FREQUENTLY
ASKED QUESTIONS (FAQs)
Dear Colleagues, I have tried to make my web page as simple as possible but I did find out that people do have questions and this FAQs section would give you info., which you were not able to get on my web page.
Q1.
What is the US medical Licensure system and requirements?
Ans. USMLE is a series of 3 exams step-1 step-2 and step-3 which lead you to US medical licensure (some states require you to finish one year residency in US before you take Step-3 exam some states don’t require that).
Step-1 and 2 can be taken in most countries in the world through sylvan technology centers. It is computer based but NOT YET ON INTERNET.
CSA (clinical skills assessment) is a new test, which is now required by foreign med grads (FMGs, people who do medical school degrees outside USA) to get their ECFMG certificate. It is only conducted in philadelphia, USA and the fees is 1200 US Dollars.
If an FMG passes step-1 and step-2, TOEFL (English language exam) and CSA, he is eligible for applying to a residency program in USA.
Q2. What is the
requirement for
step-3 exam?
Ans. Different states have different requirement
for step-3 exam but generally it can only be taken after successfully securing
ECFMG certificate (passing step-1, 2, CSA and TOEFL). Some states require you
to finish at least one year US residency training program before taking step-3
but some don’t require that. The information about different states
requirement can be obtained from
Federation of
state medical boards (FSMB)
Or calling the toll free no. 1800-USMLE XM
(1800-876-5396)
Q. How should one plan MLE steps date wise when taking steps outside USA?
A. Each year residency interviews start in september or October and Residency Match comes in March , If you plan to come to USA on visit visa to get your interviews done then you should take your steps in your country and should be eligible to take CSA by September or October each year, I mean plan your step dates accordingly. Then you can come to USA in Septemeber or October, take your CSA and do your interviews in November/December or January and then the Match result comes in March. If you match get your paper ork like Contract from program and go back to get the Ministry of health letter (NOC) from your country. you can ask ECFMG to send your IAP -66 to send to your home country, so that you can apply for j-1 visa and then come here by July 1st, when you start your residency.
Q3. Why to take step-3 before residency?
Ans. Step-3 can be taken right now only in USA. It is usually taken during the first year of residency but some states allow foreign med grads to take this exam without residency. When you pass step-3 you are eligible to apply for licensure in USA but 99% of states ask you to finish the residency requirement before applying for licensure.
Most of the states in US require that you should pass your steps 1, 2 and 3 with in 7 yrs. (from the date you passed your first exam, step-1 or 2 does not matter) as a requirement for state medical boards. Things you should consider here
1. If you don’t pass the 3 steps in 7 yrs and US FSMB change the system like they did earlier from FMGEMS and FLEX exam series to USMLE then your step-1 and 2 would be disqualified, and if they bring in some new exams series then you will have to do the new exam series again. So it is better to pass the exams in 7 yrs.
2.
Extra benefit for IMGs/ FMGs, if they pass USMLE step-3
before residency, they would be eligible for
H-1 visa, which is much better than
the usual J-1 visa for residency. If the program offers H-1 visa then the
applicant can be sponsored on H-1 (with the valid pass result of step-3), and
hence can get green card also.
3.
USMLE step-3 is universal means it is applicable in every state. It
does not matter if you do it in one state or other. But with out it you are
not eligible for licensure.
Q4. What are different visa types one can
pursue residency?
Ans. Any legal visa status that allows you to
work full time in USA.
1.
J-1 visas, these are sponsored by
the ECFMG with documentation from the residency programs. The detailed
procedure is mentioned in the VISA
INFO section of this web page.
2.
H-1 visas, these are sponsored by
the residency programs, if the applicant has met all the requirements
including the pass score on USMLE step-3. This is a better visa than J-1 visa,
which has an obligation to go back to your home country after finishing the
residency program for 2 yrs. The H-1 visa can lead to green card ultimately.
3.
Green card or valid employment
authorization, this is a legal visa status, which allows you to work full time
in USA and residency training is basically considered a full time job.
4.
US citizenship, of course you are
allowed to work full time in USA.
5.
F-1 student visa, some FMGs/IMGs
are in USA pursuing their master’s degrees, if they are accepted by a
program in residency and if they have their OPTIONAL PRACTICAL TRAINING (OPT),
they can pursue the residency program. Things to be considered:
a.
Some times it becomes difficult because the OPT is one year and the
program has to be agreed that during this year appropriate visa would be
processed.
b.
The OPT requires that you should do your job in your major study field.
For the purpose of residency OPT is not considered valid but for some programs
like OCCUPATIONAL MEDICINE RESIDENCY, if the applicant was doing Master in
public health (Occup. Hlth) and he/she has OPT, then he/she is eligible to do
residency. Same goes for Pathology residency (if some one got OPT after doing
Master/Ph.D in Pathology). The point is that OPT should be used in your major
field of study but OPT is a valid document (VISA status) to start residency.
Q5. How long it takes to get visa status
changed if the IMG is in USA?
Ans. If
the visa status has to be changed from US INS, then it may take from 90-120
days. If the visa status has to be changed from US consulate/embassy, then its
just like getting any other USA visa (just one day).
Q. Where I should get my visa stamp, from home country or USA neighboring countries (Mexico or Canada) after getting matched (for my j-1 or H-1?)
Ans... After Sept 11th Tragic event USA INS has very strict policies about giving visa stamps to people who are not citizens of Mexico or Canada.....so before u even plan to go to Mexico for your visa stamps, pls ask INS if u can even do it...I think for time being it was closed also after sept 11th..... Its tough guys....USA consulates and visa officers have such subjective criteria for your visa that you can never be 100% sure but usually H-1 and J-1 are easy visa to get....if your previous USA visit and visa history is not bad ...means no over stays....no filing of green card...no multiple rejections for visas...if your history is plain and simple like....you came on visit visa for interviews and CSA (no over stays, no other illegal activities) and now after match you want to go back and get your visa from your home country..I think its very valid and chances are if your documentation is complete ..you will get a visa... on the other hand, if you have stayed in USA on a visit visa , over stays or multiple extensions...also change of status from visitors to student or trying to get a green card... i mean not a very good and clear record.....then you should avoid going back to your home country and also try to get a lawyer involved and visit mexico or canada with a lawyer with you to get visa...it might cost you money but these lawyers are expert in handling these situations and very good..... get lawyers info from visa section of this webpage.... hope it helps some...I know its a tough decision....
Q6. What is H-1 visa annual cap?
Ans. This
is the limited number of H-1 visas offered by US INS every year and the fiscal
year starts from October 1st each year. If you need to get H-1 visa
for residency, which usually starts in July each year, either you will have to
wait unless your H-1 visa is processed or you have to go to some other visa as
J-1. The program has to agree on all these conditions like waiting for you
till October. For insyance if the annual cap for H-1 visa is finished for year
2000-2001 then, to get a new H-1 for residency applicant will have to wait
till October. You need to have your step-3 scores in April when the program
starts paper work after you match and then if the annual cap is not over you
might be able to start your residency on time (that is July or August) but if
the annual cap is reached then you will file your paper work and the H-1 visa
status would be issued/started in October when the annual cap starts for next
year.
Q7a. What is ERAS?
..ERAS is elctronic residency application system....the system initially used by US graduates and now for all. the way it works is that you contact ECFMG and pay them some fee , they give you a code and detail instuctions, to log onto their website on internet and mail your supporting documents for residency application electronically .... rather than sending by regular mail to ECFMG...you do have to some documents in mail also as specified by ECFMG and then acording to your choices ECFMG applies electronically to those programs on your behalf with all the supporting documents.. and hence you dont have to send paper application to the programs directly though program can ask you to send some more documents once they receive your application......There is a certain amount of money you pay to ECFMG for applying to each program, details on ECFMG webpage....but the initial choice process remains thesame, as it was... like call the program before applying about their citeria each year for FMGs, score wise, visa sponsorship and other specific questions you have in mind....
Q7. Where and what programs to apply for residency training?
This a tough question, i have been reading this all the time , where to send the applications. i think the best is to consider your options according to your scores, choices and preferences. Here are some general guidlines:
1. scores, 85-90 and above, any program but do call them and ask them about sponsorship of visa, so that if you need a visa sponsor and they dont sponsor you dont waste your effort and money.
2. scores 80-85, mid size programs or even small programs, dont think of too big (being honest and modest and for me passimistic too as we are FMGs.). anyway think of programs like not too big university but relatively small. i wont give any specific names because honestly programs change their policies according to need everyyear.
3. 75-79, very careful, call all the programs and ask their criteria for acceptance.
some more gen guidlines
1. if you are in USA, call the program and ask all the pertinent questions you have and then decide to send the applications.
2. some questions you should ask on phone always...1.score, 2. visa, 3. any extra requirement like US clinical experience.4. IMGs friendly or not, dont ask friendly but ask how many IMGs are there in the program
3. to me there is nothing such thing as foreigner friendly or not friendly, all programs can take you if they need people to run the program. So call up the program and talk to people over there.
4. For people not in USA, honestly go with your gut feeling, past IMGs experiences and your own choices and preferences. Dont rely too much on exceptions. Be realistic and accept facts like if you have scores in 70's or lower 80's do not apply to Harvard, unless your resume other wise is very strong. Rest is up to you.
Q. Is it advisable to use the "residency consulting services", companies who help in getting residency??
Ans: Well as i said earlier if a company is guaranteeing 100% a residency spot for 1500 or 2000 dollars , chances are they are lying.... if a company is charging some money to make your resume and telling yo uthe tips and they have helped some people (people who wont get residency otherwise) , that means they could be helpful in your case.... if people with scores of 90s are getting help from these companies , and they were able to help them its not a big deal..people with 90s would get residency anyway... if they have helped somebody with compromising scores and credentials that would be considered something positive.... so things you need to do before hiring any such company...Tell them your scores and credentials and ask them how much they can help.... talk to people who used their services and see if they were really helpful for people with yuor type of scores and credentials..... but be careful there are crooks out there who are making money from desperate FMGs.... like Coon and associate of New York....and other people too.If they are really helpful then i guess spending some money is not a bad idea...
Q. Can I do Residency on work permit issued by INS during Green card Process?
Ans... YES you can do your residency , just keep your permit renewed and up to date during residency.
Q. Should I use the services provided by commercial companies helping getting into residency?
Ans. It is a very difficult situation , a lot of people have tried to fraud poor and desperate FMGs, and made money with out any results. especially COON and associate of New York. The best way is to contact the people who used these commercial services to get into residency and ask their experience honestly. I guess nobody can put you into a residency program by charging you 1000-2000 US Dollars. so talk to people who used their services, but generally my experience is that they are FRAUD.
Q. What are the dealines for me to be eligible for 2002 match?
Answer...please look the http://www.ecfmg.org but the general deadlines are....."The National Resident Matching Program (NRMP) requires that all graduates of foreign medical schools who wish to participate in the Year 2001 Match have all required ECFMG® examination scores reported to the NRMP by February 22, 2002. Since all Step scores are now reported on a regular basis, ECFMG will revert to its standard six to eight week reporting period for CSA results, and the extension of time granted in 200 will not be offered for the 2001 Match. Hence, in order to ensure that results will reach the NRMP in time for participation in the Year 2001 Match, CSA must be taken by Jan 13, 2001. Every year ECFMG decides a deadline for FMGs to pass all the requirements (USMLE 1, 2 CSA and TOEFL) so that they have their ECFMG certification before match this date is usually toward the end of Februaury each year for that year (for eg. match 2002 it would be probably Feb. 22 2002). To get all your exams done by this date usually you have to take all the exams before mid January each year. Always confirm deadlines with ECFMG website also.
Here are some more guide lines for deadlines:
Starting in June we will mail ERAS 2002 Applicant Manuals and Document ID Stickers for all new and pending Token requests.
Early in July we will start e-mailing Tokens to all applicants who have a balance of at least $75 in their account. After that, we will fill new Token requests within a few days.
On July 15 www.myeras.aamc.org August 15 The ERAS Post Office will open. You can start transmitting your
Common Application Form (CAF), your Profile and Personal Statement/s (PS) -
and we will start transmitting documents. August 15 The Applicant Document
Tracking System (ADTS) will open, so that you can monitor the progress of your
application. Daily (Monday-Friday) from August 15 to April 30: We will scan
and transmit documents. We will update and transmit ECFMG Status Reports and
USMLE Transcripts.
November 1 Dean's Letters will be released by the ERAS Post Office, no
matter when they were transmitted.
NOV / DEC Program directors start their selection process
December 1 Application Deadline for the Match. Please go to
www.nrmp.aamc.org DEC / JAN Last chance to take CSA (to remain in the Match). Please check
the ECFMG web site for specific deadline dates later this year.
DEC / JAN / FEB is generally the time for interviews.
Mid-February We must confirm CSA Pass to the NRMP. Mid-February We must
confirm that your English exam is current for the Match.
Mid-March NRMP will post Match results on the Internet. Mid-March We will
stop mailing current Tokens.
April 30 ERAS Post Office will close, ending current ERAS cycle.
July 1 Start Residency
Q. What should the letter of rec. (LOR) look like?
Answer... First thing it is best if given by American trained MD, or MD.
Ph.D. It should cover your clinical experience or if you have done some
clinical research projects. It should mention about your clinical interests
and patient exposure. It should also say that the writer highly recommends you
to get the residency position. It is good if you can have 3 LORs from US
trained MD people. It is always good to have letters from some University
based teaching hospital settings and in the same specialty which you are
applying for. LORs are good if they are detailed and have good information
about you as the person who is writing knows you by name and by face.
Q. Can FMGs/IMGs do moonlight, during residency?
This is a cutting from ECFMG site, the rules about residency J-1 "Two
employment related or work authorization questions arises from the desire of
many participants and medical facilities to have the foreign medical graduate
participate in residency training as a "chief" resident or work
outside of the residency program. First, the number of years of eligibility
for program participation and thereby work authorization is totally dependent
upon the period of time established by the American Council for Graduate
Medical Education as published in the American Medical Association: Graduate
Medical Education Directory. It appears that many residency programs have
attempted to add an additional year of residency training and thereby have the
services of the foreign medical graduate for the additional year. Given the
requirement that the USIA administer this activity on a national basis and in
conjunction with criteria established by the Secretary of Health and Human
Services, USIA will not authorize program participation for this additional
year unless such additional year is set forth as a requirement in the American
Medical Association: Graduate Medical Education Directory. Further, a foreign
medical graduate is not authorized to "moonlight" and is
without work authorization to do so. A foreign medical graduate may receive
compensation from the medical training facility for work activities that are
an integral part of his or her residency program. The foreign medical graduate
is not authorized to work at other medical facilities or emergency rooms at
night or on weekends. Such outside employment is a violation of the foreign
medical graduate’s program status and would subject the foreign medical
graduate to termination of his or her program."
for all pertinent information on j-1 visa and rules pls. visit the ECFMG
site US info. agency's statement
also visit the ECFMG site for additional info US
info. agency's statement addendum
Q. HOw do Internship thing works like float and other common terms in
internship?
A. The thing is before starting the residency it is hard to
understand all the common terms used but some common terms like FlOAT, ok the
float is the person who covers for the whole service, lets say in a hospital
there are four int. med teams, one team would be on call every nite and the
rest of the teams who leave at 5 or 6 PM would check out their patients to
FLOAT so that during nite he can take care of patients. some hospitals do have
services like Hepatology , Hematology, and others and their admission if come
during nite hours then float has to admit those and tell the respective teams
in the morning about those patients. Usually float hours are different in
different hospitals but its usually to cover nite hours..Check out patient
information should be appropriate and to the point and the website below
allows you to make good check out list. it's a free site.
http://www.medcalc.com/checkout
Ambulatory, means clinic like outpatient clinic where you as resident go
and see patient in OP clinics.
SNF, skilled nursing facility , it is for patients who are not very
sick/ill and they some care which nurses can provide. they are placed in those
facilities and then discharged after completing IV medication or any other
purpose they were placed in.
q4 Hours , as standard medical abbreviation q is "every", SQ is
subcutaneuos, also buy a small pocket publication called "Maxwell quick
medical reference" and the pocket publication for every subject
"current clinical strategies". (www.ccspublishing.com/ccs)
Every hospital has dietician and nutrition service and there are different
formulas for tube feedings like NEPRO for renal patients, others are osmolite,
promote, vivonex but the name may be different in diff. hosp. Standard are AHA
(amer. heart assoc diet, usually low salt) and ADA (amer. diabetic assoc
diet).
Q. Which programs offer H-1 visa?
Ans....Some of The following places offer H-1 visa:
1. Cleveland Clinic Foundation, OH
2. Henry Ford Hospital, MI,
3. Hahnemann University Hospital, PA
4. SUNY @ Buffalo Program A
5. St. Raphael Hospital, CT
6. St. John's Hospital, MI
7. Abington Memorial Hospital, PA
8. Harbor Hospital ,MD
9. Graduate Hospital, PA
10. St Vincent's at Bridgeport, CT
11. Temple University Hosp-Samaritan Program, PA
12. Mt Sinai SOM @ VA Bronx, NYC
13. Mt Sinai SOM @ Queens Hospital Center, NYC
14. Lincoln mental ......, Bronx
15. Coney Island Hospital, Brooklyn
All of them sponsor H-1 visa except for No2. No 11, No12 and No15 go almost
entirely thru prematch.
Q: What is fifth pathway program and who is eligible for that?
Ans: Fifth pathway is a type of internship (supervised clinical
training) offered to only US citizen FMG who graduate as medical doctors from
outside USA in countries where Govt./social service or 1 year internship is a
requirement to obtain the medical degree or diploma. for further details pls.
follow the following links.
http://www.imgi.org/fifthpathway1.html
http://www.nymc.edu/depthome/fifth.htm
http://www.gdl.uag.mx/83/fifth.html
http://www.bcm.tmc.edu/pathology/Prog/foreign.html