Category: NRMP

Kidney disease is a growing problem around the world, but if you are looking to specialize in nephrology, one of the best countries to train in is the United States. According to the National Institutes of Health, about 14 percent of the American population has chronic kidney disease (CKD), as compared to only 10 percent of the world population as a whole. In total, about 661,000 American have kidney failure. About 468,000 of these patients are on kidney dialysis, and about 193,000 have a functioning kidney transplant. According to the American Journal of Kidney Diseases, the prevalence of CKD in the United States is expected to increase by 27 percent by 2030.

The two most common causes of CKD are high blood pressure and diabetes, with almost half of CKD patients reporting that they have been diagnosed with one or both of these conditions. That’s why CKD is so common in the United States — because of the high prevalence of cardiovascular disease and diabetes. However, its is important to note that changing lifestyles in developing countries are also raising the rates of these diseases worldwide, especially as the number of elderly individuals in countries like China and India grow. Therefore, in the future, there will probably be a high demand for nephrology specialists around the world.

If you are looking to become a nephrologist — that is, a physician specializing in the treatment of kidney disease — it just makes sense to complete your residency and fellowship in the United States, given the high rate of CKD in the country and the likelihood that it will rise in the future. Read on to learn more about the educational pathway to becoming a nephrologist.

Internal Medicine Residency: The First Step on the Path to Nephrology Career

Because nephrology is a specialization within the field of internal medicine, the first step to becoming nephrologist (after finishing medical school) is to complete an internal medicine residency program. These programs last for three years, and they are particularly popular among foreign medical graduates. Of all the foreign medical graduates who were matched to residency programs in the United States in 2015, 67.3 percent were matched to internal medicine programs, according to the National Residency Matching Program (NRMP).

In an internal medicine residency program, you can expect to gain a broad background education in the diagnosis, treatment, and management of disease and disorders that affect all of the internal body systems — including the renal and urinary systems. In addition to your clinical and didactic training, you may also have the opportunity to engage in research. If you are hoping to become a nephrologist, you may be able to conduct advanced research in nephrology, which can help you prepare for the specialization later on in your career.

Once you finish your internal medicine residency program, you will be prepared to take the American Board of Internal Medicine (ABIM) certification exam. After you pass the exam, you will be eligible to apply for a fellowship in nephrology in order to pursue your dream of becoming a specialist in the field.

Completing a Nephrology Fellowship Program

During a nephrology fellowship program, your studies will focus specifically on kidney-related diseases and disorders. As previously mentioned, CKD is the most common kidney disease in the United States and around the world, but as an aspiring nephrologist, you will also gain expertise in other kidney conditions, including:

• Kidney stones
• Polycystic kidney disease (PKD)
• Acute renal failure
• Glomerulonephritis
• Pyelonephritis
• Bartter syndrome
• Dent disease
• Nephronophthisis
• Gitelman syndrome

Depending on your area of interest, a nephrology fellowship program can last anywhere from two to four years. If you choose to focus your fellowship on clinical training, it will typically last for two years. In addition to learning about the treatment of the conditions listed above, you may also have the chance to learn about cutting-edge clinical treatment options, such as home-suitable dialysis. You will also gain expertise in related areas of clinical care that you will likely encounter in your practice, such as geriatric care and palliative treatment.

Alternatively, you can choose to focus your fellowship on research — either clinical research, translational research, or basic science research. For aspiring researchers, a nephrology fellowship typically lasts three to four years. If you choose the clinical research pathway, you may be able to earn a master’s degree over the course of your training. As a nephrology research fellow, some of the topics you might study include:

• Epidemiology of kidney disease
• Public health strategies to improve access to CKD treatment in developing countries
• Drug development for rare kidney disease
• Cancer-related signaling pathways in kidney cells

After you finish the fellowship program, you can take the optional Nephrology Certification exam offered by the ABIM to demonstrate your expertise in the field. From there, you start your career as a nephrology-focused clinician, researcher, your researcher/practitioner.

If you are a foreign medical student or graduate, getting a job as a nephrologist might seem like a long way off, considering the years of preparation that are required, but it’s never too early to start preparing yourself! A clinical externship in nephrology can be a great way to get a feel for the field and establish connections with medical professionals in the United States before you apply for an internal medicine residency. Contact FMG Portal today to learn more about how this opportunity and the other ways we can help you get matched!

The United States is one of the largest and most diverse countries in the world. A few weeks ago, we talked about the differences between medical residency programs in urban and rural areas. However, it is important to note that even within the category of “urban” or “rural,” there are significant differences between different parts of the country. Within the geographic borders of the United States, you can find an example of almost every climate zone, and there are distinctive cultural differences between regions as well.

During your residency, the characteristics of the region in which you live can affect both your lifestyle and your work as a physician. This is especially true if you are pursuing a residency in one of the more general medical residency subjects — such as family medicine or pediatrics — since the types of cases you encounter can depend largely on the cultural circumstances of the region. Therefore, if you are a foreign medical graduate looking to get matched to a residency in the United States, it can be helpful to learn more about the different regions of the country so that you can apply to programs in places where you will feel comfortable living and where you will have the chance to work on cases that fit in with your medical interests and career goals.

The East Coast

The East Coast is one of the most densely populated areas of the country. As a result, you can find more medical residency programs in this region than any other, and you will find most of them in urban and suburban areas. The East Coast is home to some of the largest cities in the country, including New York City, Boston, Philadelphia, and Washington, DC — each of which has its own unique culture. However, they do share some general characteristics, such as highly diverse populations, good public transportation, and easy access to restaurants and grocery stores.

If you live on the East Coast, you can expect to experience four distinct seasons. Summers are hot, and winters can be very cold. In the northern areas, you might get a lot of snow in the winter, but further south, heavy rain is more common. Both spring and fall on the east coast are considered to be beautiful. In general, the culture on the East Coast tends to be more formal than in other areas of the country.

The Midwest

The Midwest, also known as the Great Plains, refers to the inland states between the east coast and the Rocky Mountains. Some of these states include Ohio, Iowa, Illinois, Michigan, and Minnesota. Although large portions of these states are rural, there are also a few major cities, such as Chicago and Detroit. Like the states on the east coast, you can expect cold winters and hot summers in the Midwest states. People in the Midwest are especially well-known for being friendly.

One of the most significant health issues that you will face if you work as a physician in the Midwest is the opioid abuse epidemic. The misuse of opioid medications (such as morphine, oxycodone and hydromorphone) is a growing problem in all parts of the United States, but it is especially concentrated in the Midwest. As a medical resident in the Midwest, you may treat overdose cases or individuals who are seeking treatment for addiction, so if you are interested in pharmacology, psychiatry, or any other drug-related area of medicine, a residency program in the Midwest may be of interest to you.

The South and Southwest

As in the Midwest, the South and Southwest regions are mostly rural, but with a few major cities, such as Atlanta (in the South) and Houston (in the Southwest). The climate in these states is much warmer and more humid in the summer, but Southerners also enjoy milder winters. The South is famous for its hospitality and its delicious comfort food.

Two medical issues that are more prominent in the South than in any other part of the country are obesity and smoking. Southern states like Mississippi, Louisiana, Alabama, Kentucky, and West Virginia have some of the highest numbers of people who meet the criteria for obesity and who say they smoke regularly. As a result, physicians are challenged to treat patients with many obesity-related medical conditions (such as type II diabetes and heart disease), as well as health problems caused by smoking (such as lung cancer).

The Mountain West and the West Coast

The Mountain West region includes the states that are between the Midwest and the West Coast. Some of the states in this region include Colorado, Utah, Idaho, and Montana. Because of the Rocky Mountains, much of this region is rural, although there are a few large cities, such as Denver. The Mountain West is known for its dry climate. In the winter, there is often snow, especially in the high country. In the summer, you can expect a daily temperature swing, with warm days and cool nights.

Outside of the East Coast, the West Coast is the most populous area of the country. Most people on the West Coast live in California, where the climate varies considerably. Southern California is warm and sunny, while Northern California is overcast and cool for most of the year.

The Mountain West and West Coast states are well-known for being among the healthiest in the United States, with low rates of smoking and obesity, and high rates of activity and exercise. However, the outdoor adventure opportunities in the states — like hiking, rock climbing, and skiing — can cause traumatic injuries. If you are interested in treating sports- and outdoors-related injuries — in either an emergency room or a rehabilitation setting — this region could be a great place to work. California is also particularly well-known for cutting-edge technological advances, so a residency in this area could be of interest if you are interested in medical technology research and development.

Choosing Between Regions of the United States

As an aspiring medical resident, it can be a challenge to figure out which region(s) of the country you would be comfortable living in. One way to experience life in the United States first hand is to complete a student elective or graduate externship before you apply. Not only can this give you a better idea of what it is like to live in a particular region of the United States, but it can also give your CV a boost and connect you with physicians who could possibly write letters of reference for your application.
FMG Portal offers student electives and graduate externships in a wide range of fields. Contact us today for more information!

As a foreign medical graduate, there are many factors that you must consider when applying to medical residency programs in the United States. With so many different residency programs available at universities and medical centers, it can be hard to narrow down the list, even after you have identified your specialty area of interest. One of the factors that you should take into account is the setting of the residency program — that is, whether your choose a program in an urban area, a rural location, or a small city / suburban area. The setting that you choose can make a big difference for your residency experience, in terms of both your medical work and your life outside of the program. Read on to learn more about what you might expect from U.S. medical residency programs in urban and rural areas.

Choosing a Medical Residency in an Urban Area

U.S. medical residency programs in urban areas offer distinctive opportunities for foreign medical graduates. In cities, you can find lots of hospitals, outpatient care centers, and community health centers, so your clinical rotations may take place at many different sites around the city. This can give you a broader range of experiences than you might get from a residency program in a rural area or a suburban setting.

Many of the cities in the United States are also characterized by significant racial and socioeconomic diversity. Indeed, a 2015 study by the  Brookings Institution found that the 50 largest cities in the United States had a significantly larger gap between the rich and the poor than smaller cities and rural areas. Therefore, if your residency is in an urban area, you might have the chance to work with patients from a wider range of cultural and economic backgrounds. Depending on your country of origin and the city in which you choose to work, you may have foreign language skills that can come in handy when working with the diverse populations of American cities.

Choosing a residency program in an American city will also significantly impact your lifestyle outside of the program. One of the benefits of living in a large city is that you will never need to worry about being bored — from restaurants to museums to concerts, there is no limit to the cultural experiences you can find in American cities! However, one of the drawbacks is that living accommodations are more expensive in American cities, so you may need to live with roommates. At the same time, public transportation systems are better in cities than in rural areas, so you may not need to own a car.

It is important to note that there is no “typical” American city, so if you are looking for a residency program in an urban area, you should do additional research about the cities you are considering. As of 2015, the 10 most populous metropolitan areas in the United States were:

• New York City, New York
• Los Angeles, California
• Chicago, Illinois
• Dallas – Forth Worth, Texas
• Houston, Texas
• Washington, DC
• Philadelphia, Pennsylvania
• Miami, Florida
• Atlanta, Georgia
• Boston, Massachusetts

Choosing a Medical Residency in a Rural Area

The opportunities that you would get as a medical resident in a program in a rural area are different from those that you would get in an urban area, but they can be just as educational and fulfilling. According to the Centers for Disease Control and Prevention (CDC), health risks for Americans in rural areas are significantly greater than for those living in rural areas, so as a medical resident, you may have the opportunity to gain experience with more serious cases. Here are a few statistics from the CDC about health disparities in rural areas that can provide insight into some of the challenges that medical residents in rural areas face:

• Compared to Americans in urban areas, rural residents are more likely to die from heart disease, cancer, chronic lower respiratory disease, and stroke.
• Death from unintentional injury is 50% higher in rural areas than in urban areas — primarily due to motor vehicle crashes and opioid overdoses.
• Children living in rural areas are more likely to have mental, behavioral, and developmental disorders than those living in urban areas.

Because there are fewer physicians in rural areas, residency programs in rural areas are more commonly available in the broader specialty areas of family medicine, pediatrics, and internal medicine. That’s good news for foreign medical graduates, since the NRMP reports that these were the top three areas in which foreign medical graduates got matched in 2015.

The rural areas in the United States are located primarily in the Midwest, the South, and the West, each of which offers different cultural opportunities and lifestyle options. For example, in many rural areas in the West, there is easy access to outdoor activities like hiking, rock climbing, and rafting. On the other hand, the South is famous for comfort foods like fried chicken and pecan pie. Rural Midwesterners are known for being particularly friendly. On a more practical note, if you are living in a rural area, your housing will probably be less expensive, but you may also need to own a car in order to get around.

Clinical Externships in Rural and Urban Areas

Researching rural and urban areas in the United States can be helpful as you decide where to apply for a U.S. medical residency program, but there is no substitute for real-world experience. A great way to learn what life is really like in one of these settings is to complete a clinical externship. FMG offers clinical externships in many areas around the country, including rural and urban settings, as well as small cities and suburban areas. Contact us today to learn more about all of the resources we offer for foreign medical students and graduates!

If you want to dedicate your medical career to working with kids, a residency program in pediatrics may be the right option for you. According to 2015 data from the National Resident Matching Program (NRMP), pediatrics was the third-most popular residency specialty area for foreign medical graduates, behind only internal medicine and family medicine.

As a pediatrician, you could work with infants, children, and adolescents, ranging in age from birth to 21 years. Pediatricians are trained to provide preventive care and treat a wide range of conditions, including hereditary diseases, infectious illnesses, and traumatic injuries. You may choose to work in a primary care setting as a general pediatrician, or you may specialize your practice on a certain area of the field. It all starts with a pediatrics residency.

Pediatrics Residency Programs in the United States

US medical residency programs in pediatrics last for three years and provide general training in the wellness of infants, children, and adolescents. However, because pediatrics is such a broad specialty area, the programs can vary widely between schools. That means that when you are searching for residency programs, you should pay careful attention to what makes each one unique.

For example, programs may differ in the relative amount of time dedicated to clinical work in ambulatory and primary care settings. The location of a school often plays a role in this, since some schools are located in large cities where you may end up working at multiple hospitals and outpatient centers, while programs in rural areas allow you to gain extensive experience working at one or two locations. There are also programs that allow you to focus your studies by pursuing a certificate in an area of interest, such as global health, community health, medical education, or academic research.

In general, though, you’ll usually spend the first year of a pediatrics residency building a broad base of knowledge and developing basic skills in pediatric care, through a combination of clinical and didactic work. In the second year, you will have the chance to take on greater responsibility in clinical decision-making. You’ll probably also have the chance to pursue particular areas of interest through electives. Finally, the third year of a residency program will give you the chance to step into a leadership role in the clinic and prepare for your future as a pediatrician, whether you choose to focus on a specific subspecialty or practice as a generalist in the field.

Post-Residency Fellowship Options

Once you finish your residency in pediatrics, you can start your career as a general pediatrician or you can apply to a fellowship program. Almost all pediatrics fellowships in the US require an additional two or three years of study, although there are a few one-year fellowships available as well. Although this is not a comprehensive list, here are some of the options you could consider:

• Adolescent medicine (3 years)
• Allergy and immunology (2 years)
• Pediatric cardiology (3 years)
• Pediatric endocrinology (3 years)
• Neonatal medicine (3 years)
• Pediatric infectious disease (3 years)
• Pediatric emergency medicine (2 years)
• Pediatric sports medicine (1 year)

Getting Matched to a US Program

If you are interested in a US medical residency program in pediatrics, you might want to complete a graduate externship or student elective in the field. Not only can these experiences help you decide if pediatrics is the right specialty area for you, but they also look great on your CV. Many residency programs also require foreign applicants to submit a letter of reference from a US physician, and an externship program is a great way to make connections in the States.

FMG Portal offers student electives and graduate externships in many different specialty areas, including pediatrics. Contact us today for more information!