ALTERNATE PATHWAYS FOR FOREIGN MEDICAL GRADUATES

Dear Friends:
One of the aspect or cause of our failure to get into residency program here in USA is wasting of time in observerships. The programs don’t consider observerships/research/externship as clinical experience for foreign medical graduates because whatever you do they think it’s not a quality clinical experience. So I don’t know how much it really helps. It might help also depending on individual cases but it is my opinion that if a USA degree is mentioned like a master’s degree or strictly clinical experience like surgical assistant or something like that, it would look good on resume/CV. Honestly if you are in USA for more than 1 year just doing observership, its not gonna help. If you in USA for 3-6 months waiting for match or applying for match than it’s a good idea to do some observership/externship. People usually say observership is helpful, well it indeed but not for 2-3 years, program director might have applicants who did master or some post grad degree while in USA, so they would prefer applicants with some educational/academic activities rather than just observership/research etc.. I hope I am clear now. I have seen it myself and hopefully you will also be able to see the change in your CV when you do a USA degree.
The other thing is when you are in USA don’t waste time get some diploma or something so that even if you could not get residency for whatever reason you should always have a back up plan and something you can do. And lastly my friends “USA is not the end of world, wasting years and years in search of residency and driving cabs or working at gas station does not worth it”. If you have resources then please travel somewhere else and get your goals over there. So bottom line is “Don’t waste time while staying in USA waiting for residency.”
I am going to mention some link so that you can try them and find out, what is good for you.
1. Optometry, is a degree which lets you practice as an optometrist and thinking long term you might get residency in ophthalmology. There is a school in Massachusetts, New England School of optometry, which lets foreign medical grads. finish the degree in just 2 years.
The New England College of Optometry
Association of Schools of Optometry
2. Master in Public Health, (MPH) It helps you getting a master degree and residency in occupational health, preventive medicine and even family practice. One example is a link below, there are almost 26-30 schools of public health in USA and it’s easy to get admission. Search the web for school of public health.
The Univ. of Texas-Houston-School of Public Health
American Public Health Association, links for all Public health schools
3. Surgical Assistants, certified surgical assistant get good pay and great clinical experience.
National Surgical Assistant Association
American board of surgical assistants
4. Master/Ph.D. degree in any basic Medical sciences like Pathology, pharmacology etc… this is offered by a lot of university programs and it’s not very hard to get into. It definitely helps in getting residency and a job. One example is a link below, there are 100’s of universities offering masters programs. search the web for your program of choice
The University of Texas-Houston Graduate School of Biomedical Sciences
5. Non-accredited fellowships in USA, these are fellowships offered by different intitutions like post doc research fellowships and clinical fellowships. US graduates don’t do these because they are not accredited and don’t make the eligibility criteria for board exams purposes. Some of the examples are below and you can find opportunities like these on web. The clinical fellowships require you to have ECFMG certificate, so that they could issue you a institutional permit, to work with the patients. Post Doc research fellowships could be in any field, pharmacology, pathology, biochem etc.. Clinical fellowships are in CV surgery, ENT and other subspecialties.
MD Anderson Cancer center, Houston, Texas
Texas Heart Institute, Houston, Texas
There is also another option of “School of perfusion technology”. The perfusionist makes good money and it’s a technical work. Basically it is the person who runs the By-pass machine during cardio-thoracic surgeries. It’s a good field but schools in USA don’t emcourage FMGs to do this course but there is no harm in trying.
Texas Heart Institute, Houston, Texas, look for perfusion technology
“Physician Assistant” is also another option but most schools require that you have BS degree from USA to enter into the school.
American academy of Physician assistants
6. PG medical education in the world: Follow the following links for post graduate medical education in Canada, England, South Africa, Australia and New Zealand.
Australian Medical Council
College of Medicine of South Africa
NZ med jobs
New Zealand (NZ) medical council NZMC
Royal College of Physicians London
Royal College of Physicians of Edinburgh -
Royal College Ireland Royal College of Surgeons-IRE
The Royal College of Physicians and Surgeons of Canada - Homepage
The Royal College of Surgeons of England
Some information based website done by docs in New Zealand, are also good.
Oversaes doctors
Oversaes doctors
I hope it helps all of you and please if you find any information about some other better alternate things in USA pls. email me and I will post it on web. My friends we have to help each other by spreading the information don’t keep the info to yourself spread it. It might help somebody like you.

Immigration Law and International Medical Graduates

At the risk of leaving out much pertinent information, this article proposes to serve as a general overview of the erstwhile complex and complicated area of Immigration law as it concerns foreign physicians seeking to enter the U.S. for purposes of graduate medical education, clinical practice, teaching and/or research. This article will be limited to providing some operating definitions and proceed with a general discussion of the B-1, H-1B, O-1 and J-1 nonimmigrant visa categories. The article will then address the two-year foreign residence requirement that J-1 residents and fellows are subject to and mention the various waiver strategies thereof. This article will not discuss the various immigrant visa or “green card” options. Interested parties are invited to contact the author directly with their queries about immigrant visas or any other immigration-related matter

Definitions
An “alien” is any person not a citizen or national of the U.S. All visa holders, non-visa holders, and permanent residents (that is, green card holders) are classified as aliens. An immigrant is a person who is a lawful, permanent resident of the U.S. This classification does not include persons with temporary visas. A nonimmigrant is a person who has been issued a temporary visa by a U.S. consular officer (if abroad) or other authorized official (if in the U.S.).
An International Medical Graduate (IMG) is a person who has graduated from a medical school in an international state or who is otherwise qualified to practice medicine in an international state. To claim IMG status by virtue of having gone to medical school, an IMG must have graduated from a medical school that 1) is listed in the World Directory of Medical Schools published by the World Health Organization (http://www.who.org/), and 2) is located outside the U.S., Canada, and Puerto Rico. All IMGs desiring to enter the U.S. to practice medicine must have passed parts I and II of the NBME examination or its equivalent (that is, VQE, FMGEMS, or the USMLE). Unless a Canadian medical school graduate is conferred a degree by a medical school that is accredited by the Liaison Committee for Medical Education (http://www.lcme.org/), he or she is considered an IMG and is subject to all the requirements of an IMG. Examinations are waived for IMGs who 1) are of national or international renown in the field of medicine, 2) were licensed and practicing medicine in the U.S. before 9 January 1978, or 3) come to the U.S. to teach or to conduct research in which no direct patient care is involved.
The Educational Commission for Foreign Medical Graduates (ECFMG) (http://www.ecfmg.org/) administers examinations to IMGs and determines whether they are qualified to enter an accredited residency or fellowship program in the U.S. The ECFMG website offers a tremendous amount of information about the USMLE, J-1 sponsorships and provides valuable links to other web resources.
The United States Medical Licensing Examination (http://www.usmle.org/) was introduced in 1992 and replaced the National Board of Medical Examiners (NBME) examination, the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), and the Federation Licensing Examination (FLEX). The USMLE is a three-step examination offered at various times during the year in selected locations throughout the U.S. and the world.

Nonimmigrant Visas
B-1 (Temporary Visitor for Business)B-1 visas are available to (1) IMGs or international medical students (IMS) who are coming to the U.S. to take an elective course at an American medical school or hospital that is part of their formal medical education, (2) IMGs who come to the U.S. to observe medical practices, to consult with other physicians on the practice of medicine, or both, and (3) IMGs desirous of coming to the U.S to interview for GME positions. A B-1 nonimmigrant may not work in the U.S. and cannot participate in any patient care. Generally, a person may not remain in the U.S. with a B-1 for more than one year.

H-1B (Temporary Worker)
The H-1B is the most preferred visa by IMGs and, if offered by a GME program, can often be used to attract the most qualified candidates. An H-1B enrolled in a GME program may engage in any medical activity provided the he or she (1) has passed all parts of the USMLE (or its equivalent) or is a graduate of a U.S. medical school, (2) has established competency in oral and written English, (3) is fully licensed to practice medicine in a foreign state, and (4) is otherwise authorized to practice in the state of intended employment.
If an IMG has not passed the necessary examinations, he or she may still enter the U.S. under the “researcher/teacher” classification, which specifies that the employer must certify that any patient care will be incidental to the IMG’s research. After coming to the U.S. and passing the necessary examinations, a “researcher/teacher” IMG may legally change his or her H-1B classification to “medical resident.”
The H-1B visa can be granted for a maximum of 6 years. As of the date of this article, IMGs who will be employed in a research or GME capacity by (i) institutions of higher education, (ii) their related or affiliated non-profit entities, (iii) nonprofit research organizations, or (iv) governmental research organizations are exempt from the number of H-1Bs that may be granted annually (195,000 for fiscal year 2001). Once a petition filed by an employer is approved, the IMG (other than citizens of Canada) must apply for an H-1B visa at a U.S. consulate. If the IMG is in the U.S. under some other visa status (such as B-1/B-2, F-1, and so forth) the IMG’s status may be adjusted to H-1B in the U.S.

J-1 (Exchange Visitor)
Administered by ECFMG, the J-1 visa is the most common visa for IMGs. To qualify for certification and sponsorship by ECFMG, an IMG must have passed Steps 1 and 2 of the USMLE, have a contract for a position in a “matched” program accredited by the Accreditation Council for Graduate Medical Education (www.nrmp.aamc.org/nrmp) and have demonstrated competency in oral and written English. A J-1 may engage in direct patient care.

J-1 Waivers
Many J-1s are subject to a two-year foreign residence requirement upon the completion of their training. This rule is strictly enforced wherein the J-1 visa holder must return to his or her country for at least 2 years before being allowed to re-enter the United States in another visa category. Many J-1 visa holders, however, try to have the 2-year rule waived. Not surprisingly, this is difficult. The following are the only statutory grounds for an IMG to obtain a waiver of the 2-year foreign residence requirements:
Pursuant to a recommendation by an interested federal agency or a state department of health to the INS
Upon the issuance of a “No Objection” letter from the J-1’s home country (not applicable to IMGs who were issued J-1s for GME purposes)
Upon a showing that the J-1 will face persecution upon returning to his or her home country
Upon a showing that a U.S. citizen or permanent resident spouse and/or child would face “exceptional hardship” were the J-1 required to fulfill the 2-year foreign residence requirement
J-1s are required to work in federally Designated Health Professional Shortage Areas to be eligible for a waiver. The agencies that most frequently act as interested federal agencies are the U.S. Department of Agriculture and the Appalachian Regional Commission. In addition to USDA and ARC, other federal agencies, most notably the U.S. Health and Human Services Administration, can act as an interested agency. Finally, each state is empowered to recommend up to 20 waivers. Each agency had its own waiver application guidelines and should be consulted on a case-by-case basis.

O-1 (Alien with Extraordinary Ability)
Given the difficulty of J-1 waivers, IMGs and their employers often look to the O-1, which is the only relevant visa that a J-1 who is subject to the foreign residence requirement can apply for. To qualify for O-1 status, one must demonstrate sustained national or international acclaim and recognition for achievements in the field of expertise. This is established by receipt of nationally or internationally recognized prizes or awards, membership in associations field which require outstanding achievements of their members, published material in professional publications or major media about the alien concerning the alien’s work in the field, participation on a panel, or individually, as a judge of the work of others in the field, scientific, scholarly, or business-related contributions of major significance in the field, authorship of scholarly articles in the field in professional journals or other major media, employment in a critical or essential capacity for organizations and establishments that have a distinguished reputation, high salary or other remuneration commanded by the alien for services and other comparable evidence. There is no explicit statutory limitation on the period of stay for an O-1.

Advice for Foreign Physicians on Job Opportunities

I have listed some temporary Job Opportunities for Foreign Doctors entering into US Medical System. While there are many factors that are important in the success of getting into a residency program, the ability to persist and preserve in life stands out head and shoulders above the rest!

Life to most doctors who did not match seems to be filled with uncertainty, self doubt and financial shackles. I’ve been there and I am very much familiar with that life situation, it is natural to feel let down and disappointed but the wisdom we gain from going through the process of feeling deep disappointment gives us access to the heart of humanity. If it’s any consolation, like everything else in life... this too shall pass. A few years from now you will wonder why you let yourself worry so much. I'm not trying to make light of it here. I just want to put it in perspective.

Not in a particular order but these are few of the alternative job opportunities you can pursue until you get into a residency program:

1. Physician Assistant
2. Medical Assistant
3. Working in Kaplan with Student Visa
4. Research Associate
5. Pre-Residency Fellowships
6. Nursing
7. Sleep Technician
8. Others

1. Physician Assistant - Although most states in US require a PA license to practice, there are County hospitals affiliated with Universities which provide Foreign Medical Graduates (FMG) with Temporary Residency Training License which allows you to work as an Intern/PA/Fellow, they are Non-ACGME accredited programs and will sponsor H1b Visa's if you passed step 3 and J1 if you haven't.

Some of the Non-ACGME programs, which provide these opportunities, are:

(A) Liver and Renal Transplant (Surgery) programs
(B) HIV/ Special Immunology (Medicine) programs

Your Salary will be the same as the first year resident and you are required to be ECFMG Certified.

I've known colleagues who have not completed USMLE and switched to being a Physician Assistant after taking the 2 year PA course and are now earning a very good income with a 9-5 job.

2. Medical Assistant - This also requires you to be certified but there are private clinics who will take you as a medical assistant without certification. I doubt if they will be able to sponsor your visa, but if you are a green card or a citizen and are unable to get an observerships or clinical experience, this is a safe alternative. (Also a good way of acquiring recommendation letters)

3. Working at Kaplan with Student Visa - I don't think this requires much explanation.

4. Research Associate - There are tons of positions available in this arena. All you have to do is go the website of the University near you and look at Job Opportunities section. The draw back with this is that they all require Research Experience. Don't be discouraged, the best way to approach this is to personally go to the department at least 3 times a week and just help them out with anything and everything. You have to use your interpersonal skills here. You will achieve much more by doing this than sending your application online and waiting for reply.

5. Pre-Residency Fellowships - These are fellowships which provide you with US Clinical Experience. You will be working as an Intern and earning similar income as an Intern, These programs are only available at University based hospitals. They sponsor H1b and J1 visas and require you to be ECFMG Certified.

Some of the Non-ACGME programs, which provide these opportunities, are:

(A) Interventional Radiology
(B) Trauma
(C) Neurosurgery
(D) Pediatric Surgery

6. Nursing - While working at the university, I've met number of FMG's who took a temporary appointment as a Nurse at a hospital. When I inquired why they chose this route, almost all of them replied that it was either for financial reasons or to secure their immigration status. All of them got their Green Cards through this opportunity and made considerable amount of money to finish their USMLE steps and apply for positions. Most of them had family and children to support. Last year, I was delighted to find out that out of 7 individuals, 5 of them matched successfully in Family Practice (mostly NJ). Drawback – You have to complete a nursing course at a nearby college for 1 or 2 years and have to pass NCLEX.

7. Sleep Technician - This is getting more popular now days, Sleep clinics all over the country require Sleep Technicians. The job responsibilities are simple, apply EEG electrodes and gather data. This is especially a great opportunity if you are interested in pursuing residency in Neurology. Drawbacks – Most probably no visa sponsorship and you should be willing to work at nights.

8. Miscellaneous Jobs - There are sometimes situations in life which requires one to work at jobs which are not related to the medical field. There is no shame in this, but is sign of great strength and maturity. I have known Cardiologists, Surgeons, Pediatricians etc. who worked at gas stations, waiters at restaurants, janitors and some even as barbers. Interestingly, some of them mentioned this experience in their personal statements very eloquently which added depth and humility to their personality. Honoring whatever experiences we have in our lives is an invaluable way to transcend to the next level, our greatest teacher is off course life itself.