Month: June 2019

Foreign Medical Graduates’ Barrier is Red Tape

According to the Association of American Medical Colleges, the United States will suffer a shortage of 122,000 doctors by 2032, which is similar to past predictions by other organizations. As aging populations with multiple, co-existing morbidities continue to grow, a shortage of this magnitude should be worrisome. People are living longer, and older physicians are retiring. For many Americans, the idea of not being able to see a physician when necessary is unimaginable. However, it is quickly becoming a reality.

One solution to the shortage of physicians in the U.S. is to enable more foreign medical graduates (FMGs) to practice medicine. There are plenty of FMGs trying to advance their medical knowledge and careers by entering the U.S. for a medical residency. There’s also too much red tape for many of them to get through. Limitations on visas and residency slots hamper America’s ability to produce enough doctors to fill this deficit.

J-1 Visa

Most FMGs apply for a J-1 visa. There are multiple requirements to be eligible for this type of visa including:

  • USMLE step 1 and step 2 CK completed and passed
  • ECFMG certification
  • Position in a graduate program or medical school
  • Statement of need from Ministry of Health

After training in the graduate program or medical school is complete, the visa holder has to go back to their home country for two years. This is intended to spread the wealth of their knowledge gained in the United States to their home country. This prevents nations from losing all of their skilled workers and increases levels of global health. It can also present significant hardship for visa holders who may not get a chance to return to the U.S. Following the 2 year return to the home country, FMGs can attempt to change their visa to an H-Temporary worker, L-Intra-company transferee or U.S. permanent resident.

J-1 visa waiver

The two-year return to home country can be waived in 3 circumstances:

  • If applicant can prove he or she will suffer in home country.
  • If applicant’s absence will be a hardship to immediate family members who are U.S. citizens.
  • Sponsorship by an Interested Governmental Agency (IGA).

Once an FMG gets a waiver and a medical license, he or she can apply for a H-1B or immigrant visa.

H-1 B Visa

To get an H-1 B visa, an FMG must have passed all USMLE exams and have an unrestricted license to practice medicine. There is no 2-year home requirement, and the FMG can be employed in the U.S. for up to 6 years. This is the best visa option for FMGs looking to enter the U.S. for a medical residency.

H1-B visa requirements

  • Position in residency or fellowship
  • Medical school graduate
  • ECFMG certification
  • USMLE steps I, II, III passed
  • State medical license if required

The story behind H1-B visas

The purpose behind H1-B visas is to get employers the skilled workers they need for their businesses. Employers petition for a pool of visa numbers, and there is a cap on the amount of visas offered at 65,000 new hires per year with 20,000 extra slots for those who have graduated with a U.S. master’s or doctorate degree. This cap is always met quickly, and the majority of H1-B visas are not in healthcare positions.

Residency Positions

Although medical schools are trying to produce more medical graduates, residencies are not able to create more slots because of a cap set by congress on the number of Medicare-funded residencies. Congress has control of how much money is allocated to teaching hospitals for residencies. The 1997 Balanced Budget Act of 1997 and 1999 capped funding, and at that time, America was looking at a surplus of physicians in the future. Things have definitely changed, but the cap has not been adjusted to make up for the shortage, mostly based on budgetary concerns. Some hospitals privately fund extra residency positions, but the majority are funded by Medicare.

Protecting the U.S.

Much of the red tape surrounding FMG visas has been an attempt to maintain the opportunities for American citizens. However, H1-B visas bring in skilled workers, and studies show that they improve the economy. One study of an increase in H1-B visas predicted that it would create 1.3 million jobs by 2045. Foreign skilled workers and FMGs are not a threat to U.S. citizen opportunity. In fact, Americans need more FMGs training to become U.S. physicians to address the shortage of physicians.

It is clear that the consideration of FMGs has not been paramount to the decision-making of the U.S. government, or else there would be more residency programs and better visa options for FMGs. However, change is coming. The looming physician shortage is scary to all Americans, and it is stimulating people to come up with solutions. One of those solutions will surely be the promotion of more FMGs into U.S. residencies. There are not many suitable alternatives.

It starts with an ECFMG identification number.

What is EFMG?

The Educational Commission for Foreign Medical Graduates (ECFMG) is the organization that certifies foreign medical graduates for U.S. residencies that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). It is essentially like a Dean’s Office for all medical schools outside of the United States. The ECFMG certifies that the education you received abroad meets or exceeds the standards of the United States Medical Education System. Their stamp of approval means you are free to continue with the USMLE exams and onward into the Match to apply for residencies. ECFMG certification is not an approval into any residency program, but it makes you eligible.

How to get an ECFMG identification number

The first thing you will need to move forward with ECFMG certification is a USMLE/ECFMG identification number (web application here).  The information in the application must be legal and current, or you will not be assigned a number.

An ECFMG identification number will be used on all of your future USMLE and ECFMG application forms. For more information about ECFMG number details, see the ECFMG website.

How Much Does It Cost?

An application for certification from ECFMG cost $135. For USMLE step 1 and 2 (Clinical Knowledge, the fee is $940 each. Step 2 (Clinical Skills) cost $1,580. Rescheduling the exam or changing the testing region can add fees. For a schedule of all fees through ECFMG, check out this link.

What are the USMLE exams?

In order to get certified by the ECFMG, you have to pass the United States Medical Licensing Examination (USMLE). Step 1 and Step 2 CK are considered the medical science part of testing, and this requirement can be replaced with a passing ECFMG examination, Visa Qualifying Examination, Foreign Medical Graduate Examination in the Medical Sciences, or part 1 and 2 exams of the National Board of Medical Examiners. The clinical skills portion of the USMLE is also required and can be replaced by passing both the ECFMG Clinical Skills Assessment and an acceptable English language proficiency test.

Is there a time limit?

The ECFMG requires USMLE exams to be finished within a 7-year period. The period starts on the exam of the first exam passed. You cannot get an ECFMG certification if you do not complete all of the exams within this time period.

Developing a Lifestyle for Success

Beginning the ECFMG certification process is arduous, but this process preps a medical graduate for the process of the Match and then residency. Rather than thinking about the extra work involved in becoming a medical resident, it is better to plow through the paperwork and make sure everything is done properly. This is part of developing a lifestyle for success that will get you to your end goal of becoming a practicing physician in the United States of America.

A Healthy Lifestyle is a Successful Lifestyle

The USMLE exams are tough, but so is the Match process. All the while, you need to keep your medical knowledge and skills updated by participating in clinical externships and anything that can add medical experience to your curriculum vitae. If that weren’t enough, it’s never too late to work on your interviewing skills. For the foreign medical graduate, it can be tough to get into a medical residency, so they must keep their health in top shape.

This means eating right, getting enough sleep, and exercising. A person who stays up all night studying will not retain information better than the person who stopped studying and got a good night’s sleep. Getting enough water, health food, and exercise also has performance benefits. You want a clear mind when you go through this whole process.

Planning is a Recipe for Success

There are many dates, fees, and plans that must be made in order to successfully get to the Match and land the residency of your dreams. It is important to keep track of all the dates because missing one can set you back an entire year. That may not be a lot in the whole scheme of things, but it will seem like a long time while you are waiting.

The Foreign Medical Graduate Bias

Unfortunately, the foreign medical graduate bias is not a myth, but thankfully, it is more often an implicit bias than something people outwardly feel and support. The world is more globalized than ever, but old habits and thoughts will persists through the generations. What this means for the foreign medical graduate is that you must now live the life of the physician you one day will be. In order to show residency directors with hidden biases that you are an excellent candidate for a residency despite your FMG status, you will have to make sure you meet all the requirements, but you will also have to present yourself in a way that is likeable, intelligent, and organized. It all starts with an ECFMG identification number, and you will begin your path to residency.