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 fulfill the state licensing requirement after doing the 4 year alternate pathway. (To my disappointment 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.
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Here are answers to your two separate questions here. To refer to the other information about the alternate pathway go to the ask the residency director question at the following link: How To Complete The ABR Alternate Pathway As A Foreign Physician
Answer to First Question:
In order to be licensed in a state, you do not get your certification from the ACGME. Rather, the ACGME certifies the program that you attend as a resident, fellow, or attending. 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?
Two Ways To Satisfy The Alternate Pathway Requirements.
1. An ACGME accredited institution would need to sponsor the foreign radiologist 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. 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 special 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 for a faculty position.
2. It is possible to get an unaccredited fellowship in an institution that has an ACGME accredited residency program. This year of unaccredited fellowship would be enough to count toward the requirement of having 4 years of training. You would need four such years as this. Through this pathway, you would potentially only have to deal with the issues of getting a J-1 visa, which is a bit easier than an H1b visa.
Issues For The Alternate Pathway Applicant
For both of these alternate pathways, there is a possible complication of some individual states not recognizing the training of foreign residents who do not complete an ACGME accredited residency/fellowship. This means that the alternate pathway training may limit which states he/she chooses to work.
As you can see, it is possible but a bit complicated to go through the alternate pathway via both methods. The ABR alternate pathway has become 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!!!) In addition, there is a risk that your opportunities as an alternate pathway candidate, could be more limited.
Answer To Second Question:
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.
Director1
