Medical When Should I Move to the US?

[Mr.Smile12]

I am currently an Australian high school student interested in eventually moving to the US to practice medicine (with no plans of coming back if I do). When would be the best time to do this? For undergrad, med school or residency?

I am interested in practicing medicine in the US because the residency training is quicker, and I'm attracted to the prestige of American institutes and residencies, and have aspirations of becoming an academic clinician-researcher. I have the impression that the United States has more opportunities for clinician-scientists and doctors looking for academic/research positions. I also want to immigrate to the US in general (bigger country, more people compared to Australia, I have a desire to "swim in a bigger pond" so to speak). I have no family there. Are these good enough reasons, or should I stay in Australia forever?

I am interested in doing an MD/PhD, and am also interested in surgical subspecialties. I am aware residencies, especially for surgical specialties, are very competitive for FMGs. However, I work incredibly hard and am extremely self-motivated and ambitious, and am more than willing to persevere for many many years to achieve my goals.

One the one hand, it seems like medical schools in the United States are much more expensive than Australian medical schools, and it is extremely difficult for international applicants who are not citizens or permanent residents of the United States to gain admission to US medical schools. Does this still apply even if they did undergraduate studies in the US? In regards to student debt, is it always possible to pay it back when I'm making more money, or would that be a very big hindrance to studying medicine in the US? Furthermore, what are the chances that I can become a permanent resident in the United States during four years of undergraduate studies? Slim to none (would I have to marry an American or something haha)? What about getting a visa to study in medical school? In addition, from what I have gathered, studying for USMLE (and perhaps MCAT as well) is easier for students in the US as their curriculum is more relevant to the exam than Australia's.

On the other hand, it seems like it is much harder for FMGs to get into residencies (for competitive specialties and/or top programs) compared to US MD graduates.

So in conclusion, I am unsure as to whether I should be aiming to move to the US for undergraduate, medical school or residency. Is it harder to get into a US residency for a competitive specialty as an FMG than get into a good US medical school as an international student (with or without permanent residency)?

Any advice would be appreciated.

Thanks so much!

My opinion is before undergraduate so you can network, shadow, and get involved with good research projects.

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[Mr.Smile12]

Have you already started? I just find a lot of students waste opportunities in their first two years as undergraduates.

Also you bring up that as a noncitizen, getting into a US medical school is both expensive and extremely difficult. The more time you have in the US, the easier it is to work towards finding the schools that accept internationals.

Continuing my thoughts, residency during or after medical school also works. I host physicians for a month to a year visiting local academic medical centers to learn from doctors on a short internship or fellowship. I'm sure they had to pay the hospital CME office to attend. But that is feasible too.

Subject to edit below, not on my computer:

Also Ochser (sp) in New Orleans has an affiliation with Queensland in Australia, right?

 

[lord999]

What you write flatly does not make sense to me. Australian practitioners enter earlier than US practitioners due to their abbreviated professional training (you are admitted directly to the MBBS for the six-year program). For PhD training, Australia is widely viewed as comparable to the US for many subjects, and if you have an MBBS, it makes graduate admissions to either side easier.

Would you qualify to enter MBBS studies as they are with UMAT? Because if so and are talented enough, it probably would be better to take the MBBS and then go the IMG route. If you are as competitive and ambitious (and frankly, just good enough) as you say you are, you should be able to make the bar for the IMG and the US surgical subspecialties without terrible difficulty as an Australian MBBS with the right stats. PhD training is fairly open to medical school graduates of either country, and is not a high difficulty to enter given good enough research interest and ability.

 

[Mr.Smile12]

Yes, I think there is a program at the University of Queensland, where US students come to UQ to study their medical degree.

Let me know why doing medicine at UoQ isn't appealing to you, and whether there may be opportunities to do clerkships in the US.

When you say "the more time you have in the US, the easier it is to work towards finding the schools that accept internationals," do you mean that the longer I stay in the US, the higher chance I have of being admitted into a US med school? I'm confused by the phrase "finding the schools".

Networking is very important in a lot of job searches and in professional school selection. Yes, we have online resources, but networking with other premeds, med students, admissions officers, and student services officers is really important to get a sense of where you belong in the US system. Your financing will be a big problem in you start med school in the US unless you become a US permanent resident by the time you apply..

 

[lord999]

Yes, it is true that medical degrees in Australia are shorter since they can be entered straight out of high school. However, postgraduate training is much longer than the US, with 1 year internship, 1 year residency, and at the very least 2-4 years of "unaccredited registrar" work for surgical subspecialties (can be much longer, some people never get onto a program after PGY7+) before a 5-7 year training program. So you'd be looking to do around 10-15 years after graduating, and it can be very uncertain since training spots are competitive.

Most medical schools in Australia have actually changed from MBBS to MD now as well, and the UMAT has been replaced by the UCAT. But the crux of the matter was really if it would be harder to enter a US medical school (thus making matching into residency easier as I wouldn't be considered an FMG and would have more connections to the US, and preparing USMLE would be easier), or do my degree here and then match into a US residency (which I've heard is extremely hard for surgical subspecialties, and would involve me having to do many away rotations in the US to get LORs and various connections, as well as achieving much higher USMLE scores to even have a shot).

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Well, if the US practice is to be a guarantee, relocate here, work on changing from student to work, and play the lottery (the Department of State's Diversity Visa Lottery, that is), https://dvlottery.state.gov/

You're from Oceania, so your chances are actually much better than the average.

That or go into an undergraduate here in the States that has H1-B potential and use the H1-B to gain permanent residency.

Extremely competitive in all respects, but you are extremely ambitious.

The part of the streamlining is that permanent residency or citizenship does have effects on licensing and residency placement as you have observed. The question is whether you just are good enough to do so with the MBBS or whether you might need to take a detour in the US working a different career for a bit to gain eligibility to fully vest.

If residency issues cause this much anxiety for you, then I would address that first. That said, we see quite a number of IMG's in our competitive residencies on the J or H1-B visas, and they went through the whole IMG process. I still do not see your line of reasoning in this process though. If physician scientist is what you are aiming for, then it is quite doable where you are at as well as here, but my advice on this not wanted. I suppose that an US Class E-12/E-21, or the National Interest Waiver (NIW) is too far out of reach domestically.

 

[lord999]

I'm currently leaning towards coming to the States for undergraduate. What do you mean by "H1-B potential"? Would certain colleges have greater chance for this than others, and if so which ones? How long would it take to get permanent residency, would I be able to get it during medical school?

In terms of licensing and residency placement, is it harder to get competitive residencies without a green card but as a US grad? I'm not very knowledgeable on this matter... I was under the impression that if I could go to medical school in the US, it would be significantly easier to get into a competitive residency as I would be considered a US grad rather than IMG?

After doing some more research, it seems like it would be an easier path to apply as an IMG to residency than doing undergraduate + medical school in the US, since US medical schools seem to be almost out of reach for non-US residents... I am not sure about the relative difficulty in comparison to getting into an extremely competitive specialty residency (like neurosurgery) as an IMG. I'm just worried that if I graduate from a US college and don't get into a medical school I'll essentially be screwed in terms of my student visa. Could I just continually do master's degrees to maintain the F1 status or something, then reapply? I don't want to make a decision that I will be regretting for many years.

To gain permanent residency, you must have some sort of immigrant visa here in the States. Most use the H1B route for skills needed, That means you have to choose to move from a nonimmigrant visa (the educational ones or some of the work ones) to an immigrant visa. Essentially, you have to enter the lottery or go the H1B route.

But many do not know that the usual pathway that we recruit MD/PhD's or frankly even PhDs to an academic setting from another country is to use the E12/E21 visa route. If they are working on special projects for our US Government (Energy, Physics, NBC, or Military applications), that government agency will even give something called a National Interest Waiver which more or less amounts to "Hello Department of State, please call me if you want to decline this application, we need to chat. Very respectfully, DoD or DoE or some other agency." For physicians of outstanding academic productivity and quality, the E12/E21 route is the usual pathway, but you have to be quite good at your work locally before you emigrate.

Why I have some problems reading your reasoning is that time alone in a residency is not the right answer. Possibly competitiveness for the harder specialties might be, but very few MD/PhDs maintain both a practice and a bench, eventually, one or the other are chosen due to time and bureaucratic constraints. You are also very young, and while I don't necessarily think that PhD's are antithetical to the surgical subspecialties, you have to go out of your way much more than general practice to find a balance between both, as surgery practice rightfully dominates the majority of professional time for most surgeons (with some specialized exceptions where you're dealing with vertebrate animal models at the bench).

So, without knowing quite precisely where your skillset ranks and the nature of the research you intend to pursue, it's still a long shot in all respects. But sooner or later, if you want to live in the US, you are going to have to deal with immigration somehow.