Archive for July, 2011

AmeriClerkships: Trials Faced by Foreign Medical Graduates in the United States

Historically, foreign medical graduates have faced significant challenges in obtaining residencies and entering the American medical workforce. These physicians continue to struggle with limited residency spots, visa restrictions, and widespread prejudice, despite the fact that they have proven an invaluable asset to many aspects of medicine in the United States. Studies have shown that medical graduates from schools outside of the United States are more likely to practice in medically underserved areas than physicians educated in America. Currently, foreign physicians comprise almost half of all doctors serving in inner-city or large metropolitan areas. In addition, foreign doctors constitute a disproportionately large percentage of general practitioners in the nation.

While many foreign medical graduates continue to fight for positions in American residency programs, those now practicing have demonstrated a high level of competence. Many of the nation’s largest medical organizations feature a high percentage of international physicians, and these professionals hold leadership positions increasingly often. In recent years, international medical graduates have also consistently performed better than those who graduated from American schools on standardized tests taken in coordination with residencies.

When considering coming to the United States for a residency, individuals from foreign institutions must obtain travel visas to come here and take an exam required for entry into residency programs. This alone proves difficult for many applicants, especially those from the Middle East and South Asia. After securing admission to a program, these individuals must then obtain a long-term visa. The popular J-1 visa requires that the individual return to his or her country of origin after completing the academic program. Many American residency programs cap the number of foreign medical professionals that they will accept, increasing the competition in an already fierce contest. Congress effectively capped the number of residency positions open in the United States more than a decade ago by limiting the funding that the federal government could offer programs. Until Congress reexamines this figure, programs will remain very competitive.

About AmeriClerkships

AmeriClerkships offers foreign medical students the opportunity to work with a variety of medical professionals in several different specialties in order to pursue pre-residency clinical training. These experiences enable international students to transition more easily into the American medical system and provide a serious advantage in the residency application process. For more information about AmeriClerkships, including participant requirements and program options, visit www.americlerkships.org.

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AmeriClerkships: International Medical Graduates in American Residency Programs

In general, international medical graduates prove an invaluable asset to residency programs, strengthening them through diversity. These individuals offer a unique perspective, insight into a different system of values and beliefs, and an understanding of different forms of medicine. Unfortunately, Americans often associate “different” with “inferior.” As a result, many American medical graduates gravitate toward programs that do not accept many international graduates, believing them to be superior in some way. In reality, American medicine will remain forever indebted to the contributions of international medical graduates. In addition, these individuals often perform better than graduates of American institutions.

Unfortunately, international medical graduates still struggle to gain acceptance into American residency programs, largely due to prejudice, difficulties with visas, and a dearth of residency spaces. Once in a program, they often face discrimination from other residents, staff members, practicing physicians, and patients. Language often proves a significant barrier, especially when communicating with patients. While international medical graduates certainly possess excellent English writing and speaking skills, things such as regional differences, slang, and idioms prove difficult to understand. In addition, body language varies dramatically between cultures, requiring that the international students continue to learn American English expressions in addition to practicing their medical skills.

International medical graduates also struggle with differences in the medical education system, and Americans may mistake their deference for shyness or ignorance. Foreign graduates require time and guidance to grow accustomed to questioning their teachers and interacting with other students in a team-based learning environment, an educational system that remains largely American. For this reason, international medical graduates may want to research programs with instructors who have dealt with students from foreign countries extensively. These teachers generally understand how to encourage active participation from international students, and they have furthermore conquered their own biases against foreign education. International students may also want to make their intentions about education clear. While some come to the United States in order to stay and practice medicine, many plan to return to their respective countries and improve the medical systems there. Others may wish to do both.

About AmeriClerkships

International medical graduates can gain invaluable experience with the American medical system prior to enrolling in a residency program through AmeriClerkships. Clinical trainees work closely with attending physicians and other medical professionals, and later they receive an assessment and feedback about their performance. With AmeriClerkships, international medical graduates gain a strong competitive edge in the residency application process.

AmeriClerkships: American Residencies and Discrimination

Multiple studies have uncovered a considerable amount of discrimination toward those with medical degrees from institutions outside of the United States in the selection process for American residency positions. Two independent studies suggested that family practice programs sent applications in response to identical requests 80 percent more often when the candidate graduated from an American medical school. Many academics and medical professionals have pointed to graduates of foreign institutions as a solution for the current shortage of physicians, which will become sharper in coming years as health care reform comes into effect. By expanding coverage, the health care reform bill will result in a considerable increase in demand for general practitioners and other family doctors. Discrimination exists outside of family practice, as studies have seen similar results in psychiatry and surgery.

Many program directors seem to discriminate against graduates of medical schools outside of the United States despite the assertion that medical education should function as a meritocracy. Some programs enforce quotas on the number of these physicians accepted as residents, and some educators have actually expressed a degree of embarrassment about the presence of foreign graduates in their programs. Despite this discrimination, foreign graduates have consistently outperformed American graduates on the In-Training Examination since 1995. The presence of international graduates generally strengthens programs by providing diversity of culture and perspective.

Professionals inside and outside the medical community have called for a reexamination of residency selection processes, reducing the amount of non-academic prejudice exercised by committees. American medicine owes an enormous debt to the discoveries made by physicians educated in other countries and, while it outwardly renounces discrimination, evidence suggests that a large degree of prejudice remains. Instituting a monitoring system would perhaps reinforce this sentiment and demonstrate the unacceptability of caps and quotas in a self-proclaimed meritocracy.

Graduates of international medical schools face a number of challenges when they come to the United States to begin a residency. They do not need the added difficulty of securing a residency position due to discrimination, which ignores their demonstrated academic abilities.

About AmeriClerkships

AmeriClerkships grants graduates of foreign medical schools the ability to gain clinical experience in the United States before applying to residency programs. Qualified medical graduates pair with attending physicians and other hospital professionals, who offer training and evaluation. With AmeriClerkships, international students gain insight into the American medical system, easing the transition and accruing invaluable experience.

AmeriClerkships: Challenges for International Medical Graduates in the United States

Numerous physicians who graduate from foreign universities wish to practice medicine in the United States. Many countries do not have the resources necessary for the efficacious practice of medicine, mostly due to economic constraints. By choosing to complete residencies in the United States, medical graduates learn about the most cutting-edge medicines and techniques. Americans spend more money on medical development and research than any other country, making the United States an ideal place for physicians to further their careers. Unfortunately, these medical professionals often face a number of challenges, beginning with gaining acceptance into a residency program. Places in American residency programs are limited, and competition has become exceedingly fierce in recent years. Before applying, international medical graduates must obtain a travel visa to complete an exam and then secure an additional visa after finding a suitable program.

Once an international medical graduate arrives at his or her place of residency, the student faces a number of other hardships. In addition to dealing with possible prejudice, the individual must struggle with different customs, new cultural concerns, a foreign language, and an altered value system. In the end, however, the student must remember that diversity means strength and that these initial struggles will prove invaluable assets in the future. An average of one in four residents participating in a given program in the U.S. studied internationally, and facilities have grown accustomed to easing transitions. Still, the student must remain proactive, seeking help and guidance whenever necessary. Often, international medical graduates feel completely overwhelmed by the transition to the United States, but they must retain the confidence that got them through medical school. They experienced success in their respective countries and can do so again. Eventually, the feeling of foreignness fades as an individual becomes accustomed to a new culture and embraces new conventions.

The most important piece of advice that anyone can offer is to never fear asking for help and seeking out those organizations created to ease the transition, offer guidance, and address concerns before they become real problems. International medical graduates are not alone in facing the challenges of finding a residency, emigrating, and adapting to life in the United States.

About AmeriClerkships

In order to give international medical graduates an advantage in the residency application process, AmeriClerkships pairs qualified individuals with attending physicians for pre-residency clinical training. After each clinical block, supervisors evaluate program participants according to the 11 medical competencies that they use to assess residents. Many residency programs now expect international medical graduates to pursue such training, making AmeriClerkships an invaluable asset for these students.

AmeriClerkships: The Looming Physician Shortage and Foreign Medical Graduates

President Barack Obama’s recent health care reforms aim to increase overall access to health care while reducing the associated cost. Unfortunately, the United States already suffers from a shortage of primary care physicians, and the demand for more will grow sharply in the coming years as the government implements the reforms. The Association of American Medical Colleges expects a shortage of more than 91,000 doctors by 2020, a figure that has more than doubled from previous estimates due to expanded coverage. Part of the problem lies in the fact that graduates from American medical schools generally choose to pursue specialties, which earn more money than general practitioner positions. Many even feel forced to do this, anxious about the student loans that await them in the future.

Many people have suggested turning to foreign medical graduates in order to minimize the shortage of family doctors. Unfortunately, restrictive licensing rules and limited slots in American residency programs keep many foreign medical graduates from practicing in the United States. Those who wish to practice in American facilities must complete at least three years of residency here, but many applicants get turned away. In the European Union, partnerships exist between countries to import medical professionals to areas most in need. While the United States has a similar arrangement with Canada, graduates of institutions in other nations often face great difficulties in finding a residency program. Before these medical graduates can apply for the residency, they must travel to the United States and pass an exam. Many, especially those from the Middle East and South Asia, have trouble securing a travel visa in order to take the exam. If accepted into a program, students must then obtain another visa. The J-1 visa for education, however, requires that applicants leave the United States after training, defeating the purpose of completing a residency here.

The federal government’s Medicare program subsidizes hospital training programs, effectively giving Congress the power to control the number of available residency positions. Many foreign medical graduates are unable to gain entrance to residency programs due to a 1997 cap on Medicare-supported positions. Congress declared it would pay for only 98,000 residency slots. Since that time, the number of available residency slots has not grown at the same rate as the American population. Most of that expansion, furthermore, represents opportunities in advanced fields, not family medicine. Foreign medical graduates now fill about one in four residency positions, but that figure will decrease as more Americans choose to attend medical school. Many have proposed that Congress fund more residency slots, but that will detract from the funding that goes to health care subsidies. As the need for general practitioners increases, however, the United States will need to reach beyond its borders for new physicians.

About AmeriClerkships

AmeriClerkships matches pre-qualified foreign medical graduates with attending physicians and other medical professionals, allowing them to gain pre-residency clinical experience in a variety of specialties. This experience gives clinical trainees a serious competitive advantage when looking for a residency; in addition, several programs actually require foreign medical graduates to complete such training. After finishing clinical training through AmeriClerkships, international medical graduates receive an evaluation of their performance from their supervisor, who uses the same criteria applied to residents.


ABHES Accrediting Bureau of Health Education Schools Advice American Academy of Family Physicians American Heart Association American Medical Association American medical industry American residencies American residency positions American residency programs americlerkship review 2014 AmeriClerkships americlerkships.org reviews americlerkship services americlerkships experience AmeriClerkships Medical Society americlerkships medical society inc americlerkships medical society review California cardiovascular disease Challenges discrimination dr pedram mizani ethics experience with americlerkships first postgraduate year foreign-trained physicians foreign medical graduates foreign physicians Go Red for Women Greg Belshe Health Care healthcare graduates IMGs immigrant physicians international medical graduates international medical students International Medicine interview Irvine Irvine Award Program larkin community hospital medical graduates medical school medical students National Residency Matching Program National Resident Matching Program NRMP Palo Alto VA Medical Center pedram mizani md physician shortage practice interviews Residency residency applications Residency Interviews Residency Matching residency programs reviews about americlerkships Santa Clara Valley Medical stanford hospital internal medicine residency stanford internal medicine residency stanford internal medicine residency program stanford university hospital internal medicine residency subinternships The Match Tips United States USMGs

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