight (I think)


2) The H1B Visa is for a maximum of 6 years, and about 1/3 of all residency programs that offer J-1 will offer H1B. Fellowships will most likely not sponsor H1B visas which also makes sense considering you will run into issues with the 6 year H1B limit (minimum 3 year residency plus 3 year fellowhip and you are already at the limit = no time for greencard processing). Its a dual intent visa which means that you are allowed to apply for an employment based greencard after training.
-H1B are the best options if you are not a chinese/Indian national, are not interested in fellowships, single and want to get your greencard asap.
-H4 visas (wife/husband) can not work. They can study, volunteer but they are not allowed to be in employment
-H1Bs are sponsored by the employer, are limited nationally each year. (although some physician based H1B visas are excempt from yearly limits.)
-The H1B visa allows you to work for an employer following training, allows your employer to sponsor your greencard process. Greencard waiting times depend on the country but as far I understand waiting time is usually below 12 months.
-As soon as you have the greencard, you are free to live and work in the US. This should be the endgoal
-The spouse receives a greencard too and will be able to work as well.
-I think they allow for moonlighting.

Example (H1B): an IM resident working with a H1B visa can graduate, apply to a job in the US which sponsors the employment based greencard and the physician can then possess a greencard a year after graduating residency. The IM resident can apply to fellowships with a greencard (and probably has much better chances with it). The wife/husband will not be allowed to work until greencards are issued. Now, they can wait until they become U.S Citizens.

Example (J1): an IM resident working with a J1 visa can choose to go into fellowship or graduate now, apply for a J-1 waiver and work for the next 3-5 years with an H1B in an underserved area in the state they did their residency in. Alternatively, they return home for 2 years. The spouse can work with the J-2.

3) The O-1 Visa (Einstein Visa) is for especially talented individuals and is extremely complicated and expensive. If you are in fellowship training, published a lot, won prices and have been critiquing and teaching others, you could qualify for the O-1. The O-1 can be renewed each year indefinetely. The spouses can work.

____

" You can always do a 1-year fellowship and use that as a means to apply for residency "
-I'm not sure why you would apply to residency training after completing fellowship training. Also notice that doing ACGME-Fellowship training often requires ACGME-residency (US residency). Spartacus applied to uncompetetive ACGME-fellowship training posts where the director can make an exception. If you are a specialist in your home country you can apply to US-residency training. If you are a resident in your home country or a graduate you can also apply to US-residency training. Some program directors actually prefer to take young residents vs old specialists. What I'm saying is that you dont need fellowship training to apply to residency and it might actually be disadvantageous. Why the hassle? You might as well do 3 years of fellowship training and you would fulfill some training requirements. Although since 2016 some things have changed which have made that process impossible (I think). But there used to be orthopedic trained specialists from abroad that would do 3 fellowships and would then be able to practise as orthopods in the US. This door has closed I think.

" The USMLE exams require pretty rigorous studying. Yes for the route mentioned above you might not need good scores as the candidate already has green card, but in the case of IMGs without a green card we might need to have average to good scores at least above 220, in a case if we might have to apply for residency after fellowship "
Spartacus (the candidate) has a US-greencard, which simplifies some work-authorisation and right to live issues. The USMLEs are required to become state licensed in most states. Maine/Oklahoma require you to have passed USMLE exams to be issues a state license. The score of the USMLEs do not matter for state licensure. You can even fail the first two attepmts in Oklahoma. The scores matter when applying to US-residency training, perhaps even fellowship training. The scores matter for us IMGs who apply directly to US-residency training but do not matter for the above mentioned route. Dont need fellowship to apply for residency as said above.

"With UK training I hope it becomes easy to prepare for the USMLEs but for me it wasn't. I took them before coming to the UK
Any particular reason you considered Germany over the UK for Gp training? German training is not recognized in any of the anglophile countries"

I think UK training helps with interpersonal skills and helps with residency application (english taught/english trained) and especially USMLE 2CS. All the OSCE training, MRCGP clinical skills training is great for USMLE 2CS. USMLE Step 1 has almost nothing to do with clinical practise or the UK medical school curriculum. I'm not sure about USMLE 2CK. I talked to an european grad who worked in the UK and applied to US residency training. She said that the US clinical experience requirement was waived for her, as they considered her UK work experience to be equivalent. It seems that "some" programs want proof that the candidate can communicate in english and communicate with patients and colleagues in an empathetic and safe way. UK training alleviates that worry.

Imagine that Germany has really low language requirements and that foreign doctors barely speaking German are allowed and hired to practise. The worst part of my job is communicating with a colleague and being uncertain if they understand the patients in my handover. Many mistakes happened that way. And tbh its a true pain in the **** having somebody in the team who can barely speak the language, barely communicate with colleagues and patients. In addition, some cultures have strange behaviors towards patients, sometimes completely unacceptable. example: Talking down on patient, shouting to patient, ignoring wishes and requests. Horrible bedsite manners. Its crazy but I witnessed that in Germany more than in the UK.

I didnt know about alternative pathways to the US. My understanding was that you HAVE to do residency in the US. I moved for personal reasons, I was unhappy about the 2 year long foundation program, unhappy about brexit, unhappy about junior doctors contract, unhappy about pay and really unhappy about the rotational program. I was not ready to rotate every 6 months for training. In Germany you can do your entire 6 years training at one hospital. There are not many requirements and pay is good. (FY1 50% banding= 33k vs German first year trainee base 55k on calls= 85k) But yes, they are not in the "anglophile" club. I think that is the result of the missing german equivalent of the royal college which sets international standards. Back then I also havent considered the US before.

What is your background? Why the UK? USMLE scores? Your plan?
 
Mar 16, 2020
15
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There is a chance we are not on the same page here.

Almost all non-us foreign physicians will have to go through a greencard process (employment vs. family) eventually, if they want to stay and continue practising in the US. As a foreign non-us physician you can either work on a J-1/H1b or O-1 Visa.

1) The J-1 Visa is for a maximum of 7 years, can be used in residency and fellowship training ONLY and has the 2 year home requirement following training. Note: Fellowships only accept J-1 Visas. Most IMGs are on a J-1 Visa. The spouse can work on a J-2 Visa. But you are not allowed to apply for other visas until you completed the 2 year home requirement/or fulfilled the waiver requirement which obligates you to work in an underserved area under a H1B visa.
-If you want Fellowship training, you have to take this visa
-If you want US training and dont mind going home for 2 years, or never want to work in the US after completing training, you should take this visa.
-If you are Indian or chinese, a J-1 Visa is better in the longterm as you can exhaust the 7 year limit before beginning to exhaust the 6 year H1b limit. These guys have horrendous greencard processing times. (I'm not sure if greencard applications extend the limits on a H1b; This is the case in Germany)
-If you want your spouse to be able to work, you should take this visa. J-2 allow you to work EVERYWHERE. H4 (H1B spouses) are not allowed to work.
-If you are in an IM/FM residency or fellowship program, this visa is a good option, as its easy to waive the J-1 requirements after.
-This visa has limited options after training/fellowship, as you most likely have to work in underserved areas for a few years
-The visa-waiver process is quite complicated and not 100% bulletproof.
-You cannot moonlight (I think)


2) The H1B Visa is for a maximum of 6 years, and about 1/3 of all residency programs that offer J-1 will offer H1B. Fellowships will most likely not sponsor H1B visas which also makes sense considering you will run into issues with the 6 year H1B limit (minimum 3 year residency plus 3 year fellowhip and you are already at the limit = no time for greencard processing). Its a dual intent visa which means that you are allowed to apply for an employment based greencard after training.
-H1B are the best options if you are not a chinese/Indian national, are not interested in fellowships, single and want to get your greencard asap.
-H4 visas (wife/husband) can not work. They can study, volunteer but they are not allowed to be in employment
-H1Bs are sponsored by the employer, are limited nationally each year. (although some physician based H1B visas are excempt from yearly limits.)
-The H1B visa allows you to work for an employer following training, allows your employer to sponsor your greencard process. Greencard waiting times depend on the country but as far I understand waiting time is usually below 12 months.
-As soon as you have the greencard, you are free to live and work in the US. This should be the endgoal
-The spouse receives a greencard too and will be able to work as well.
-I think they allow for moonlighting.

Example (H1B): an IM resident working with a H1B visa can graduate, apply to a job in the US which sponsors the employment based greencard and the physician can then possess a greencard a year after graduating residency. The IM resident can apply to fellowships with a greencard (and probably has much better chances with it). The wife/husband will not be allowed to work until greencards are issued. Now, they can wait until they become U.S Citizens.

Example (J1): an IM resident working with a J1 visa can choose to go into fellowship or graduate now, apply for a J-1 waiver and work for the next 3-5 years with an H1B in an underserved area in the state they did their residency in. Alternatively, they return home for 2 years. The spouse can work with the J-2.

3) The O-1 Visa (Einstein Visa) is for especially talented individuals and is extremely complicated and expensive. If you are in fellowship training, published a lot, won prices and have been critiquing and teaching others, you could qualify for the O-1. The O-1 can be renewed each year indefinetely. The spouses can work.

____

" You can always do a 1-year fellowship and use that as a means to apply for residency "
-I'm not sure why you would apply to residency training after completing fellowship training. Also notice that doing ACGME-Fellowship training often requires ACGME-residency (US residency). Spartacus applied to uncompetetive ACGME-fellowship training posts where the director can make an exception. If you are a specialist in your home country you can apply to US-residency training. If you are a resident in your home country or a graduate you can also apply to US-residency training. Some program directors actually prefer to take young residents vs old specialists. What I'm saying is that you dont need fellowship training to apply to residency and it might actually be disadvantageous. Why the hassle? You might as well do 3 years of fellowship training and you would fulfill some training requirements. Although since 2016 some things have changed which have made that process impossible (I think). But there used to be orthopedic trained specialists from abroad that would do 3 fellowships and would then be able to practise as orthopods in the US. This door has closed I think.

" The USMLE exams require pretty rigorous studying. Yes for the route mentioned above you might not need good scores as the candidate already has green card, but in the case of IMGs without a green card we might need to have average to good scores at least above 220, in a case if we might have to apply for residency after fellowship "
Spartacus (the candidate) has a US-greencard, which simplifies some work-authorisation and right to live issues. The USMLEs are required to become state licensed in most states. Maine/Oklahoma require you to have passed USMLE exams to be issues a state license. The score of the USMLEs do not matter for state licensure. You can even fail the first two attepmts in Oklahoma. The scores matter when applying to US-residency training, perhaps even fellowship training. The scores matter for us IMGs who apply directly to US-residency training but do not matter for the above mentioned route. Dont need fellowship to apply for residency as said above.

"With UK training I hope it becomes easy to prepare for the USMLEs but for me it wasn't. I took them before coming to the UK
Any particular reason you considered Germany over the UK for Gp training? German training is not recognized in any of the anglophile countries"

I think UK training helps with interpersonal skills and helps with residency application (english taught/english trained) and especially USMLE 2CS. All the OSCE training, MRCGP clinical skills training is great for USMLE 2CS. USMLE Step 1 has almost nothing to do with clinical practise or the UK medical school curriculum. I'm not sure about USMLE 2CK. I talked to an european grad who worked in the UK and applied to US residency training. She said that the US clinical experience requirement was waived for her, as they considered her UK work experience to be equivalent. It seems that "some" programs want proof that the candidate can communicate in english and communicate with patients and colleagues in an empathetic and safe way. UK training alleviates that worry.

Imagine that Germany has really low language requirements and that foreign doctors barely speaking German are allowed and hired to practise. The worst part of my job is communicating with a colleague and being uncertain if they understand the patients in my handover. Many mistakes happened that way. And tbh its a true pain in the **** having somebody in the team who can barely speak the language, barely communicate with colleagues and patients. In addition, some cultures have strange behaviors towards patients, sometimes completely unacceptable. example: Talking down on patient, shouting to the patient, ignoring wishes and requests. Horrible bedsite manners. Its crazy but I witnessed that in Germany more than in the UK.

I didnt know about alternative pathways to the US. My understanding was that you HAVE to do residency in the US. I moved for personal reasons, I was unhappy about the 2 year long foundation program, unhappy about brexit, unhappy about junior doctors contract, unhappy about pay and really unhappy about the rotational program. I was not ready to rotate every 6 months for training. In Germany you can do your entire 6 years training at one hospital. There are not many requirements and pay is good. (FY1 50% banding= 33k vs German first year trainee base 55k on calls= 85k) But yes, they are not in the "anglophile" club. I think that is the result of the missing german equivalent of the royal college which sets international standards. Back then I also haven't considered the US before.

What is your background? Why the UK? USMLE scores? Your plan?

Hi,
Thanks for the very detailed reply. I must say you have looked into the visas much more in detail than I ever did. It still needs work on my part though.

I graduated in 2014. I am an IMG from Pakistan. So instead of going for home country internship or residency I went into preparation mode for the USMLE and well took more time than I should have. Now IMGs average 1 year of sitting at home for each step. I tried doing the same but that didn't reflect very much on the actual( Both my steps are in the mid 220s) exam result. My biggest mistake during this time was not being involved in clinical practise both at home and also not so much experience gaining in the US. Now getting US LORs and experience was paramount and well I was wasting time ( Finances was a big part of this as well and also being part of a toxic group of people). Anyhow fast forward to 2016, I am sitting in US with not so much to show on the CV. I was in talks with a P.D who mentioned about me having no chances with such a CV. Advised me to forget about applying that year and start preparing for a CV. Including working on getting US clinical experience and working on research experience. Anyhow, I got distraught with the situation, 2 years from graduation, not earning anything and putting an undue financial burden on my family and with no means of staying in the US, I made the ultimate decision to not to continue for the time being and to focus on somewhere else. Thats when I came across a friend who happened to be in the UK since 2015 and was already in training. Uk was more straightforward; u can start a job and then make your way to training. Hence I spent another year getting UK exams done and ended up here. Now I knew I don't have to live my life in the UK and places like Aus/Canada were always the option with UK experience(Hence the 'anglophile' reference). Aus/Can are good, pay good and have way better work-life balance. Aus is just too far, North America is nearby( In my mind). In Canada, I can practise after the MRCGP since I am done with the USMLEs. In Canada, except for a 25 per cent pay rise I don't see the attraction. It's sparsely populated, has a horrendous climate and means that I would be isolated from the rest of the world ( People have ended up in the wilderness of the arctic away from city centers. Such money is not worth it), so I am not geared towards Canada very much.
Now coming to the US. I knew that British experience does help, it looks better on the CV. Plus as you mentioned being from an English speaking country and a work environment very similar to many US hospitals, it makes it easier to settle. I would still be requiring things like US experience, LORs, research experience. Things which are much more difficult to get while working full time here. The only way I can get about it is by trying for it after I have secured some sort of training in the UK. PDs in the US are looking at many more things besides the scores. Scores are like an initial physical attraction. .The personality part comes later. Commitment to speciality matters more. Getting a fellowship is geared towards that. A UK family physician training and a year of fellowship training, LORs, and may some conference attendances would help as well. I was indicating towards this as I think it would be easier to practise in other states with this route. Plus many PDs are willing to reduce residency training years with prior training outside and in the US. I am not discounting the above-mentioned pathway, just indicating towards a pathway to have more options to practise in the US. (Oklahoma is not what I think about when I think about US).
Spartacus has been mentioning about some sort of manual for ACGME fellowships. I have not been able to find any such manual but have done some research on FRIEDA. Some of these programs have very vague requirements which can be looked into. So yeah i plan into getting into GP residency soon. So I do have a good 3 years before I can get into applying for US
 
Mar 16, 2020
15
1
Status (Visible)
  1. Pre-Health (Field Undecided)
There is a chance we are not on the same page here.

Almost all non-us foreign physicians will have to go through a greencard process (employment vs. family) eventually, if they want to stay and continue practising in the US. As a foreign non-us physician you can either work on a J-1/H1b or O-1 Visa.

1) The J-1 Visa is for a maximum of 7 years, can be used in residency and fellowship training ONLY and has the 2 year home requirement following training. Note: Fellowships only accept J-1 Visas. Most IMGs are on a J-1 Visa. The spouse can work on a J-2 Visa. But you are not allowed to apply for other visas until you completed the 2 year home requirement/or fulfilled the waiver requirement which obligates you to work in an underserved area under a H1B visa.
-If you want Fellowship training, you have to take this visa
-If you want US training and dont mind going home for 2 years, or never want to work in the US after completing training, you should take this visa.
-If you are Indian or chinese, a J-1 Visa is better in the longterm as you can exhaust the 7 year limit before beginning to exhaust the 6 year H1b limit. These guys have horrendous greencard processing times. (I'm not sure if greencard applications extend the limits on a H1b; This is the case in Germany)
-If you want your spouse to be able to work, you should take this visa. J-2 allow you to work EVERYWHERE. H4 (H1B spouses) are not allowed to work.
-If you are in an IM/FM residency or fellowship program, this visa is a good option, as its easy to waive the J-1 requirements after.
-This visa has limited options after training/fellowship, as you most likely have to work in underserved areas for a few years
-The visa-waiver process is quite complicated and not 100% bulletproof.
-You cannot moonlight (I think)


2) The H1B Visa is for a maximum of 6 years, and about 1/3 of all residency programs that offer J-1 will offer H1B. Fellowships will most likely not sponsor H1B visas which also makes sense considering you will run into issues with the 6 year H1B limit (minimum 3 year residency plus 3 year fellowhip and you are already at the limit = no time for greencard processing). Its a dual intent visa which means that you are allowed to apply for an employment based greencard after training.
-H1B are the best options if you are not a chinese/Indian national, are not interested in fellowships, single and want to get your greencard asap.
-H4 visas (wife/husband) can not work. They can study, volunteer but they are not allowed to be in employment
-H1Bs are sponsored by the employer, are limited nationally each year. (although some physician based H1B visas are excempt from yearly limits.)
-The H1B visa allows you to work for an employer following training, allows your employer to sponsor your greencard process. Greencard waiting times depend on the country but as far I understand waiting time is usually below 12 months.
-As soon as you have the greencard, you are free to live and work in the US. This should be the endgoal
-The spouse receives a greencard too and will be able to work as well.
-I think they allow for moonlighting.

Example (H1B): an IM resident working with a H1B visa can graduate, apply to a job in the US which sponsors the employment based greencard and the physician can then possess a greencard a year after graduating residency. The IM resident can apply to fellowships with a greencard (and probably has much better chances with it). The wife/husband will not be allowed to work until greencards are issued. Now, they can wait until they become U.S Citizens.

Example (J1): an IM resident working with a J1 visa can choose to go into fellowship or graduate now, apply for a J-1 waiver and work for the next 3-5 years with an H1B in an underserved area in the state they did their residency in. Alternatively, they return home for 2 years. The spouse can work with the J-2.

3) The O-1 Visa (Einstein Visa) is for especially talented individuals and is extremely complicated and expensive. If you are in fellowship training, published a lot, won prices and have been critiquing and teaching others, you could qualify for the O-1. The O-1 can be renewed each year indefinetely. The spouses can work.

____

" You can always do a 1-year fellowship and use that as a means to apply for residency "
-I'm not sure why you would apply to residency training after completing fellowship training. Also notice that doing ACGME-Fellowship training often requires ACGME-residency (US residency). Spartacus applied to uncompetetive ACGME-fellowship training posts where the director can make an exception. If you are a specialist in your home country you can apply to US-residency training. If you are a resident in your home country or a graduate you can also apply to US-residency training. Some program directors actually prefer to take young residents vs old specialists. What I'm saying is that you dont need fellowship training to apply to residency and it might actually be disadvantageous. Why the hassle? You might as well do 3 years of fellowship training and you would fulfill some training requirements. Although since 2016 some things have changed which have made that process impossible (I think). But there used to be orthopedic trained specialists from abroad that would do 3 fellowships and would then be able to practise as orthopods in the US. This door has closed I think.

" The USMLE exams require pretty rigorous studying. Yes for the route mentioned above you might not need good scores as the candidate already has green card, but in the case of IMGs without a green card we might need to have average to good scores at least above 220, in a case if we might have to apply for residency after fellowship "
Spartacus (the candidate) has a US-greencard, which simplifies some work-authorisation and right to live issues. The USMLEs are required to become state licensed in most states. Maine/Oklahoma require you to have passed USMLE exams to be issues a state license. The score of the USMLEs do not matter for state licensure. You can even fail the first two attepmts in Oklahoma. The scores matter when applying to US-residency training, perhaps even fellowship training. The scores matter for us IMGs who apply directly to US-residency training but do not matter for the above mentioned route. Dont need fellowship to apply for residency as said above.

"With UK training I hope it becomes easy to prepare for the USMLEs but for me it wasn't. I took them before coming to the UK
Any particular reason you considered Germany over the UK for Gp training? German training is not recognized in any of the anglophile countries"

I think UK training helps with interpersonal skills and helps with residency application (english taught/english trained) and especially USMLE 2CS. All the OSCE training, MRCGP clinical skills training is great for USMLE 2CS. USMLE Step 1 has almost nothing to do with clinical practise or the UK medical school curriculum. I'm not sure about USMLE 2CK. I talked to an european grad who worked in the UK and applied to US residency training. She said that the US clinical experience requirement was waived for her, as they considered her UK work experience to be equivalent. It seems that "some" programs want proof that the candidate can communicate in english and communicate with patients and colleagues in an empathetic and safe way. UK training alleviates that worry.

Imagine that Germany has really low language requirements and that foreign doctors barely speaking German are allowed and hired to practise. The worst part of my job is communicating with a colleague and being uncertain if they understand the patients in my handover. Many mistakes happened that way. And tbh its a true pain in the **** having somebody in the team who can barely speak the language, barely communicate with colleagues and patients. In addition, some cultures have strange behaviors towards patients, sometimes completely unacceptable. example: Talking down on patient, shouting to patient, ignoring wishes and requests. Horrible bedsite manners. Its crazy but I witnessed that in Germany more than in the UK.

I didnt know about alternative pathways to the US. My understanding was that you HAVE to do residency in the US. I moved for personal reasons, I was unhappy about the 2 year long foundation program, unhappy about brexit, unhappy about junior doctors contract, unhappy about pay and really unhappy about the rotational program. I was not ready to rotate every 6 months for training. In Germany you can do your entire 6 years training at one hospital. There are not many requirements and pay is good. (FY1 50% banding= 33k vs German first year trainee base 55k on calls= 85k) But yes, they are not in the "anglophile" club. I think that is the result of the missing german equivalent of the royal college which sets international standards. Back then I also havent considered the US before.

What is your background? Why the UK? USMLE scores? Your plan?


Btw that salary in Germany is so damn good. Consultants in the UK start at the base salary :):lol:
 
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Immigration is so messy and confusing. I lucked out by landing with an excellent immigration attorney ( Charles H. Kuck in Atlanta). I highly recommend his services if you decide to hire an attorney. I have no conflict of interest by recommending him.
 
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Immigration is so messy and confusing. I lucked out by landing with an excellent immigration attorney ( Charles H. Kuck in Atlanta). I highly recommend his services if you decide to hire an attorney. I have no conflict of interest by recommending him.

I discussed with the medical board and the abfm regarding the visa. They said per se they do not want any green card but they need to have u have a social security number. There are two ways for that. Either we hire an attorney who makes a case tht the SSN would be obtained eventually
The other way its possible is by starting a fellowship and since that is an employment ...ssn would be issued and license can be obtained in the middle of the fellowship..
Us has the most stupid visa system ever btw
 

sugarplummy

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This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I had to move from Britain to the US for family reasons, and spent 2 years researching the pathway of least resistance. I could not find reliable information to guide me. It was very stressful and time consuming, and I hope no one has to go through what I endured.

This post summarizes my experience and recommendations. I did this myself and talked to a few others who did it also.

*** First of sort your immigration situation; whether a visa, green card, or other. At least have a plan ready because you will need this when you apply for a state license or board certification.

*** You need to have completed at least 3 years of residency training in the UK, New Zeeland, Australia, or Ireland. You need to have proof of completion of training (CCT if from the UK).

*** Do ECFMG primary source verification and take all USMLEs.
  • I used UWorld Qbank only and cleared all of them in 6 months.
  • You just need to pass, no need to score high.
  • For Step 2CS, I recommend Ximedus workshop in Florida to orient you about the exam.
  • It does not matter where you did medical school as long as ECFMG is OK with it (I know doctors who did medical school in Africa and residency in the UK, and were able to peruse this pathway successfully/practice in the US).

*** Apply for a state license without US-residency training (Maine or Oklahoma): this is the bottle neck!
  • These 2 states accept your non-US residency training as a waiver for US-residency training requirement.
  • For UK and Ireland trained doctors I recommend Maine (took me 3 months to get my license). Everyone else have no other choice but Oklahoma.
  • Make sure that you are within 2 years of clinical practice, preferably within 1 year. If needed, you can go back home and practice for a few months to restart the 2 year licensing requirement.
  • For Maine, FCVS will verify your UK training. Make sure to provide them with the contact info for your program once you submit your application (this is a must, although they do not ask you for it). Follow up with FCVS aggressively. For UK training: FCVS does not verify foundation years, only core training in your specialty.
  • You do not need a DEA number for Maine application purposes.
  • You MUST get FCVS.

*** Once you have a state license, you can practice in that state. I talked to a cardiologist and a surgeon who are practicing without board certification in Maine. Your options of employment are community hospitals and private practices. Academic centers require American Board certification. Without board certification, you will do some extra paperwork with insurance companies and have to get letters from your chairman, but it will be fine in the end.


*** I recommend doing a 1 year fellowship before practicing solo:
  • This is OPTIONAL. Some people did not do this and they feel perfectly fine practicing in the US.
  • The science is the same but logistics are different between systems.
  • ACGME accredited fellowships can take you although you did not finish an ACGME-accredited residency in most cases (at the discretion of program director).
  • You will be using a training state license while during fellowship, not a full license.
  • For family medicine or internal medicine getting a geriatrics fellowship is easy (all geriatrics fellowships are ACGME accredited). Refer to ACGME fellowship-specific manual if you need to know which fellowship programs take non-ACGME trained applicants.
  • I will be doing a 1 year ACGME-accredited fellowship this summer to orient myself before practicing solo. I applied broadly and got multiple offers.
  • ACGME accredited fellowships help you get licenses in other states. Some states require 2 years of ACGME accredited training (residency or fellowship). Other states require 3 years.
  • Non-ACGME fellowships are not worth it in my opinion.

*** Get Board Certified:
  • This will open doors for employment.
  • This will make all insurance companies accept you as a provider, no questions asked or extra paperwork needed.
  • This will open licensing in many other states. Some states waive US-residency training requirement if you are US-board certified.
  • American Board of Family Medicine has a reciprocity agreement. American Board of Internal Medicine has an alternative certification pathway. American Board of Radiology has an IMG pathway. Other boards may have pathways for you to get certified based on your overseas qualifications/training or cumulative practice in the US after a while. Please contact specific boards for info. Be patient and read the fine print on their websites. Many customer service operators might not even know about it as this is not common. Dig deep and be meticulous.
  • On my end, I am a GP. I applied for the American Board of Family Medicine Reciprocity Agreement pathway. Last week I was notified that I have satisfied the requirements and will take my ABFM certifying exam in November 2020!
  • I talked to internists who got certified via the alternative pathway of the ABIM.

*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.
  • Once you become Board Certified, this will open other states for you. You need to read the fine print for state licensure application instructions.
  • Michigan has reciprocity if you practiced in any other state for 3 years.
  • After becoming Board Certified, I advised getting a job in a teaching hospital in Oklahoma or Maine (community or academic). Most other state accept working as a faculty training residents for 3 years as a waiver for US residency training requirement.

I hope my post enlightens your path and spare you the hassle.

Good luck everyone!
Hi,I'm almost in the same position. I finished the usmles1,2 and 3 in 2017 with poor scores and did not match,even though I have a greencard. My yog is 2008 and I took 7 years to complete the steps,all while working
. I started researching this pathway and applied to do the MRCGP after gmc registration. I got a spot and im starting in norwich uk in feb 2021,then hoping to get a license in Maine and do the ABFM exam
I did so much reading on this two years ago and wondered why did I waste so much money applying to ERAS and the match many years in a row when I could have just gone to the uk in that time and completed the mrcgp.We need to make this route more popular. So many doctors doubt me when I tell them of my plan.
One question though. Can I apply for a geriatrics fellowship before I get the Maine state license and ABFM cert?
 
Mar 16, 2020
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Hi,I'm almost in the same position. I finished the usmles1,2 and 3 in 2017 with poor scores and did not match,even though I have a greencard. My yog is 2008 and I took 7 years to complete the steps,all while working
. I started researching this pathway and applied to do the MRCGP after gmc registration. I got a spot and im starting in norwich uk in feb 2021,then hoping to get a license in Maine and do the ABFM exam
I did so much reading on this two years ago and wondered why did I waste so much money applying to ERAS and the match many years in a row when I could have just gone to the uk in that time and completed the mrcgp.We need to make this route more popular. So many doctors doubt me when I tell them of my plan.
One question though. Can I apply for a geriatrics fellowship before I get the Maine state license and ABFM cert?

There are not many who first go through the pain of the USMLEs and then do the PLABs. If u are settled with family in the US why would u leave it suddenly and go to the UK.
 
Mar 16, 2020
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  1. Pre-Health (Field Undecided)
Hi,I'm almost in the same position. I finished the usmles1,2 and 3 in 2017 with poor scores and did not match,even though I have a greencard. My yog is 2008 and I took 7 years to complete the steps,all while working
. I started researching this pathway and applied to do the MRCGP after gmc registration. I got a spot and im starting in norwich uk in feb 2021,then hoping to get a license in Maine and do the ABFM exam
I did so much reading on this two years ago and wondered why did I waste so much money applying to ERAS and the match many years in a row when I could have just gone to the uk in that time and completed the mrcgp.We need to make this route more popular. So many doctors doubt me when I tell them of my plan.
One question though. Can I apply for a geriatrics fellowship before I get the Maine state license and ABFM cert?
Fellowships accredited by acgme do not really accept non acgme unless u fulfill some exceptions. Which include things like training being equivalent and being involved in some research. Its totally at the discretion of the individual program
 
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sugarplummy

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Jul 16, 2017
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There are not many who first go through the pain of the USMLEs and then do the PLABs. If u are settled with family in the US why would u leave it suddenly and go to the UK.
I'm not settled in the US as yet, but I do have my greencard and do not want to lose it
 

sugarplummy

2+ Year Member
Jul 16, 2017
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Have you
Fellowships accredited by acgme do not really accept non acgme unless u fulfill some exceptions. Which include things like training being equivalent and being involved in some research. Its totally at the discretion of the individual program

I'm not settled in the US as yet, but I do have my greencard and do not want to lose it
Have you gone through this route also?
 
Jan 10, 2021
6
1
This post is for doctors trained in the England, Scotland, New Zealand, Australia, and Ireland interested in relocating/practicing in the US.

I had to move from Britain to the US for family reasons, and spent 2 years researching the pathway of least resistance. I could not find reliable information to guide me. It was very stressful and time consuming, and I hope no one has to go through what I endured.

This post summarizes my experience and recommendations. I did this myself and talked to a few others who did it also.

*** First of sort your immigration situation; whether a visa, green card, or other. At least have a plan ready because you will need this when you apply for a state license or board certification.

*** You need to have completed at least 3 years of residency training in the UK, New Zeeland, Australia, or Ireland. You need to have proof of completion of training (CCT if from the UK).

*** Do ECFMG primary source verification and take all USMLEs.
  • I used UWorld Qbank only and cleared all of them in 6 months.
  • You just need to pass, no need to score high.
  • For Step 2CS, I recommend Ximedus workshop in Florida to orient you about the exam.
  • It does not matter where you did medical school as long as ECFMG is OK with it (I know doctors who did medical school in Africa and residency in the UK, and were able to peruse this pathway successfully/practice in the US).

*** Apply for a state license without US-residency training (Maine or Oklahoma): this is the bottle neck!
  • These 2 states accept your non-US residency training as a waiver for US-residency training requirement.
  • For UK and Ireland trained doctors I recommend Maine (took me 3 months to get my license). Everyone else have no other choice but Oklahoma.
  • Make sure that you are within 2 years of clinical practice, preferably within 1 year. If needed, you can go back home and practice for a few months to restart the 2 year licensing requirement.
  • For Maine, FCVS will verify your UK training. Make sure to provide them with the contact info for your program once you submit your application (this is a must, although they do not ask you for it). Follow up with FCVS aggressively. For UK training: FCVS does not verify foundation years, only core training in your specialty.
  • You do not need a DEA number for Maine application purposes.
  • You MUST get FCVS.

*** Once you have a state license, you can practice in that state. I talked to a cardiologist and a surgeon who are practicing without board certification in Maine. Your options of employment are community hospitals and private practices. Academic centers require American Board certification. Without board certification, you will do some extra paperwork with insurance companies and have to get letters from your chairman, but it will be fine in the end.


*** I recommend doing a 1 year fellowship before practicing solo:
  • This is OPTIONAL. Some people did not do this and they feel perfectly fine practicing in the US.
  • The science is the same but logistics are different between systems.
  • ACGME accredited fellowships can take you although you did not finish an ACGME-accredited residency in most cases (at the discretion of program director).
  • You will be using a training state license while during fellowship, not a full license.
  • For family medicine or internal medicine getting a geriatrics fellowship is easy (all geriatrics fellowships are ACGME accredited). Refer to ACGME fellowship-specific manual if you need to know which fellowship programs take non-ACGME trained applicants.
  • I will be doing a 1 year ACGME-accredited fellowship this summer to orient myself before practicing solo. I applied broadly and got multiple offers.
  • ACGME accredited fellowships help you get licenses in other states. Some states require 2 years of ACGME accredited training (residency or fellowship). Other states require 3 years.
  • Non-ACGME fellowships are not worth it in my opinion.

*** Get Board Certified:
  • This will open doors for employment.
  • This will make all insurance companies accept you as a provider, no questions asked or extra paperwork needed.
  • This will open licensing in many other states. Some states waive US-residency training requirement if you are US-board certified.
  • American Board of Family Medicine has a reciprocity agreement. American Board of Internal Medicine has an alternative certification pathway. American Board of Radiology has an IMG pathway. Other boards may have pathways for you to get certified based on your overseas qualifications/training or cumulative practice in the US after a while. Please contact specific boards for info. Be patient and read the fine print on their websites. Many customer service operators might not even know about it as this is not common. Dig deep and be meticulous.
  • On my end, I am a GP. I applied for the American Board of Family Medicine Reciprocity Agreement pathway. I took the ABFM certifying test and I am now ABFM certified!
  • I talked to internists who got certified via the alternative pathway of the ABIM.

*** How to be free? If you want to practice outside Maine and Oklahoma?
  • VA hospitals are nationwide. These are federal facilities and take any state license. For example, if you applied for a job in Los Angeles VA hospital and got accepted, you can use your Maine or Oklahoma license to practice in that hospital.
  • Once you become Board Certified, this will open other states for you. You need to read the fine print for state licensure application instructions. Current states that accept ABFM as a waiver for US residency training are CT, GA, OR, TN, NC, NV and a few others.
  • Michigan has reciprocity if you practiced in any other state for 3 years.
  • After becoming Board Certified, I advise getting a job in a teaching hospital (community or academic). All other state accept working as a faculty training residents for 3 years as a waiver for US residency training requirement.

I hope my post enlightens your path and spare you the hassle.

Good luck everyone!

Dear Spartacus.Free

I would like to ask you more, I'm also from the UK
 
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