Category: Foreign Resident Issues

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I Am A Foreign Grad And Want Interventional Radiology… Help!!!

want interventional radiology

Question For Residency Director

Dear Dr. Julius,

First of all, thank you for writing up this excellent blog. I found the ‘choosing fellowships’ section to be of highly beneficial to me. But even after that beautifully written post, I am still undecided. I am currently a radiology resident in the UK. And, I am keen to apply for a fellowship in the USA(I have completed my USMLE). I like working with my hands. Moreover, I think that I am talented. I understand that the traditional interventional radiology fellowship will no longer be available by the time I am eligible to commence my fellowship (2021).

Now, I am quite interested in neurointerventional radiology. By 2021, I would have completed a five years residency in the UK (3 years in general radiology and two years in neuroradiology). Realistically speaking, what are my chances of getting into a two-year fellowship in neurointerventional radiology being a foreign medical graduate? I understand that it is a competitive fellowship. Also, what kind of interventions do I get to perform by doing a body fellowship?

Many thanks for your help!

 

Answer:

Azygos Lobe,

Unfortunately, all those years in the UK are not directly transferrable to the United States requirements. So, you are stuck with one of two possibilities in the United States. First, you could look to satisfy the alternate pathway requirements. However, interventional fellowships of any sort have become the most competitive of them all in the United States. Even though you may want interventional radiology, getting a slot as a foreign grad may be next to impossible. And, if you were to find one, you may not satisfy the requirements for licensure in many individual states within the U.S. when you completed your fellowship and looked for work here. Therefore, that would be a tough road to choose.

Second, you could theoretically apply to repeat your clinical and radiology residencies in the USA. But, that would mean an additional five years of training.  And, then you could ask for a fellowship in interventional for a year or two (Depending on whether the program has ESIR)

And finally, the most unlikely option, you can apply directly to the IR/DR residencies. But again, only a few accepted applicants were foreigners because it has become one of the most competitive residencies in the match.

To sum up, your options are a bit limited. For your best chances, I would apply to the US residencies and start anew. That would involve many years but would be the most likely scenario to succeed. It would be a tough road to follow.

Body Fellowship For Interventional Practice

In terms of the body fellowship, depending on the location, you may encounter a bit of interventional variability. Some programs do more biopsies and drainages. Others may have a mammo/breast component. And, even others may have a small interventional/vascular element. It comes down to the individual program practice patterns. So, you need to ask around before committing to any particular body fellowship.

Let me know if you have any other questions,
Barry Julius, MD

 

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I Am A Foreign Grad- How Can I Stand Out To Get An Interview?

foreign grad

Question:

Hello, Dr. Julius. I am a foreign medical graduate in my third year of medical school, and I want to apply for a radiology residency after graduation. I wanted to know from your perspective what would make a foreign grad application stand out and prompt you to interview them. 

Thank you for taking the time to answer my question!

Regards,

Want To Stand Out

Answer:

Foreign Grad Categories

To begin with, not all foreign residents are equal. I like to classify foreign medical grads into a few separate categories. First, you have the foreign medical grads who are United States citizens and have passed the USMLE exams. These folks tend to have the most excellent chance of acceptance because they do not have any VISA issues.

The second type of applicant is not a United States citizen but has also graduated from a foreign radiology residency in addition to an international medical school and has passed the USMLE exams. These graduates are usually a bit higher up on the totem pole because they have loads of experience to bring to a radiology residency program.

To categorize the rest, you have the non-US citizen foreign grad who has completed the USMLE series. Finally, the last group is non-US citizen foreign grads who have not completed the USMLE.

Depending on which category, your chances of an interview will vary dramatically. If you are part of the first category, you have the best chance of an interview. Instead, you have almost no chance if you are in the last group.

Regardless of which category, some U.S. radiology programs will not even look at your application if you come from a foreign medical school. So, you cannot expect to have as many interviews as a U.S. graduate. However, if you have U.S. citizenship, the odds are a bit higher.

Oh, and one more thing. Since the ACGME merged with the AOA, a D.O. graduate in the United States has the same options for residency as an M.D. Separate D.O. residencies will no longer exist. So, in effect, unfortunately, the increased pool of these non-MD candidates decreases the chances of obtaining an interview as a foreign grad.

Now That I Know My Chances, What Should I Do?

What can you do as a foreign grad if you are in any of these groups? First, I would recommend getting to know the program director and faculty to get the “inside track.” Often, personally knowing the faculty may be the only way to get an interview as a foreign grad. So, that would be my first strategy. What else? Participating in research or an observership can also help the foreign grad. Finally, the board scores of a foreign grad will often need to be significantly higher than an American grad to receive an interview.

Also, I received a lot of questions about how to apply. Most programs will not even look at your application unless you go through the ERAS system. So, make sure that you are filling out the ERAS application! And, unless it is a unique circumstance, don’t even bother to apply to a program without going through the online system.

 

I hope that answers your question,

Barry Julius, MD

 

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Is It Possible To Get Into Radiology Residency With An H1B Visa?

Good evening, I am an MS3 just starting to discover the excitement of radiology on my radiology selective. I am contemplating radiology as a career, but I have low Step 1 score (227) and I am also an international student requiring H1B visa for residency (I attend a top 40 US allopathic school and am not Canadian). Is radiology still an option realistic to consider given my circumstances (I hope to match into a university program)? What can I do now as I start my third year going forward to increase my competitiveness? Thank you for all your help!

Adele

Hi, Adele!

H1B And J1 Visa Issue

The answer to the question of your chance for getting into a program may hinge on the next few questions I am going to ask you. Why is it that you require an H1B vs. a J1 for getting a residency? What kind of visa do you currently have? This may make a big difference because universities are much less likely to support a resident with an H1B visa since it costs the university a lot of legal fees and time to support a candidate to obtain the H1B visa. Also, the federal government limits the numbers of H1B visas. Therefore, you significantly limit the playing field of choices of programs to apply.

Some of the larger academic university programs may allow applicants with an H1B visa. But, many smaller programs like ours do not take applicants with H1B visas for the reasons I mentioned (with a few rare exceptions). When applying, if you can’t get a J1 visa, I would definitely call the individual programs to see which ones would take an H1B visa.

Biggest Positives In Your Application

So, what do you have going for you? First, the fact that you are graduating from an American medical school will help your situation immensely. We, as program directors, selfishly like to get applications from American medical schools. At least we can vouch for the quality of the institution and compare to other applicants. Second, your scores are not bad. Many programs have cutoffs around 220 or 225. So, it should allow you to meet that requirement at many programs.

Other Recommendations

In addition to the recommendations above, I would also consider taking the next USMLE early, studying hard, and perhaps completing a USMLE Step II course so that you can show improvement from your 1st USMLE examination to the next one. Program directors like to see improving scores going in the right direction.

Why The Visa May Be The Biggest Issue

Unfortunately, the visa issue may the biggest impediment to getting a radiology residency slot. I would like to refer you to my article called The Alphabet Soup Of Residency Visas And The Radiology Alternate Pathway: A Guide For The Foreign Radiology Residency Applicant at the link above:

Thanks for the great question. I would be specifically interested in why you need an H1B. Let me know if there is any other information that you think I can help you with. I will post it on the website at some point because I think it would be useful for other applicants in your situation as well.

 

Regards,
Barry Julius, MD

Dear Dr. Julius,

Thank you for your reply and great advice.

I am currently on an F1 student visa and was advised against a J1 visa by my immigration attorney because of the requirement to return to my home country for 2 years. I am Singaporean and have been looking into the H1B1 visa for Singaporeans. It is similar to H1B, but has its own cap that has never been filled historically, can be obtained anytime throughout the year, and only requires the employer to file LCA (I-129 is not needed).

I am under the impression that it would be easier to approach programs that offer H1B already to ask about sponsoring for H1B1 visa, than programs that offer J1, since they may not be familiar with the H type visa. Is this likely to be true?

Also, how and when would you advise me to contact programs and discuss visa-specific issues/requests. Should this be done before I submit my residency application?

Thank you for all your help.

Best regards,
Adele

 

 

Thanks for the additional information. That allows me to understand the issues that you have and why you need an H1B1.

I would definitely make sure to contact the residency programs and the Graduate Medical Education (GME) office prior to applying because many of the programs will not even look at a candidate who has to get an H1B or H1B1 visa for a residency slot. Most programs are set up for the J1 visa. If you need an H1B or H1B1 visa to get into a program, it puts you into a different application pool.

You certainly don’t want to waste your time and money applying to those programs that only take J1s and not H1Bs. It makes sense to contact each of the individual radiology programs and the GME office prior to applying to save you a headache. Typically, the person to speak with would be one of the folks in the GME office who handles visa issues. And, you probably want to speak to the residency coordinator because occasionally the individual program policy can potentially differ from the GME office. ( the program may not take a resident with a visa issue, but the GME office may say it is OK) At our institution, this person is a secretary and is very knowledgeable about all things visa related since she has been doing it for a long time.

Hope that gives you a little bit more insight about when to contact the program and who to contact.

Regards,
Barry Julius, MD

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Is It Still Possible To Become An ABR Certified Radiologist Through The Alternate Pathway?

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.

 

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