Indian doctors in US ; Fellowship and Practice in US

Hi Guys,

I have seen lot of traffic on my blog searching for "Indian Doctors in US" of course which is the main theme for my Blog!
I started this blog just out of fancy keeping myself in mind who is obviously an Indian doctor.
I started my life searching here and there how to get into US medical system.Today I wanna post a blog what are our chances of getting into this system.

If you are a Medical student you can do electives here.In any branch you want and which is like doing our Internship/House surgency in India.but just doing only selective departmenmts which help in our chosen career.For e.g., if you want to pursue Internal Medicine...You can do any IM related i.e., Gastro or cardio "Elective" in any med school.These days getting electives are also getting tough.Some are paid and some are non-paid.Once you are done you will be having hands-on clinical experience which helps you in smooth transition into residency.But you wont get any degree here that you have done electives but,Some LORs(Letter Of Recommendations).

If you are a Physician ,have done Internship and got MBBS degree,you are not eligible to do electives in US.
OR
If you are a MD or MS Physician the fate is same but here comes the option of PRACTICE in US
Residency is what we call post graduate training in India or simply PG

In Order to practice in US u need to get state license which requires at least 2-3 yrs of "Accredited American Graduate medical education"(RESIDENCY) according to AMA(American Medical Education) found ...HERE

and if u r Board Certified it adds to authenticity and value ...!

Basically to practice in US one need NOT ! be BOARD CERTIFIED according to certiFACT

"Board certification is a voluntary process and over 80% of the physicians in the U.S. are board certified; however, a physician is licensed by the state to “practice medicine and surgery” and board certification is not a requirement for licensure. A licensed physician may practice in whatever area of medical interest they have and can legally hold themselves out to be practicing in that field of interest without necessarily having obtained a residency or fellowship providing advanced training in that area. Board certification, however, means that the physician’s skill and knowledge in the specialty/subspecialty has been examined and tested and meets standardized requirements"
"Most International Medical Graduates need to complete some required training in this country before they are able to take a particular board’s exam if all the postgraduate training was completed in another country. Exceptions are made and vary with each board. (Some boards may accept Canadian and/or United Kingdom residencies. Call the Member Board for further information on this.)"

also

"If a doctor is "licensed to practice medicine" does that mean he/she is certified?

No. Obtaining a medical license and being certified as a medical specialist by an ABMS Member Board are two different and separate processes. A license, legally required in order to treat patients, is issued and required by the state or territory in which a doctor practices medicine. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide. Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be, " board certified." Today, approximately 89% of licensed physicians are certified by one or more ABMS Member Boards."

You must have gone through atleast 3 years of residency training apart from CME credits and other requirements) and cleared the state specialty board examination.For e.g., ABIM (American Board of Internal Medicine) has to be cleared to be BOARD CERTIFIED in US in the case of IM

But I came to know that if you have done residency here,You can start practicing here as affiliated with a hospital called "HOSPITALIST" and you will be given 3yrs time to clear the board exam.
At the beginning of residency people apply for Initial Medical licnsure and its requirements vary by state and if you are an IMG
In order to get this initial licensure, you have to finish USMLE Step 3 and which in turn requires the clearance of step1,2(CK ,CS).
For clearing STEP3 the criteria vary by state.some require at least one year of residency training,where as some don't need any special requirements.
So in order to practice here,you need to finish all the USMLE steps includin Step3.

More info can be found here

This is what mentioned on FSMB(www.fsmb.org)

"In the United States and its territories, a license to practice medicine is a privilege granted only by the individual licensing authority (i.e., "state medical board") of the various jurisdictions. All decisions regarding acceptance of USMLE results and/or licensure eligibility are made by the individual state medical boards of the United States.

It is important to note that eligibility to sit for the USMLE Step 3 for a specific state medical board does not automatically signify your eligibility for medical licensure in that jurisdiction.

To obtain complete licensure information, you should contact the state medical board directly where you intend to seek your medical license. The FSMB provides a listing of all state medical boards and their contact information."

Here is a sample Licensure for Alabama state http://www.albme.org/Documents/540-X-3%20ER.pdf

and the website is http://www.albme.org/

If you don't wanna practice in US but want to do Fellowship (which is Superspeciality in India)
Most of them require the residency in US.So ,for them Indian PG is not valid.
But here is an exception for some fellowships like Ophthalmic Oncology and Emergency Care (i dont have the complete list and it will be on Individual hospital websites for how to get the list see below)where you can directly apply for them.you don't have to go through all the USMLE steps.Even you dont have to go through all the ERAS process.(For ERAS go through my other blogs).
Once you are done you can use that training in your home country but cannot practice herer.

For these list of programs,

1.go to http://www0.ama-assn.org/vapp/freida/srch/
2.select "Choose specialty"
3.select the "Subspecialty/fellowship" you are interested in
4.select the "Choose Location" select the states you wanted
5.Click on "Optional Criteria"
in National Resident Matching Program: select DO NOT PARTICIPATE IN NRMP
in ERAS drop down select DO NOT PARTICIPATE IN ERAS
These are the programs have their own criteria like "atleast 3 yrs of PG training back in home country"
Now you have to contact the individual programs.

Indian Doctors who came to US back in 70's 80's have done radiology and some competetive specialties.Now its real tough even to get into residency.

Those who want to do residency and then Fellowship...read my other blogs..

Hope this Helps
Pavan
_________________________________________________________________
*i've done background research for myself.It may be incomplete or may have some flaws but for most part its how the system in US is.If you have any doubts or comments post them.Once I start my residency I will know more abt the system!

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Question Yourself before Chosing USMLE !

Hi Friends I wanted to post a blog on how USMLE can be
The questions you must ask to urself before coming to US or taking USMLE.....

First let me clarify that USMLE is a longer process than expected. It takes years to get into the system.Its money consuming and it tests ur patience.you will be facing lot of hurdles and there will be moments of despair and loneliness and deserted feeling.i am not scaring u its the truth.The competition is that severe.The people coming here are not just the graduates of foreign med school.Some people are even taking MPH or certain other courses just for the sake of getting residency.There is no genuine reason behind doing MPH(Master's in Public Health) 'cuz they r not gonna continue it as their career anyway.But being in US with legal status to work, some of them are doing research and even having publications.Also for being here,they r learning the culture of this country which helps them get absorbed in to this system quickly.So,that shows the level of competition.I don't suggest u do F1 courses.But they have some edge over ordinary IMG's.Of course u can work as a volunteer in any research with your Non-Immigrant visa too (Like B1/B2) but the chances r slim.
The questions U shud ask to urself are :

1. Are you academecially bright or hard woker to get good score?'cuz score bring you interviews and ur communication skills help u get selected in the interview
2. Are you financially sound?-Its gonna cost you a ton - Can be upto a maximum of $25000
3. Do u have relatives here in US? They will help u for food shelter and may get you some observership or even recommendation?!
4. Are you patient enough? - It takes years as I said atlest 1-2 years and as you know its a once an yearly process and the interview process it self takes 6months
5. Do you have moral support? As I said some times u get lost in this alien country....so u need good friend it can be your spouce or some one who can give u very good advices..
6. Do you have good communication skills?- I mean if you r shy U cannot go anywhere / do any thing in this country.Apart from that getting into residency requires this vital skill...thats what make you get selected for the interview...

Hope This Helps....!

Pavan

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Step3 How to crack CCS...

Hi guys i found this one posted on a forum and i brought it with the permission of the author ...to this forum hoping it will be helpful our members...i will add more experiences....

If you are travelling across timezones, arrive at your exam city two days prior to adjust. It is a long and tough exam, requiring max concentration.
Day 1 is tougher, I feel. There are seven one hour blocks of MCQs. On either day, you have 1min 15 secs per question, and you’ll need it because the questions are long.
-Because of the above, ALWAYS READ THE ANSWERS FIRST!
This will focus what you are looking for when scanning the question. For example, the actual choices may be about what ethical decision to make, but the body of the question will contain lots of technical waffle.
-Focus your studies on satellite/office settings. This is the bulk of the exam. In fact, those of you with family practice experience will love Step 3.

Day 2 includes ~3 shorter blocks of questions, followed by CCS.

Now on to CCS which is what this posting is mainly about:

-The CCS is really good fun to do actually! Very enjoyable.
The cases (nine in all) are usually quite easy to diagnose. The issue is how to manage them appropriately.
-Before doing the actual exam, you MUST play around with the five sample scenarios that you are given by USMLE. You should also do practice scenarios and think yourself through the case.
-When you start, you are given a one sentence introduction, like: “a 45 year old white man attends complaining of severe chest pain.”
Next, you will be shown the History of the Presenting Complaint, plus PMH, DH, Allergies, FH, ROS, etc.
Up to this point, you have no options, you just have to read through and note the key points.
Before you leave this page, you should do the following:
-Decide on a NARROW differential diagnosis (yes, even before any physical exam has been done).
-Make note of allergies, so you don’t accidentally administer the wrong Rx.
-Make note of risk factors like smoking, obesity, hyptn, etc., and at the end of the case, you will win points by COUNSELLING your patient about these. [in the Order page, you can type ‘counsel’ and click, which will show you all the choices of things to counsel on]
If pertinent, you can also end your case by ordering sensible screening tests, like mammography, pap smear, etc
Okay, now that you have read the full history and decided on a narrow differential, you must next answer this very important question:
Is the patient stable?
ie. will I need to do anything right now?
If yes, do not waste time proceeding to the physical exam, this is inappropriate. Imagine yourself physically there. If you had a man with severe chest pain before you, would you do a thorough exam first? No. You’d immediately bang on some oxygen, pulsox, iv access (for pain relief, among other things), EKG and portable CXR. Don’t forget ABCs, ever.
And if indicated, do not forget obvious tests like: ABG, PEFR, serum glucose, urinalysis!
They are so routine that you might forget about them.
And another important point, what if this happened in an ‘office’? You could get away with applying oxygen and perhaps an iv line/analgesia (if the simulator lets you), but you must very soon ‘move location’ to ER, where you can carry out further management.
If your patient is quite unwell, you will be justified to do lots of emergent things before the actual physical exam. Once you have done those, move on to the PE and click which systems you want examined. A cardio/resp/abdo exam should always be in there, I think, .. plus any other relevant ones.
Once you have read the PE findings, you will be able to narrow your differential even more. And, for example, once the CXR & EKG & blood results come back, you will have a primary diagnosis.
This will be the time to start specific management.
If you have ordered a number of tests and are waiting, you can move the clock forward to get those test results.
If your management is working, you will get feedback like ‘the
patient appears less breathless’ or ‘more comfortable’.
If you’ve gotten the diagnosis & therefore the management wrong, you may see feedback like ‘the patient is getting more breathless’, etc.
Remember the location! If your patient is quite unstable, eg. acute heart failure, MI, DKA, pneumothorax, MOVE THEM TO THE ICU. (In the USA, generally DKAs and pneumothoraces are cared for in ICU). If necessary, give them a central line, or PA catheter, or arterial line. If immobile, remember heparin.
If you see a well patient in an office, with a minor complaint, there is no need to rush. You have time to examine them. Then order any tests if necessary. If you need those test results to get your diagnosis, don’t leave the patient hanging around in your office all day and all night!
Every test you order will show you what time/day it will be back. In an office, most blood tests take about a day. So, send the patient home (with analgesia or whatever else needed) and give them an appointment to come back when the test results are ready.
Particularly in an office setting, you may need to see your patient two or more times over a few weeks, to make sure they are getting better. So, for example, if you see someone with Fe deficiency anemia, don’t just give them some ferrous sulphate and counselling, and not see them again!
And always remember to counsel them as required, eg. drug compliance, smoking cessation.
Altering patient location also applies in the reverse. If your patient on ICU is much better.. send them to a normal ward.
Remember that you will not benefit from overtreating. If you
do an invasive or expensive procedure when not warranted, you risk losing points.
You are expected to be the primary physician to the patient.
But in general, you will not be able to carry out specialised things like evacuating a subdural hematoma. So, if you need to order a specialised procedure, you will need to involve the relevant specialist.
By typing ‘consult’ in the orders page and clicking, you will get a choice of specialists.
BEFORE you refer to a specialist, you must have enough evidence of your reason for referral, otherwise they won’t come. I’ll clarify, if you see a patient with a cough, the pulmonary meds will most likely decline your referral. But if you perform imaging on the chest that shows a discrete lesion,
not only will you interest the pulmonologist, but perhaps also the oncologist. So my point is, you must have solid evidence for a referral, eg. by imaging.
Once you refer, you may find that they go ahead and operate on the problem...

Thanks to intellidoc who posted this...

This i give as experience1

I will post series of advises n experiences from now onwards....

Dr Pavan

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An Img Experience...

I am Posting the story of a poor immigrant who managed walking up the hill on residency and finally succeeded ....Thanks To Intelligentdoc For sharing this With me...
And i hope this will be Inspirational to our members....

An IMG Experience

I graduated in 1998 from medical school and was not able to start my residency right away. In my country, residencies are not paid, so the majority of residents have to live with their parents or be sponsored by their wifes/husbands, coming from a humble family, and being single, that was not my situation.
I immigrated to the US in 2002, and started to re-learn English, those were tough times, no job, no english, and not a single clue about how to continue with my education. Finally after spending 2 years learning english and understanding the intrincacies of the ECFMG Certification - Match I decided to start, by then I was already 28 Years old, been out of medical school for 5 years, and the worst part, I wanted to do Surgery.
Talking to a lot of people, I quickly realized that things were going to be harder than I thought, I got a job as a computer programmer (!), and started from there, the long hours in front the computer, so far from what I love (my patients) made study every day a difficult task. after a couple of months fighting against the routine I was able to get started.
Setting up goals
The first thing I did, which, I think was key to success, was to stablish a detailed plan, all the way from Step 1 to residency. I joined several forums and was aquainted with the general timing of the exams, I learned that in order to be ready and on time, I would need to have my last exam done by the end of September (1st Rule of thumb), and that would allow me to start my residency by june Next year.
I decided to go in order, Step 1, CK, CS, that mean that I would tackle the hardest one first and would work my way through Step 2 without much problems.
Step 1
I decided to study for a full 8 months for step 1, and here comes my second rule of thumb for the USMLE: You will never be as ready as you would like to be for the Exam, just set a timing goal and adhere to it, if you wait to set the dates for the exam once you are ready, most likely that time is going to be more than what you really need.
After gathering the materias, I took the kaplan 150 question practice exam just to see and gauge an starting point. The results were not any good, I was close to 38%!!! in some of the areas, and my best score was not better than 60%. I took the decision to distribuite the time as follows:
6 months reading the Kaplan Lecture notes (3 Huge books by then)
1 month reading and reviewing First Aid
1 final month exclusively doing practice questions.
In between I started doing the Kaplan Qbank in tutor mode, that helps a lot, but in the end that final month was to be done simulating the actual conditions of the exam, in weekdays I use to do timed blocks of 50 questions and in the weekends try to do as many blocks as possible. In the final days of review I was doing an average of 75% in kaplan, enough to pass the Exam, I took the exam in the end of 2004 and got 85. It was not the score I would like to have, but I was relieved it was over.
Getting into a hands on clinical possition - Possible?
Just after getting my results on the exam, I was told by a friend that there was a position available for Foreign Graduated Physicians in a Hospital in Miami, the position is called House Physician, the state of Florida let people like me work as physician, mostly doing History and Physical exam in patients that either are going to surgery or are admitted in the wards. I was able to secure a position and started seeing patients again. Check in your state with the local department of health, they may have this type of position available.
Step 2 -
I Started to study for Step 2 a few weeks after taking Step 1. for step 2 I used only Kaplan Lecture notes and USMLEworld, after reading the book I did every single one of the 2000+ questions, and was able to repeat at least 800 of them. My final score for USMLE World was 58%, I was confident that this score would guarantee at least 90 in the exam. I spend 5 months preparing the exam, and I still remember taking Step 2, Everything seemed so easy, I got 92, almost 93.
Having fun, that’s what matter
By then I had been on my job as a physician for 6 months, doing at least 12 - 15 Cases a day, Step 2 CS was going to be a breeze, I prepared the exam for 15 days, mostly reading the material of First Aid, and the USMLE video, took the exam in Atlanta, in September, Last year, just as I had envisioned 2 years before… The first case was difficult, because I was very nervous, as soon as I exit trhough the door, somehow I realized that my dream was fulfilled, there were only 11 doors, between me and my ECFMG certificate, I just needed to have some fun in between. Results arrived 4 weeks later, I was a certified physician now.
Here comes the difficult part… maybe not
Getting into Surgical residency was going to be hard, I knew, my scores were not perfect, I had no research experience, and my age (30) and the time after my graduation (7 years) was a handicap in my application, but first I needed to get the Letters of recommendation, and after receiving 2 negative answers from attendings, I was able to get letters, from the chairman of the Surgical department at my hospital, a prominent Laparoscopic surgeon and the medical director of the hospital.
Next step was to compose my Personal Statement, it got to be something that while being true to myself also allow me to get the attention of the committees, I received help from a friend who was able to capture my ideas, and at the end the result was better that I was hoping for. I applied for a whooping 92 programs nationwide on the national residency matching program, spending close to $2000 in the process, I did this trying to cover my deficiencies with a massive ammount of program applications.
and then I started to receive emails from the different programs, the first 30 Emails were negatives, something like “thank you very much for applying, but you are not getting an interview here” It was November last year, when a friend told me that someone got into surgery after completing an Observership in a very big and important hospital in my city. despite everybody telling me that it was going to be near impossible to get a position in such that institution, I decided to try to sign up for an observership.
I was lucky enough to fill a position of someone who had already signed up but was unable to attend, that was the only spot that was available for the next 6 months in the trauma unit of the hospital, I was there 3 months, Dec, Jan and Feb, working around the clock with the Surgery intern and the Senior Resident.
At the same time I applied for residency in that hospital, and talked to the Senior Resident, letting him know that I wanted to stay for my residency. Somehow, they called me for interview, I was astonished. it was the end of 2005 when I got my interview, minutes before I was going to talk to the program director, the Senior resident Popped in and talked to him privately for a couple of minutes. My interview was a breeze.
Now, after writing this, I am heading to Jackson Memorial Hospital in Miami, FL; to finish the paperwork and to do the physical, I signed the contract in December,2005; 3 months before the match, and I will be starting my residency in General Surgery in June… Although I am anxious, I know that everything is going to be all right, I am confident that with hard work and the help of who is now my wife, that has supported me since I was in my country, I am going to be able to go through my residency, being successful, but most of all, having fun, enjoying it, as I have enjoyed every single step of the way, experiences, that happen only once, but last for a life time.
By the way, I was called by 13 different programs across the nation, never went to a single interview!

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Hi Guys Welcome to My World!

I will be Informative in terms of ...USMLE..Movies,Music,Software Downloads,etc.,!

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