dear sir,
I have completed my radiology residency from India in 2015 and I wish to pursue radiology residency in usa.
I am unsure of how alternate pathway for radiology.ABR website says one must have a mix of radiology residency /fellowships/faculty post for four continuous years.If residency itself is for a duration of 5 years ,how would it be possible to have a combination of residency and fellowship for 4 years?
Is it possible to get 4 fellowships consecutively at the same institute?
kindly help me in this regard.
regards,
Fiona
Director1 response:
Radiology residency is for a total of 4 years in the United States. Prior to beginning a radiology residency, you need to have an additional year of clinical internship, usually medicine, surgery, or a transitional year (a year of multiple electives). The expectation from the ABR is that you will either repeat an entire 4 year radiology residency program at the same place (not the initial clinical year). The other possibility is that you have the experience to complete part of a radiology residency program and complete subsequent radiology related fellowships. So, you could theoretically have any combination or permutation of experiences, i.e. 2 residency years and 2 distinct fellowship years, 4 fellowship years, and so on/so forth. As you stated, all the years need to be performed at the same institution.
There are some large institutions that do have more than 4 different types of fellowships. But, if you did attend a United States residency program, more commonly, the foreign resident/fellow would complete a 2 or more year fellowship instead of a typical one year fellowship. (Nuclear medicine, neurointerventional, and neuroradiology fellowships can be 2 or more years) As long as you complete the prescribed 4 years in a radiology related area, you can satisfy the requirement.
Take a look at the following URL:
Dear sir,
Thank you very much for the detailed reply.This is a wonderful blog!
I have one more query to clarify.
Would a foreign radiologist be eligible for fellowships after just 2 years of American residency?since fellowships are usually offered after 4th-year radiology.
Is it practically possible for foreign radiologists to get ABR certified via this pathway or Would it be better to do the usual 5-year residency pathway?
I apologize for asking a similar question again but I was unable to find answers for this question and I feel this might bring clarity to many IMGs.
regards,
Fiona.
Theoretically, you should be eligible for fellowships after 2 years of residency if you have satisfied all the requirements for finishing the American residency with your prior training in a foreign country and the two year of American residency training. This would have to be approved and recognized by the ABR. In order to find out that detailed information, you should probably contact the ABR if it is relevant to you. In either case, you would still have to have a total of 4 years of American residency and/or fellowship training to get your ABR certification. Again, this all depends upon finding an American radiology program to sponsor your training and allowing you to complete only two years of residency and fellowship. (That is probably going to be the most complicated part)
It would be a bit easier (but still difficult) to find a program that would take you in the standard 4 year radiology residency pathway. Again, the biggest problem for you: to get the funding for the residency or fellowship program. Residency funding is usually sponsored and paid for by Medicare for American residents. Since you are coming from a foreign country, you will need to find a program that can privately finance your residency. That significantly limits the programs that will take you as a foreign resident.
Dear sir,
Thank you for the explanation.
I shall contact ABR for further details and the practicality of this pathway.
Regards,
Fiona.
Dear Barry,
I am also interested as Fiona in the alternate Pathway. My biggest question here would be, if I have any chances after ABR certification in actually pursuing a career as an independent radiologist in the US. As far as I understand, in many if not all states, you are required to complete a minimum time of postgraduate education, within an ACGME accredited program, before being granted the corresponding state license to practice as a physician. Considering the rule that you are allowed to take a fellow position in an ACGME accredited fellowship program ONLY if you graduated from an ACGME accredited residency program (this because of recent changes); how could any radiologist trained abroad be able to fulfil the state licensing requirement after doing the 4 year alternate pathway.
(to my disapointment explained here by the SPR – Society for pediatric radiology – ¨ http://www.pedrad.org/Education/Fellowship-Directors/Pediatric-Radiology-Fellowship-Directors-Library ¨ )
The ABR clarifies that the changes introduced by the ACGME are not affecting the alternate pathway, which I understand and see as no impediment for certification, however I still don’t see clearly the possibility of full licensing. Why would a foreign radiologist be interested in ABR certification if the chances of practicing radiology in the US are so scarce or null in the future.
One last question: wouldn’t a fully trained radiologist from abroad be a good candidate to match through the traditional residency system, under your perspective as a program director ?.
(Dear Fiona: Maybe we can get in contact and share our views and findings. Please email me if you are interested).
Thank you for reading this, cheers, Esteban.
Here are answers to your two separate questions here.
1. In order to be licensed in a state you do not get your certification from the ACGME. Rather, the program that you attend as a resident, fellow, or attending has to be certified by the ACGME. The ACGME only certifies programs not people. So, it is still possible to be certified by the ABR and to get a state license via the alternate pathway. However, as you mentioned in the new addendum in 2015 to the alternate pathway, you will have a difficult time getting into an accredited fellowship via the alternate pathway because of the new requirement (having to get an ACGME fellowship only after completing an ACGME accredited residency).
Regardless, it is still possible to use the alternate pathway to become an ABR board certified radiologist. So, how would that happen? You would need to be sponsored by an institution with ACGME accreditation for a junior faculty position for four years. In other words, the institution would be responsible for getting the H1B visa for four years so that you could work in the ACGME accredited institution in the United States for four years. The problem with this- the sponsoring institution will incur lots of legal and immigration fees in order for the applicant to get the H1B visa and the junior faculty position. So, it is unlikely that the institution will take a foreign applicant unless he/she offers something or is trained in a subspecialty area that is useful to the institution and a United States applicant cannot fill that need. Therefore, it is true that the institution is much more likely to take a United States applicant than a foreign applicant. The alternate pathway is becoming a rarely trodden method of obtaining a radiologist position in the United States. (It is not impossible, but very difficult and probably involves lots of connections!!!)
2. From an associate program director’s perspective, I would love to take a candidate who has been trained as a full-fledged radiologist in another country. Our job becomes a lot easier since these residents are usually very independent. In fact, one our best residents has been a candidate such as that who attended our program four or five years ago. He was absolutely fantastic!
Again however, there are several impediments for the foreign radiologist who wants to repeat a United States residency. First of all, many programs do not want to have to deal with the stresses of getting a J-1 visa sponsorship for their foreign applicants, even though a J-1 visa is usually not that difficult to obtain. And, second, there is a prestige issue for many programs. Some high-end university programs take pride in the fact they do not take foreign applicants to their program. (Even though they will not say it on their website or brochures)
Bottom line… It is becoming more and more challenging for the foreign applicant to obtain a spot in a United States training position to eventually become a United States ABR trained radiologist. It’s not impossible but it’s very, very difficult. The applicant that is successful is going to have to be at the apex of the foreign applicant pool and is going to have to be on top of the visa situation.
Hope That Helps,
Barry Julius, MD
Dear Barry,
I want to commend you for the insightful information in this thread. It appears to be the only forum I see issues of radiology training being addressed in-depth.
I am also a foreign trained radiologist who just relocated to the United States and I will love to work as a radiologist. I have a green card so visa would not be an issue. I want to know what the requirement for getting into a radiology fellowship are with respect to USMLE scores. Is fellowship in a non-ACGME program accepted for ABR certification as well?
Thank you
Gbg
For the United States radiology resident, typically, by the time you get to a radiology fellowship, USMLE scores are not important at all except that the examinations need to be passed. On the other hand, programs really care about whether or not the resident has passed the core examination. If a resident has not passed this test, some programs could theoretically deny a previously accepted applicant to the program depending upon the policy of the fellowship. Fellowships would rather not have to deal with new fellows studying for the core examination rather than concentrating on the fellowship.
In the case of a foreign residency graduate applicant, however, USMLE scores may be used since there is less certainty as to the quality of the program that the foreign resident graduated. And, the foreign resident can’t sit for the core examination until he/she completes the requisite amount of training. I would say that the higher the scores the better and that a cutoff is variable, depending upon the program. But, more importantly, there are going to be very few fellowship spots out there that are willing to take non-U.S. graduates. That is usually the bigger problem for foreign grads.
In terms of non-ACGME fellowship programs, they can count to your ABR certification as long as the hospital has other ACGME accredited fellowships and/or radiology residencies within the institution. These programs would be the ideal fellowship for someone like you to meet the requirements of the alternate pathway.
Most foreign resident graduates nowadays, unfortunately, have to repeat a residency in the United States since there are very few fellowship/faculty opportunities available via the alternate pathway.
Usually,
Thank you Dr. Julius ,
I have more questions please about the alternate pathway, If I get matched in traditional 4-year radiology residency , can they accept me without the preliminary clinical year required?! especially if I applied for Physician R position ( PGY2)
The other question , as it is required to get into ACGME accredited fellowship to have prior ACGME accredited residency, Is it impossible to get into ACGME accredited fellowship or there will still be a chance ?
First question: In order to start a radiology residency, you need to have one clinical year in an acgme accredited program. You can theoretically match to only a radiology residency program without a clinical year but you are under obligation to complete a prelim clinical year prior to beginning. Sometimes matching to a prelim year can be harder than radiology!
Second question: It is true that it is only possible to get into an acgme accredited fellowship if you complete an acgme accredited residency. However, if you are looking to complete the alternate pathway, you can complete a nonaccredited fellowship in a program that has an accredited residency. And, that will count toward the alternate pathway requirement. You need 4 of those fellowships to be able to sit for the abr examinations.
A little bit confusing. But, I hope that helps!!!