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Truesdale Associates, Inc.

Graduate Medical Education
in America

Truesdale Associates, Inc. has been recruiting International
Medical Graduates on behalf of some of America's leading
residency programs for the past seven years. This webpage is
intended to inform overseas physicians how to qualify for and
obtain a position in an American residency program. The subjects
it covers are:
  1. The structure of American graduate medical education
  2. Overview of requirements for International Medical Graduates
  3. The Educational Commission for Foreign Medical Graduates
  4. The United States Medical Licencing Examination
  5. The J-1 Exchange Visitor Visa
  6. The H-1B Specialty Occupation Visa
  7. The residency recruitment environment for IMGs
  8. How programs assess IMG applicants
  9. Conducting your search for a residency position
  10. Eligibility for Green Card after training
  11. Truesdale Associates
  12. Definitions and Acronyms
  13. Other links
  14. Submit your credentials online

The structure of American
graduate medical education

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."

Overview of requirements for
International Medical Graduates

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:

  1. earn a medical degree from a school approved by the
    World Health Organization;
  2. hold an unrestricted medical licence in his/her home country;
  3. receive a passing score (75+) on Steps 1 and 2 of the
    three-step U.S. Medical Licensing Examination ("USMLE");
  4. pass the ECFMG English test; and,
  5. apply to the ECFMG, with documents and application fee,
    for the ECFMG Certificate.

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.


The Educational Commission for
Foreign Medical Graduates


The United States
Medical Licencing Examination


The J-1 Exchange Visitor Visa


The H-1B Specialty Occupation Visa


The residency recruitment environment for
International Medical Graduates

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:

  1. volume of applications;
  2. American school preference;
  3. shortage of US-trained physicians for residency training; and,
  4. crowding of IMGs into anesthesiology and internal medicine.

How programs assess International
Medical Graduate Applicants

Conducting your search
for a residency position

Eligibility for Green Card after training

Truesdale Associates

Definitions and Acronyms

ACGME
The Accreditation Council of Graduate Medical Education: governing body that sets GME program content and other standards for specialties and subspecialties and audits compliance.
Board
The governing authority for a particular specialty or subspecialty. It administers the examination to accredit physicians who have completed GME programs and, on occasion, recognizes some or all foreign GME and exempts an IMG from all or some of the years of required specialty training.
ECFMG
The Educational Commission for Foreign Medical Graduates: non-governmental organization responsible for assuring that IMGs meet educational standards required by GME programs and for the greater part of the processing for J-1 visa applicants.
Fellowship
A period of medical training in a subspecialty (e.g. cardiology) taken after completion of a medical degree and a Residency (e.g. internal medicine). In rare cases, an IMG will have his foreign GME recognized by the applicable Board which will waive the requirement of an American Residency.
GME
Graduate Medical Education: medical training in a specialty (Residency) or subspecialty (Fellowship) taken after completion of a medical degree.
Green Card
The Green Card is the document which proves a person has Lawful Permanent Residence in the United States.
H-1B visa
The Specialty Occupation visa: it (and the J-1 visa) are the employment visas available from the U.S. Government to physicans coming to the United States for GME. The H-1B applicant must pass Step 3 of the USMLE and obtain an American medical licence but does not face the 2 year Home Residence Requirement or need a Support Letter from the home country.
Home Residence Requirement
The requirement imposed by the U.S. Government on physicians who train on a J-1 visa that they return to their home countries for at least two years before applying for a visa to work, study or live in the United States.
IMG
International Medical Graduate: the graduate of a medical school located outside the United States and Canada. The term is unrelated to citizenship. A U.S. citizen who earns a medical degree abroad is an IMG while a foreign citizen who earns a medical degree in the United States is a USMG.
J-1 visa
The J-1 Exchange Visitor visa: it (and the H-1B visa) are the employment visas available from the U.S. Government to physicians coming to the United States for GME. The applicant need only pass the first two Steps of the USMLE and does not need an American medical licence. However, a Support Letter from the home country is required and a 2 year Home Residence Requirement applies upon completion of training.
Lawful Permanent Residence
Commonly called the Green Card, this is a status conferred by the U.S. Immigration and Naturalization Service on persons who are not U.S. citizens. It enables them to work, study and live permanently in the United States and, normally after five years, to apply for American citizenship.
Residency
A period of training after completion of a medical degree in a specialty such as anesthesiology or internal medicine. Distinguish Residency and Lawful Permanent Residence (i.e., the Green Card).
Support Letter
A letter to the ECFMG from the Ministry of Health of a J-1 visa applicant's home country stating that the country needs the skills the physician will acquire and that the physician intends to return to the home country for at least two years after completing GME in America.
USMG
United States Medical Graduate: the graduate of an American medical school, whether a U.S. student, Green Card holder or foreign student.
USMLE
The United States Medical Licencing Examination: a three-step test of medical science and clinical practice which physicians trained in the United States and elsewhere must pass to obtain an American medical licence. IMGs must pass at least the first two Steps to be eligible to undertake an American residency.

Other links


Submit your credentials online

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.

Your name:

Medical School at which you earned
or are studying for your degree:

Your E-mail address:

Your postal address:

Enter your highest two digit score on each Step of the
USMLE for which you have received results:

Step 1 Step 2 Step 3

Brief comments (or email: truesrec@aol.com)

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
:

  1. Curriculum vitae;
  2. Score reports for any Steps of the USMLE you have taken;
  3. Medical degree;
  4. Medical licence(s); and,
  5. Documentation of (non-American) graduate medical education.

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:

Truesdale Associates, Inc.
Resident Recruitment Division
8745 Niagara Falls Blvd.
Niagara Falls, NY 14304-1947
U.S.A.

visitors.

Copyright (c) 1997 Truesdale Associates, Inc.
All Rights Reserved


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