Doctor

[katdluna 2]

Hi my husband is a doctor in the dominican republc we have our interview on march... I was wondering if there is any fellow doctors who have come to the us and went through the process of getting their degrees here ... Please how can we go about doing this he worked so hard to b where he is now and i would love him to still be able to work in the medical field, thats what he loves

[Gigli2008 70]

Hi my husband is a doctor in the dominican republc we have our interview on march... I was wondering if there is any fellow doctors who have come to the us and went through the process of getting their degrees here ... Please how can we go about doing this he worked so hard to b where he is now and i would love him to still be able to work in the medical field, thats what he loves

I happen to work for a medical group in North Texas area. We have many doctors who trained out of the country, so here is the process. All physicians who've trained out of the country (with the exeption of Canada and some UK and few European Countries) have to repeat their Internship and Residency here in the US before ability to get licensed and work in the US.

And, before one can be admitted to a US Internship/Residency (1 year Internship and 2 - 4 years Residency depending on Specialty, eg., Internal Medicine 1yr Internship and 2 years Residency BUT OB/Gyn 1 year Internship and 4 years Residency, General Surgery 5 years Residency etc.,) Before this Internship/Residency admission, a foreign medical graduate (regardless of how many years they've practiced in their country) have to undergo an equivalency exam by ECFMG (Educational Commission for Foreign Medical Graduates. This may take 1 to 3 years depending on how fast you get your stuff in order. Like all US graduates this involves exams for USMLE 1, 2 and 3 (United States Medical Licensing Exam) and an additional English Proficiency test.

After you complete ECFMG (USMLE Exams) then you can apply for Internship & Residency (minimum 3 years depending on specialty) After completing Residency then you can decide which state you want to work in and send in your State Licensing Application which also has exams. It takes roughly 4 - 6 months to obtain a license in Texas (I don't know about other states)

Therefore, you are looking for at least 6 years to start working as a doctor if you are a foreign medical graduate.

[sctdixon 6]

My wife is going throught his process right now. She is currently studying for her Step 1 Exam. It is a difficult path to take but she is expecting to complete all 3 steps yet this year and apply for her residency on next year's cycle.

BTW, an English Proficiency Test is no longer a requirement per the USMLE.

[Gigli2008 70]

My wife is going throught his process right now. She is currently studying for her Step 1 Exam. It is a difficult path to take but she is expecting to complete all 3 steps yet this year and apply for her residency on next year's cycle.

BTW, an English Proficiency Test is no longer a requirement per the USMLE.

You are right, which is sad. At our Medical Group we had a doctor from India who during her first year of internship was put on 3 months probation (by her program director) for lack of English proficiency. She was re-admitted after taking a mandatory English course. Not requiring English proficiency is going to let a lot of doctors in who might not exactly communicate very well with their patients. This obviously is putting the burden on Residency Institutions.

[sctdixon 6]

You are right, which is sad. At our Medical Group we had a doctor from India who during her first year of internship was put on 3 months probation (by her program director) for lack of English proficiency. She was re-admitted after taking a mandatory English course. Not requiring English proficiency is going to let a lot of doctors in who might not exactly communicate very well with their patients. This obviously is putting the burden on Residency Institutions.

I have seen the study materials and pratice tests my wife does for her USMLE Step 1 and there is no way anybody could pass that without a good grasp of the English language. Guess I'm saying that if that person has a difficult time speaking or understanding it, they will unlikely pass the testing of the USMLE and never make it through to get a license & residency. It would be interesting to know how the doctor from India you mentioned even made it through all three USMLE Steps.

[Gigli2008 70]

I have seen the study materials and pratice tests my wife does for her USMLE Step 1 and there is no way anybody could pass that without a good grasp of the English language. Guess I'm saying that if that person has a difficult time speaking or understanding it, they will unlikely pass the testing of the USMLE and never make it through to get a license & residency. It would be interesting to know how the doctor from India you mentioned even made it through all three USMLE Steps.

I have two theories. That the reading and writing was easy. But the communication part may have been off. Or maybe (and this is most likely), the program director was a little too hard on her or too impatient to listen through her accent. I have an accent too, not a bad one. Majority of people understand me perfectly, and infact speak highly of my accent, but there is that one or two people who just as easily and quickly brushed me off saying they couldn't understand a word I said. Personally, I did not have a problem with this doctor, infact we hired her for our group and we wouldn't have done so if we were unable to communicate during the interview process.

I agree. If one can grasp the content in USMLE, then it's a given that one is fluent in English.

[Latoscha 0]

Hi my husband is a doctor in the dominican republc we have our interview on march... I was wondering if there is any fellow doctors who have come to the us and went through the process of getting their degrees here ... Please how can we go about doing this he worked so hard to b where he is now and i would love him to still be able to work in the medical field, thats what he loves

[/q

WELL I AM NOT SURE OF THE PROCESS BUT I AM A US CITIZEN AND IF THERE IS ANYTHING I CAN DO JUST CONTACT ME AND LET ME KNOW IF I NEED TO GO AND GET ANY PAPERWORK FOR YOU OR HELP YOU WITH FILING JUST CONTACT ME THANK YOU

[Flames9_RN 358]

I'm a RN and my sisters are RN's back in Canada and they have run into the lack of English with foreign Nurses! Their skills are great, know thier stuff, BUT they can not communicate with the English staff, nor their patients!! Makes it rather frustrating for them and the patients!! Makes no sense not to have some kind of language proficiency!!

[katdluna 2]

THANK YOU FOR YOUR TIME AND ALL THIS INFORMATION

[Justine+David 218]

I'm a RN and my sisters are RN's back in Canada and they have run into the lack of English with foreign Nurses! Their skills are great, know thier stuff, BUT they can not communicate with the English staff, nor their patients!! Makes it rather frustrating for them and the patients!! Makes no sense not to have some kind of language proficiency!!

Quick pet peeve though: If you have grown up in an English speaking country with a bachelor's taught in English, shouldn't you theoretically be fluent in English? I had to take the IELTS to get a UK nursing license even though I have grown up here in the USA and have my BSN...wasted $200 for it

[Dr. A ♥ O 203]

He'll have to start with the Educational Commission for Foreign Medical Graduates (ECFMG) by registering with them. It's a process that takes several months. He'll have to fill out their application with the correct information. Then they will send a letter to the dean of his medical school asking if he is was a medical graduate with their university and the dean will have to check and sign it and send it back to the ECFMG. From there they send a packet to the medical school requesting all his transcripts and information on his clinical rotations. He can then begin his study and registration for the United States Medical License Examination (USMLE's). He'll have to complete and pass Step 1 and both parts of Step 2 which is the CS and CK, and have his medical school diploma submitted prior to the ECFMG certificate being issued. This is important because he'll have to become ECFMG certified before he can even apply for a residency (known as the match) through the National Resident Matching Program (NRMP).

Step 1 is computerized and offered in most cities around the US and in some foreign countries. So he can study and take the exam already if he has access to a testing location in his country. It covers the important concepts of science and the basics of practicing medicine.

Step 2 CK is Clinical Knowledge. It is also computerized and offered in most cities around the US and in some foreign countries if they have access to testing locations. Again it can be taken over seas. It's just as important if not more important to get a good score on this exam as it is on Step 1. It assesses a physicians ability to apply medical knowledge, skills and understanding of clinical science for patient care under supervision.

Step 2 CS is Clinical Skills. This is a pass or fail examination only. This one is hands on with actors who perform symptoms in order to test medical students and medical graduates ability to gather information from patients, perform physical exams and communicate their findings to patients and colleagues. This portion of the exam is done in 3 parts.

CIS Communication and Interpersonal Skills (ready to practice medicine in the US.)

ICE Integrated Clinical Encounter (ability to be a physician and by building a patient history and typing that note)<br style="color: rgb(51, 51, 51); font-family: Verdana; font-size: 13px; ">SEP Spoken English Proficiency (ability to speak and understand the language)<br style="color: rgb(51, 51, 51); font-family: Verdana; font-size: 13px; "><br style="color: rgb(51, 51, 51); font-family: Verdana; font-size: 13px; ">So it's three tests in one day and you have to pass all three.

It is only offered in six cities around the United States so they have to fly to the location to take them. This exam is undergoing changes this year and will not be offered between May 20th and June 16th. After that exam has changed specifically the CIS and ICE will change. The check list will change on these two components. When typing your note you'll have to support your diagnosis. You can't just write a crazy diagnosis and be done with it. It is the most expensive of the exams not including the travel expenses and has the highest failure rate among international medical graduates. This is simply because most of them are already medical graduates who have practiced in a foreign country. They think it is the easiest one to pass so they don't prepare themselves for it. Most of them just go for it without any preparation and fail because they weren't prepared for it. It is recommended to have a clinical rotation or medical observation in the States prior to this examination.

Actually it is recommended to have at least six months of clinical experience in the States prior to applying for a residency. This is difficult for those who have already graduated and are not currently in medical school but can be achieved though a research position. True some don't do that and take their Steps abroad but then they fail to get interview letters and waste thousands of dollars on applying for the match.

My husband is doing the ECFMG certification right now too and is scheduled to take the USMLE Step 1 at the end of March. He is taking Step 2 CK in LA in May and Step 2 CS by August 13th in order to catch the match this year. Applications for residency begin Sept. 1st. Interview invitations start arriving by mid-Sept and can go thru Feb. Though from a group I'm involved in most of them have only had interviews thru Jan this year. There are some specialties like Urology that have a different match deadline and that is because they start their residencies in January. However, these programs are highly competitive and rarely take IMG's so you probably don't have to worry about that match. We're all waiting for the results of the Match on the annual day of March 15th. Most all the US medical graduates and international medical graduates will find out that day where they matched to for their residency or fellowship. Those that don't match, which does happen, will have to hit what we call "the scramble". Pray you don't have to do this. It's like the match after the match for those that didn't match and are trying to fill spots in programs that are left open. Most resident programs begin on July 1st every year. Some places have a mandatory "two week orientation" prior to that so they will begin by June 15th.

Most IMG's go into Internal Medicine or Family Medicine to insure a spot that year because of the highly competitive nature of the various other programs. It's not unheard of to get a Surgery slot but they have to be really something with exceptional scores. There are over 400 IM programs to choose from and over 500 FM programs. States like California have their own additional process for medical graduates called "the California letter" where they have to get a letter from every place they did a clinical rotation at. For foreign medical graduates who've been out of medical school for some time this is very challenging, especially if their primary language is not English and they have to get these letters translated. This is for the state boards. Most states aren't like this and in fact some places are very IMG friendly.

The fees for the Steps have increased as of last December and went into effect Jan. 1, 2012. Step 1 and Step 2 CK are $790 a piece. Step 2 CS is $1375 not including travel expenses.

Here is the NRMP 2011 Charting Outcomes in the Match look at page 6. The mean Step 1 score for Matched independent applicants (IMGs, DOs, previously graduated US student) is 219. That is the mean score of people who actually matched. For Step 2 CK the mean is 223. So you see this step is just as important if not more important than Step 1.

Step 2 CK may not be required for US graduates to apply for the match but it is absolutely required for IMG's because it is part of the ECFMG certifications process and without the ECFMG certifications they can not legally apply for the match. Some places are not aware of this an send out interview invitations but most places are up to speed on this and will automatically reject an IMG's application without all the Steps required for the ECFMG certification. Programs use filters before someone even lays eyes on the applications. If your application gets filtered out because there is no score for Step 2 CK then the people never get to see the application and the money is wasted.

Here is the 2012 match schedule so you have an idea. Early bird gets the worm so submit complete applications the first day the system opens on September 1st. I've known some people to have interviews as early as the 4th day after applying. If you wait to apply it reduces the number of open interview slots available.

Now there is a Step 3 that some IMG's take prior to applying for the match to make themselves more competitive. US medical students can't take this until after their first year of residency though they do try to find the loophole by traveling to some few states that will allow them let them take so they too can be competitive. It's the final examination. All this means is they can practice medicine without supervision and some places like this from experiences IMG's who have practiced medicine in the past in their own countries because this means that if something happens with the doctor then it's on them and not their superiors.

I have to tell you though that the exams and studying never stop even after all of this. It's not glamorous or easy to be married to a medical spouse. They have to have a passion for it. I've already spent several years going through the Egyptian Medical School with my husband. Then onto his clinical rotations and residency after that. Then waited through his mandatory military duty with the Egyptian Army as a Doctor. To finally his attending years as a private practice doctor on the Red Sea in a clinic that serviced foreigners who would come to Hurghada as tourists. Now it's painfully like we're starting it all over again from the beginning with his study for the USMLE's and onto a second Internal Medicine Residency, hopefully a three year categorical spot, this time in the States. After which he can choose to go into attending or pick a fellowship which is additional training and another match to go through. It's not a lot of fun.

Training years are considered medical school, residency and fellowships. When they start a residency it doesn't mean they will get an attending doctors salary. Residency can last for 1 year up to 7 depending on what they go into. Most are 3 years. If they get a one year spot it's to see how they do but they will have to match again to complete their residency which is several thousand more dollars so they'll want to go for the residency's that they don't have to match again to complete it. Most learning hospitals and institutions will list their salaries for residents on their websites under Graduate Medical Education (GME). Just go to a hospital website and type in GME. Here is an example for resident salary based on Post Graduate Year (PGY) from Oregon Health and Science University (OHSU). If you scroll to the bottom and examine Salary you'll see that for the 2012-2013 year they start at PGY1 and go through PGY8. The different levels are based on the year completed of training after medical school in some hospitals PGY8 can also mean Chief Resident.

Training Level Salary

PGY1 $49,800

PGY2 $52,000

PGY3 $54,500

PGY4 $57,200

PGY5 $60,000

PGY6 $62,600

PGY7 $65,500

PGY8 $68,400

Now I have to tell you this example is of a prominent hospital in Portland. It's a large city and standard of living is much higher than say some remote areas so salaries will vary depending on where you apply. When looking at programs you'll want to consider places based on preferences and not just salaries. You'll have to consider cost of living, the weather, the location, ect. I've seen many places that start residents at $35,000 a year. It's a common misconception that doctors make a lot of money. It isn't until after years of post graduate training when doctors get into their specialties that they start to make the kind of salaries in the +100K. Also expect never to see you spouse during these training years. So if you want to have a family basically consider yourself a single parent in charge of the children and manage the household. Expect them to miss important holidays and birthdays. They will work an average of +100 hours a week even though they told the legal standard is to work the 80 hours a week. You do the math on that one and see how much our doctors are really making an hour based on the hours they work versus the salary they get paid starting out. It not much more than the average low income wage.

It's a lot of time and money to get them there. If there is something, anything else, that your significant other is good at. Such as mathematics, engineering, computer science, business or anything that could provide a nice lifestyle in the states and would take less time and money to complete I would seriously consider this now while you have the option to. Once you get on that path it is very difficult to justify getting off. If it means they have to come here and pursue a college degree it may be worth it. Many of their credits may transfer so it won't be like they have to repeat a bunch of classes over and it will take probably less time. They can get a suitable job in their field and probably have a wonderful 9-5 daily grind like the rest of us working stiffs and have a weekends off and be able to raise a family and be a birthdays and celebrate the holidays together. It's a lot to consider then just where to get started.

If you'd like further assistance let me know and I can refer you to a place for further support and guidance so you don't have to go through this process alone.

[Dr. A ♥ O 203]

I probably should have proof read my essay before posting it but it's late and I'm tired. I just wanted to offer as much information as possible as someone going through it and almost to the stateside residency part. I hope from the information I provided that you get the idea and it helps you. I know it's a lot and can be overwhelming.

Here's a funny. That last part is really true about the study time continuing. My husband has a Sister and BIL in the States from Egypt. Both finished a PhD back east and are medical doctors. Dh's Sister is a cardiologist and has finished Step 3 so she's a fully licensed MD and his BIL is and orthopedic surgeon. They are well advanced in their medical careers with many years of experience and have been mentors to us during this process. From what I've seen from them the studying never ends even at their level. Practicing medicine truly has to be a passion for all the years of studying and training that they have to put into it for the long working hours and not that great pay during training.

[sctdixon 6]

The above write up is very accurate as it is the same process we (my Dr wife) is going through right now. But the FIRST thing is to see if your foreign medical school is listed in the ECFMG as "qualified medical school". If it is not listed there, there is no way for you to even start this process as they will not acept your foreign medical credentials. Not all medical school around the world are accepted by the ECFMG & USMLE. This is very important!

[Dr. A ♥ O 203]

Here is the list for the Dominican Republic.

It doesn't cost anything to start the ECFMG and during the application process it is really easy to see if your medical school is on the list. In our case it asked which country my husband was from and he selected Egypt. Then it asked him to pick from the list his medical school.

I should mention it is possible to come from a medical school not currently registered with the ECFMG. It just takes a little more work. My SIL who is a cardiologist back east came to the States from a medical school in Egypt that needed to be added to the IMED registered medical school list that the ECFMG goes off of. Her medical school is divided into a boys side and girls side. The boys side was already recognized by FAIMER but no one had ever come from the girls side of the medical school before so they had to get her Dean's signature on file. She had to get her medical school to submit the paper work about them for her to FAIMER who works jointly with the ECFMG to create the IMED. DORA also submits a list they go off of and AVICENNA Directory for Medicine is another primary database that is used.

[katdluna 2]

thank you guys his medical school in the dominican republic is listed in the ECFMG as "qualified medical school". everything is so over whelming, i like in new york state I am going to research if this will be one of the states offering it so he wont have to travel we waited so long to be together and then having to seperate again ...