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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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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Google Docs A good site for PDF document creation& conversion,Save n Share!

Hi Guys as the point of converting word to Pdf arouse i know a better alternative for that ...Its Nothing But Google documents....(Click on the images below to see them)

The Link is ...http://docs.google.com

This is also a free service and unlike pdfonline.com..It has no limitations...

its very simple and Handy...as most of us r having Gmail Account .....u can see an option on top left of ur account named "DOCUMENTS" click on it

u ll be guided to a window where u have to sign in again with ur Gmail id ..This is one time setup...

Once u log into it...

U can see the sample page how it appears after u log into ur account...

1)Upload Word documents, OpenOffice, RTF, HTML or text (or create documents from scratch).
2)u can use its inbuilt editor to edit/format your documents, spell-check them, etc. when u feel the out put of ur pdf document is not good , like misalignments,border problems etc.,
3)u can directly save them in ur Google Docs and u can even Share That with ur friends
4)U can download them into pdf by clicking on"FILE" and "export as PDF"..the file is downloaded immediately to ur computer!

If u click "PUBLISH"it will be published over internet with a URL(I mean a website link) is given which u can share with ur friends..when u click it u can see the File directly !

Unlike PDFONLINE.com its not time taking and u can save ,share,edit documents....and its delivered as a download directly to ur computer when u click Export as PDF...rather than sending to e-mail..

Hope this Helps

Dr Pavan

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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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