United States of America | Residency Database

Section A. Residency System

1. Does this country accept international physicians for specialization in its hospitals?:

Yes

2. Specialties offered (name duration)::

Please refer to the Fellowship and Residency Electronic Interactive Database(FREIDA)
http://www.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html
for the most up-to-date information on specialties offered in the USA.

3. Are there examinations during the residency? How are the residents’ evaluated?:

Knowledge based and practical examinations may be administered within an individual residency program. These examinations are developed locally by each program and it is also up to the program how much weight is placed on these examinations, i.e., whether passing the examinations is required for progression from year to year or graduation from the program.

Most programs also require their residents to take “In-Service” examinations that are developed and administered by the medical or surgical specialty board that would ultimately offer certification to the resident in their particular specialty. These examinations are primarily for self-assessment and are generally not used as requirements for progression for graduation.

One other examination is frequently taken during residency, although for residents entering the US on an H1B (work permit) visa, it must be taken and passed before beginning residency. This is the USMLE Step 3. It is one of the examinations required for licensure and is not specialty specific. In some states, it is required to obtain a license sometime during the residency, and Step 3 is the last of licensing exams. In other states, it is required to have a license in order to continue beyond a certain point in the residency. Please refer to the USMLE Step 3 website for more information:

During residency, residents are evaluated by direct observation by faculty, and residency programs are required to provide this information directly to the residents periodically. Satisfactory performance based on these observations is generally required for progression and graduation.

4. How many hours of work per week are there?:

The current cap on resident hours is 80 hours per week.

5. What is the ratio between this country’s doctors and its population?:

272 per 100,000

6. Which languages are necessary for the medical residency?:

English. A small number of programs may require English and Spanish.

7. References:

http://www.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html
http://www.usmle.org/step3/purpose.htm

Section B. Finance

1. A. Is there a tuition fee for the residency? If so, how much (in euro or usd)?:

A. No, there is no tuition fee for residency, but there is a fee to apply for residency programs.

2. What is the annual salary (in euro or u.s.d)?:

Residents receive stipends ranging from US$35,000 to US$50,000 for the first year of training and these increase with each additional year of training. Residents also have comprehensive benefit programs including health-insurance and paid annual vacations and often are provided free or discounted meals and uniforms. Sleeping quarters are provided when residents are on call in the hospital overnight.

3. How expensive are the costs of living (average annual expenditure in euro or u.s.d)?:

About $20,000 - $30,000

4. References:

http://www.ama-assn.org/ama/pub/category/194.html

Section C. Application Procedure

1. Accreditation procedure:

International medical graduates (IMGs) must receive certification from the Educational Commission for Foreign Medical Graduates (ECFMG). Additionally, your medical school must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®). If you are a medical school graduate, your graduation year must be included in your school's IMED listing. If you are a student, the "Graduation Years" in IMED for your medical school must be listed as "Current." You can access IMED on the ECFMG website. To be eligible for certification, you must graduate from a medical school that meets the requirements described above, and fulfill the following additional medical education credential requirements:

* You must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) at a medical school listed in IMED.
* You must supply ECFMG with copies of your medical education credentials. These medical education credentials are listed in ECFMG's Reference Guide for Medical Education Credentials, available in the ECFMG Information Booklet on the ECFMG website. ECFMG sends medical education credentials to the medical school that issued them and must receive verification of these documents directly from the medical school.

Certification by ECFMG also requires passage of several standardized examinations developed and administered by the United States Medical Licensing Examination (USMLE). (www.usmle.org).

* Medical Science Examination. USMLE Step 1 and Step 2 Clinical Knowledge (Step 2 CK) are the exams currently administered that satisfy this requirement. Applicants register for these exams with ECFMG and take these exams worldwide at test centers of Prometric, a division of Thomson Learning, Inc. ECFMG also accepts certain former medical science exams to fulfill this requirement. Refer to the ECFMG Information Booklet for more information.

Clinical Skills Requirement. USMLE Step 2 Clinical Skills (Step 2 CS) is the exam currently administered that satisfies this requirement. Applicants register for Step 2 CS with ECFMG and take the exam at one of several regional Clinical Skills Evaluation Centers in the United States. Applicants who have both passed the former ECFMG Clinical Skills Assessment (CSA®) and achieved a score acceptable to ECFMG on an English language proficiency test (such as the Test of English as a Foreign Language™ [TOEFL®] or the former ECFMG English test) can use these passing performances to fulfill this requirement. Refer to the ECFMG Information Booklet for more information.

In the United States, medical licenses are granted by the individual states and jurisdictions and a physician cannot legally practice medicine without a valid, current medical license. However, there is some variation with respect to medical licensing for physicians whose practice is confined solely to that taking place within a PME program. Some states provide training licenses; others require full licensure at some point in the PME program. In addition, states have varying regulations regarding passage of examinations for the purposes of licensure. The best source of detailed information regarding these issues can be found online at the Federation of State Medical Boards’ web site www.fsmb.org.

There may be additional requirements on a state-by-state basis within the United States or programs may impose their own requirements.

2. Other requirements:

Physicians entering the US must have an appropriate immigration status to participate in PME programs. Those initially entering most commonly do so using an Exchange Visitor visa or a Work visa. Physicians on Exchange Visitor visas are sponsored by ECFMG and information regarding this program is available online at www.ecfmg.org under a section entitled Entry Into Graduate Medical Education In The United States found under the Frequently Asked Questions tab. Those remaining in the US often are granted permanent resident status or may even become US citizens.

3. Differences in application procedure depending on country of origin:

To apply for ECFMG Certification, you must be an international medical student or graduate. This means that your medical school is located outside the United States and Canada. U.S. citizens who graduate from such schools are considered IMGs and are eligible to apply for ECFMG Certification. Non-U.S. citizens who graduate from schools in the United States and Canada are not considered IMGs and are not eligible for, nor do they require, ECFMG Certification.

Step 1, Step 2 CK, and Step 2 CS are the same exams taken by graduates of U.S. and Canadian medical schools.

4. Ratio between applicants and physicians who finally obtain a residency position:

For the past number of years, approximately 50% of non-US international medical graduates (IMGs) have matched to residency programs, and approximately 93% of US medical graduates (USMGs) have matched.

5. Does everyone who passes the medical license examinations gain a residency position in a hospital?:

The vast majority of PME positions are obtained through participation in a National Residency Matching Program (NRMP). Applicants typically interview at several programs and subsequently submit a rank order list of programs in which they would like to pursue training. Simultaneously, program directors also submit a rank order list of applicants that they would like to have in their program. A computer program then matches applicants to programs. The result is that applicants are matched to programs as high as possible on their rank order list while programs fill their positions with the applicants that they most preferred. A detailed explanation of the NRMP can be found on line at www.nrmp.org. A small number of programs or positions may be offered "outside the Match” in which case there are direct negotiations between the applicants and the program director.

Almost all PME programs require application materials to be submitted through an Electronic Residency Application System (ERAS). Information regarding ERAS can also be found online at http://www.aamc.org/audienceeras.htm. After receipt of application materials, programs typically invite selected applicants to come to the program and interview. However, depending on circumstances applicants may sometimes obtain positions without a face-to-face interview.

US medical students are generally assisted in participating in ERAS and the NRMP by administrative staff at their medical schools. IMGs can participate in these programs through ECFMG and information regarding those processes is available online at www.ecfmg.org.

After the first iteration of the Match, unfilled positions are made available in a process known as the “scramble”. This situation only applies to applicants who are already registered in the Match but who did not match through the system. Details can be found on the NRMP website.

6. Specialties in which it is most difficult to obtain a position:

Unable to comment on this question since it changes from year to year.

7. Is there a waiting list for medical graduates who want to begin a residency?:

No, there is no waiting list. Applicants who are accepted into a program generally will begin on July 1st. Applicants who have applied but were not accepted into a program may be offered a position if a primary candidate is unable to assume his or her position.

8. Countries, except this one, in which the medical residency title is recognized:

Depends upon the country, residency of the medical professional within the country, and the needs of the country for physicians. It is impossible to elaborate beyond this. Check with the country where the doctor wishes to practice.

9. Requirements for international physicians to be able to work in this country after completing their specialization there:

Completion of an accredited PME program makes a physician eligible for certification in the specialty in which he or she has trained. Each specialty has a specialty Board, which has been recognized by the American Board of Medical Specialties (ABMS) (www.abms.org) which is currently comprised of 24 member boards. Individual specialty Boards have responsibility for developing and administering appropriate examinations to assess the knowledge and skills of a physician trained in that specialty. Examinations may be written, computer-based, oral or some combination thereof but are standardized within each specialty. Upon successful passage of the examination(s), physicians who have completed PME in an accredited program can then receive certification in their specialty from the appropriate specialty Board.

Approximately 85% of physicians practicing in the US are Board certified although Board certification is actually a voluntary process and is separate from the licensure process. However, hospitals and other healthcare systems may establish their own requirements for Board certification and physicians not Board certified generally have fewer practice options. The ABMS has recently required that its member boards put in place programs to ensure Maintenance of Certification by periodic and ongoing assessments of specialists’ clinical practice.

10. References:

* www.ecfmg.org
www.faimer.org
www.usmle.org
www.fsmb.org
www.nrmp.org

Section E. Other References

Other references:

See web addresses provided in the survey.

Section F. Participant's Information

Name:

Marta van Zanten

Country:

USA

Contact info:

mvanzanten@ecfmg.org

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