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Graduate Medical Education ("GME") in the United States is quite systematic and methodical. Physicians receive their training in a given specialty from a single institution. (In the United Kingdom, physicans undertake GME at several hospitals, usually switching facility, and sometimes specialty, at six month intervals.) The programs generally begin around July 1, although late arrivals can often be accommodated and some programs take in physicians around January 1 too. Programs in various specialties have a fixed duration: internal medicine, family and pediatrics (3 years); anesthesiology (4 years); and radiology (5 years).
GME programs must be accredited by the Accreditation Council for Graduate Medical Education ("ACGME"). The ACGME stipulates what skills must be acquired in each year of the program and imposes many other standards. It regularly audits programs for compliance.
Near or after the completion of a program, the physician must pass an examination set by the Board governing that specialty ("Board exams") in order to be accredited in the specialty. Only after passing the exam may the physician practice as an internist, anethesiologist, radiologist, etc. Program directors seek a pass ratio on Board exams of as near to 100% as possible. The pass ratio is perceived as one indication of program quality.
Programs are classified as residencies or fellowships. A fellow must complete a residency (in rare cases a waiver is possible on the basis of foreign training) before taking up a fellowship. For example, successful completion of a residency in internal medicine is a pre-requisite for training in cardiology. The disciplines for which residency training is taken are called "specialties" while fellowships are for "subspecialties."
The Educational Commission for Foreign Medical Graduates ("ECFMG") determines which International Medical Graduates ("IMGs") - i.e., graduates of medical schools outside the United States and Canada - are qualified to receive Graduate Medical Education ("GME") in the United States. It issues the ECFMG Certificate to IMGs who meet its requirements.
To obtain an ECFMG Certificate, an IMG must:
In addition to the ECFMG Certificate, the IMG needs a work visa
from the U.S. Government because an American residency is paid
employment. The two types of visas applicable to IMGs receiving
GME ("residents") are the J-1 Exchange Visitor Visa ("J-1 visa")
and the H-1B Specialty Occupation Visa ("H-1B visa").
The J-1 visa is available to ECFMG Certificate holders, whether
or not they have passed Step 3 of the USMLE. By contrast,
the H-1B visa entails passing Step 3. In addition, it is
necessary to obtain a medical licence (which may be a temporary,
training licence) from the U.S. in which the IMG wishes to
be trained in order to receive to H-1B visa.
The J-1 visa requires one document that the H-1B visa does not.
The Ministry of Health in the physician's home country must
provide a letter stating that the country has need of the skills
the physician will acquire in the U.S. and the physician intends
to return to the home country to use those skills ("the
Support Letter"). In most countries the Ministry of Health
issues the letter quite readily but Canada rarely grants it and
India sets significant documentation and bond requirements.
While the J-1 visa does not require Step 3 or a U.S. licence, it
also carries an important disadvantage: the two-year home
residence requirement ("the HRR"). At the conclusion of the GME,
the J-1 visa holder must return to his or her home country
to live for two years before applying for a visa to work,
study or live permanently in the United States. The HRR puts some
teeth into the statements in the Support Letter.
The H-1B visa has no HRR. Indeed, because a person can be in
H-1B status for six years (before being required to leave the
U.S. for one year), a physician who finds a job after
residency is normally eligible to work for two or three years
after GME. Of course it is necessary to apply for a new H-1B
visa, but they are routinely and rapidly granted.
Every program, and each of the people who participate in its
resident selection decisions, is unique. So there are
no rules of general application governing the assessment of
applicants. Nevertheless, during our seven years of helping
a large number of residency programs across the United States
hire International Medical Graduates ("IMGs"), we have developed
insight into how programs tend to assess physicians.
The defining characteristics of the resident recruitment
environment for IMGs are the:
Truesdale Associates, Inc. is paid by a group of leading
American graduate medical education programs to recruit
physicans to undertake residencies at their institutions.
No placement fees are charged to candidates.
We invite you to complete this brief form and submit it to us
electronically. We hope that your USMLE scores meet the
requirements of some or all of our clients. Within
three business days of receiving the form below, we would
contact you to request additional documents and further information
or, if we are unable to help you, to
provide extra suggestions about conducting your own search for
a residency position.
The information on this form will not be furnished to any of our
clients without your prior consent (and of course, your curriculum
vitae). You will receive not more than four e-mail messages
and two letters from us (and we shall not release your addresses
to any other party) so you need not be concerned that
providing us your addresses will clutter up your mailboxes.
We think that in making contact with us you have nothing to lose
and, we hope, a good opportunity for graduate medical
education in America to gain.
While useful, this form is no substitute for a complete
package of documents that allow us to view your accomplishments
as a whole and decide whether to recommend you for consideration
by our clients. We invite you to send us by regular mail your
:
In addition, we would appreciate a short letter detailing
the specialties you wish to pursue; any plans you have to take or retake
Steps of the USMLE; and the year you would like to begin a
residency in the United States. All mailed packages of
application documents are considered independently of
the electronic forms. Our mailing address is:
visitors.
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All Rights Reserved