How to Complete Your Medical Residency in the USA

Steve Toews
02/26/2020
How to Complete Your Medical Residency in the USA

Practicing medicine in the United States appeals to many international medical students and doctors, but the U.S. requires these physicians to undergo an extensive process—including doing residency abroad in America.

One way to avoid completing two residencies, which could take as long as 10 years, is to complete just one medical residency—in the United States. However, this can be challenging due to a shortage of slots in medical residency programs in many states and roadblocks for international students qualifying for financial aid.

Below, you'll discover whether you qualify for a residency in the USA, how to choose your program, and how to apply.

Benefits of Completing a Medical Residency in America

The advantages of completing a residency in the United States can include better pay, access to state-of-the-art technology, and more flexibility to work internationally in the future. Here's how to complete your residency in the USA as an international student.

In addition, the United States has some top-notch programs. While rankings can vary by specialty, outstanding medical residencies in America include:

While there are many advantages to seeking a U.S. education, be aware of these common challenges that international students often face in the United States.

Who Qualifies for a Residency in the USA?

International medical graduates (IMGs) can qualify for U.S. medical residencies in some circumstances. An IMG is someone who attended a non-U.S. and non-Canadian medical school. Everyone who attended one of these schools is considered an IMG, including U.S. and Canadian citizens and permanent residents.

IMGs must apply and qualify for certification by the Educational Commission for Foreign Medical Graduates (ECFMG). Certification requires applicants to pass a series of examinations called the United States Medical Licensing Examinations. It also requires them to have attended an educational institution approved by the ECFMG.

With respect to the latter requirement, applicants can consult the World Directory of Medical Schools to find out if their education meets the requirements of the ECFMG.

The examination requirement is split into three parts:

United States Medical Licensing Examination (USMLE)—Part 1

Part 1 is a seven-hour exam that tests the student's ability to apply scientific concepts to the practice of medicine. It is taken over the course of eight hours.

United States Medical Licensing Examination (USMLE)—Part 2 (Clinical Knowledge)

Part 2 (Clinical Knowledge) is an eight-hour exam administered over the course of 9 hours. It tests the student's ability to apply medical knowledge and skills in a clinical environment.

United States Medical Licensing Examination (USMLE)—Part 2 (Clinical Skills)

Part 2 (Clinical Skills) requires students to assess standardized patients and gather information from them, perform physical exams, and communicate their findings to patients and colleagues. According to the American Academy of Family Physicians, it's important to take Part 2 (Clinical Skills) well before December 31 of the year you're applying to Match. The AAFP suggests scheduling it no later than March of the year you intend to apply.

Medical Residency Requirements: Visa Options

The first step in qualifying for a medical residency program in the United States, after completing the United States Medical Licensing Examination, is to obtain a visa. A Temporary Employment H-1B visa and an Exchange Visitor (Physician Training) J-1 visa are the most common visas that qualify.

The H-1B is generally more desirable because it doesn't have the two-year home residency requirement that a J-1 does, which requires you to return to your home country for at least two years before returning to practice in the U.S. However, it is more difficult to obtain an H-1B visa as a foreign medical resident.

A J-1 visa also requires you to have qualifying J-1 medical insurance before entering the United States. Tokio Marine HCC—MIS Group offers two international health insurance plans, Atlas Travel and Student Secure, that meet the requirements of the J-1 visa. Both of these plans also provide you with a visa letter which specifies that your coverage meets J-1 visa insurance requirements.

Different Types of U.S. Residency Programs

Internal medicine residency programs can be split into four different categories:

Program Type Description

Transitional programs

The resident is rotated through different hospitals every few months. These programs may or may not provide sufficient credits to move on to a second training year.

Preliminary programs

The resident, who typically desires to specialize, receives 1 year of training in internal medicine.

Categorical programs

The resident receives three years of traditional, hospital-based training and may qualify for board eligibility if performance is acceptable.

Primary care programs

The resident, who typically desires to be a generalist, receives ambulatory care experience in the community.


Leading Residency Programs in the USA

For those completely unsure of which residency program to apply for, the AMA Residency and Fellowship Database (FREIDA) allows applicants to search through over 11,000 residency programs available in the United States. All are accredited by the Accreditation Council for Graduate Medical Education.

A candidate's most desired residency programs will, of course, depend on the specific professional and personal goals of the applicant. However, some programs are particularly renowned for providing stellar education and bestowing considerable prestige on the resident:

Institution

Location

Program Type

Johns Hopkins University

Baltimore, Maryland

  • Primary care
  • Categorical

Massachusetts General Hospital

Boston, Massachusetts

  • Categorical

Mayo Clinic

Rochester, Minnesota

  • Categorical


Those are just a few of the thousands of excellent residency programs available in the United States. Regardless of your specific requirements, you'll need to check the Federation of State Medical Boards website to ensure that the state you've selected will allow you to be accepted as a resident.

How to Apply for a Medical Residency in the USA

Next, complete your applications. These generally include:

  • Your Curriculum Vitae — The American Association of Medical Colleges recommends using standard fonts, paper, and format; using the active voice; and avoiding the use of first-person point of view.
  • Letters of Recommendation —  Kaplan, a test-preparation company that trains medical students to take the USLMEs, suggests that you ask an attending in the same specialty as the field you intend to enter for your recommendation. Give your letter writer plenty of time to prepare your recommendation. 
  • A Personal Statement — Although it's acceptable to seek advice and input about your personal statement, the AAFP reminds people that the statement must ultimately be written by you.

Following submission of your applications, any residency programs that are considering you will contact you to schedule interviews. Your interview will generally begin with you sitting in on rounds and end with meetings with program directors, attending physicians, and chief residents.

The Interview Process

The interview process is much like the one found in any other professional field. You're advised to be professional, know your application and the program you're applying for inside and out, dress formally, and be respectful. Do not send gifts. Thank you cards are sometimes acceptable if they don't violate the rules set out in the National Resident Matching Program.

National Resident Matching Program

After you obtain a visa, you must register with the National Resident Matching Program, which matches residents with programs on Match Day and helps you track your ranking of programs following your interviews.

When you register with the NRMP, you will also want to select a specialty. According to JAMA, the specialty with the highest percentage of international medical graduates in 2014 was internal medicine (40 percent) — specifically pulmonary, nephrology, and critical care.

Once you've completed your interviews, you can use the NRMP to rank your preferred programs. The NRMP bases a match on the rankings of both the applicants and the residency programs, therefore, there are some important rules to remember:

  1. Never rank a program that hasn't granted you an interview. You are not likely to be accepted if you have never met with the program leaders.
  2. Do not rank a program that you have no intention of attending. If you are matched with that program, you are expected to go.

If you are not matched on Match Day, the NRMP will release unfilled programs. In what is called "the scramble," unmatched students contact these programs in hopes of acceptance.

What to Do After Admission

Once you are accepted to a program, what's next?

First, make sure you have health insurance that will cover you during your time in the United States. Some medical residencies for international students offer their own health insurance plans. If you wish to explore other plans that may better meet your needs and budget, consider looking into alternative international student health insurance plans.

It can also never hurt to start planning ahead for when you complete your medical residency. Assuming you want to work in the United States, depending on your visa and residency status, you will want to start planning for getting a job or a fellowship at a medical institution in the United States.

In some cases, residents with J-1 visas can also receive a waiver from the requirement to return to their home country for two years if they agree to work in a rural area for a certain amount of time.


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