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ECFMG 2024 Update: What Does This Mean For IMG Doctors? – World Federation of Medical Education

The ECFMG 2024 Update for IMG Doctors will bring changes to the recognition of medical schools. However, these changes will not affect an individual’s eligibility for ECFMG certification. Instead of individual medical school recognition, the responsibility will shift to a national body in each country, which will then be recognized by the World Federation of Medical Education (WFME). Currently, ECFMG approves the WFME and the National Committee on Foreign Medical Education and Accreditation (NCFMEA) of the U.S. Department of Education for recognizing medical school accrediting agencies. In this article, I’ll explain what this update means for you as an IMG doctor, providing specific examples to help you understand the impact. Let’s explore this together. Click here to get help What is the ECFMG 2024 Update for IMG Doctors? If you are an International medical graduate specialist doctor who is exploring the alternate entry path program into the USA or who is someone planning to enter the USA to do a residency, here are the big changes from ECFMG you must know. ECFMG has announced that effective in 2024, eligibility for USMLE and employment as a doctor in the United States will be restricted to graduates from medical schools/programs accredited by an agency that is recognized by the World Federation of Medical Education (WFME) Recognition Program. This is big. They go on to clarify that The World Federation of Medical Education or the WFME Recognition Programme is the only program accepted by ECFMG at the current time for the recognition of medical school accrediting agencies. Can I give USMLE and be ECFMG Certified after 2024? I will explain this in detail by giving you examples so this makes complete sense to you. In the new process starting 2024, individual medical school direct approval will be gone. Instead, there will be a national accrediting body in each country that must approve the medical schools and this national accrediting body must then be approved by the ECFMG. This will be a two-step process. The onus is moved from one medical school to the national body of each country. I will give you a specific example of two doctors from the same medical college. Let’s call this ABC Medical College and the doctors Dr. A and Dr. B Dr. A: Let’s say Dr. A graduated in the year 2020 and she investigates the list of WHO approved medical schools in this list at the World Directory of Medical Schools on the website https://www.wdoms.org/ she finds her medical school; she is all set. She registers with ECFMG, applies for USMLE, passes the exam, and becomes ECFMG certified. Dr. B: In this case. Dr. B is from the same medical college as Dr. A and he is now graduating in 2024. Now Dr. B will look into the World Federation of Medical Education website which is wfme.org and not the world directory of medical schools. This is a major change. Whether Dr. B can apply for ECFMG will depend on whether his medical college or school is recognized by WFME. For some reason, Dr. B finds out that his school is not recognized by WFME and cannot be ECFMG certified even though Dr. A was ECFMG certified coming from the same medical college/school before 2024. Can Indians write USMLE after 2024? If you are an IMG from India like me, this can take two different situations. Graduating before 2024: If you are from a WHO-recognized medical school and have already registered with the ECFMG, you can write USMLE after 2024 even though you will be graduating before 2024. Graduating after 2024: If you are an IMG from India, the ECFMG 2024 update will require that the medical colleges in India be recognized by the National Medical Commission in India. The National national medical commission should then be recognized by WFME. At the time of my writing this, this recognition is still pending. Can you be ECFMG certified without USMLE? According to the U.S. Department of Education, National Committee on Foreign Medical Education and Accreditation (NCFMEA), Educational Commission for Foreign Medical Graduates (ECFMG) is the authorized credential evaluation and guidance agency for international medical graduates (IMGs) who seek to apply for residency in the U.S. or apply through the Alternate Entry Path program or practice directly in the United States. There are many requirements for being ECFMG certified. One of the requirements is the requirement of an examination. This for IMGs is the USMLE. This is the same exam that US graduates take. The difference is that they can directly apply and IMGs have to go through the ECFMG for this. Upon successful completion of the USMLE Step 1, Step 2 CK, and other requirements the candidate will be issued the ECFMG certification. Following this, the candidate can take USMLE step 3 which is required for an independent license from the State Medical Boards. Out of the different visa types for an IMG like the H1B, J-1, and O visa, having an H1B visa will ease the transition to applying for permanent residency and potentially be successful. Is ECFMG the same as USMLE? The ECFMG is an agency while the USMLE is an exam. The ECFMG agency does the credential evaluation and provides final certification for IMGs to practice medicine in the USA. The completion of the USMLE exam is one of the many requirements to be ECFMG certified. In my experience, all other requirements are paperwork to make sure the IMGs training is recognized and legit. The USMLE exams are what most people find onerous in this pathway for ECFMG certification. There are other pathways to practice in the USA, however, the ECFMG and the USMLE exam pathways are the most straightforward that almost all IMGs I know of have used. What is the World Federation of Medical Education recognition program? They are a not-for-profit, non-governmental organization. According to the website they have offices in London, France, and the Czech Republic. This makes me think they have nothing to do with the US in particular. It

What Visa Do I Need to Go to USA as IMG Doctor? Visa For IMG

Visa for IMG (international medical graduate) doctors falls into three major categories – J1, H1B, or an O visa. This could be for the traditional residency where J1 is more common and the alternate entry path program where H1B is more common. These are sponsored by the employing hospital or relevant authorities or both. There may be others but they are mostly an exception. There are two major categories of USA visas called nonimmigrant (temporary) and immigrant (permanent). There are 38 different nonimmigrant visa categories and 13 immigrant visa categories starting with an alphabet and sometimes a number. I will tell you about each of the visa for IMG types. I am neither an immigration consultant nor an attorney, but I went through this process and have seen many people living through this process. I will share my personal experience. This will give you my thoughts so you know the pros and cons of each and this will help you make a decision. By Dr. Rajeev Iyer, MBBS, MD, FASA Associate Professor of Anesthesiology University of Pennsylvania, USA Can doctors get an H1B visa for IMG? “International Medical Graduates (IMGs) who seek entry into U.S. programs of Graduate Medical Education (GME) must obtain a visa that permits clinical training to provide medical services” according to American Medical Association. The H-1B visa for IMG is meant for temporary workers in specialty occupations who hold professional-level degrees like Medical School, residency, and fellowship. A visa for IMG is a perfect fit for this requirement. The H-1B visa allows a foreign national to enter the USA for professional-level employment and this is given up to a maximum of six years. [videopress Mw0lloPy] Do hospitals sponsor H1B visas for IMG Doctors? An IMG doctor visa candidate moving into the USA can be based in any country. The first step is that the IMG doctor applies for a job in the USA. Once a suitable job offer is available based on the hospital and immigration requirements, then a petition will be filed on behalf of the IMG doctor by the employer which in this case will be the hospital hiring the IMG doctor. The H1B petition will be approved when the doctor is still outside the USA. Using the approved petition, the IMG doctor visa can be stamped on his/her passport which will enable entry into the USA and start working. There may be a situation when the IMG doctor is in the USA on a visitor visa (B1/B2) when the petition is approved. This could happen because the IMG doctor may be visiting family and friends. In this case, the IMG doctor has to leave the USA and then reenter back on the H1B to start working. Who is eligible for H1B Cap? Each year, there is a limit on how many H1B visas are issued. Like you, I read in the news about the lottery system used to allot the H1B Visa. The H1B visa for IMG at least to my knowledge is exempt from H1B cap which in other words means all eligible employed IMG doctors will get an H1B visa if sponsored by their employer. What are the disadvantages of H1B visa for IMG? As an IMG, the H1B is perhaps the best visa to have. However, there are some disadvantages of H1B visa for IMG (some general and some specific to IMG) and here they are Temporary Maximum limit of 6 years Requires renewal and a petition has to be filed The candidate must leave USA, have the H1B visa re stamped and renter USA with the new renewed visa. However, this is not a mandatory requirement unless you don’t want to leave the USA A major drawback I have seen for IMGs is that their spouses tend to be either professional people or very experienced but unfortunately the spouses or children cannot work and only the primary person can work. The dependent’s spouse or children are given a Visa called H4 which lets them stay in the USA and go to school but cannot work. Requires the passing of USMLE Step 3 What is the minimum salary for H1B visa? Since the H1B visa for IMG is offered to professional workers with a Master’s degree the salary will typically be a six-figure number. If the candidate enters the USA as a resident then he/she will be given a resident salary. I am not aware of a minimum salary with H1B visa for IMG. It depends on the nature of the job, location, and other factors that normally decide pay. Which is better H1B or J1 visa for IMG? Both H1B and J1 are temporary work visas and have pros and cons. Based on two major factors (2-year waiver requirement with a J1 visa and the ease of transition of H1B to apply for a green card), H1B scores higher than J1. Here are my suggestions: If you are offered, I suggest choosing H1B. If you are offered a J1, check if you can get H1B. Can I get a green card without H1B visa? An H1B is not a mandatory requirement to get a green card. If you enter the USA on a visa for IMG, then H1B is certainly a better choice. However, there are many eight categories available to apply for Green Card. For an IMG doctor, the most common category is likely to be employer-based and the second most common family based. The other possibilities are rare but I have seen this happen. How soon after H1B visa can I apply for a green card? Green can be applied for any time after an H1B visa for IMG. There is no predefined time limit. It comes to a point when your employer wants to sponsor you for a green card or you decide to apply on your own. I have come across many green card rejections when people have applied on their own but none when the employer sponsors it. This does not mean to say

Which Country Is Best for IMG Doctors? USA vs. Canada (Alternate Entry Path Program)

Based on my personal experience of seeing multiple IMG doctors who are specialists in Canada and the USA, the answer depends on where your primary training is from. If you are a specialist, trained in a high-income country like Australia & New Zealand, Hong Kong, Singapore, South Africa, Switzerland, UK, and Ireland, then the USA scores marginally higher than Canada. If you are an IMG specialist trained in a low to middle-income country like India, China, Brazil, Pakistan, Bangladesh, etc., then the USA is the clear winner. I will explain to you the specific differences so you know why I say this and you can make the right choice if you had an option. Let’s jump into finding more right away Rajeev S. Iyer MBBS, MD, FASA Associate Professor of Anesthesiology, University of Pennsylvania, Philadelphia, USA Can IMG doctors work in Canada and USA without residency? First, I will tell you if it is even possible to work in USA and Canada without residency and then explain in brief the different pathways. This will make it easy for us to compare both systems and make sense. Both USA and Canada offer pathways to work without residency and be a part of their system. USA: In the USA, Alternate Entry Path Program is created for international physicians who are exceptional and outstanding to be an important part of the US academic system. I will quote this verbatim from the ABA Website. “The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into our exam system for primary certification in anesthesiology. A record of documented achievement in teaching and/or scholarship, rather than the potential for future success, is critical to acceptance into the AEP program, as is the ability of the sponsoring department to provide an outstanding academic environment.” There are two ways to get into the Alternate Entry Path Program Clinician Educator Pathway Research & Fellowship Pathway Check the full guide about the options in the USA and how to be successful using this link: How to practice anesthesia without USA residency? Alternate Entry Path Program Canada: There are two major options for IMGs to practice in Canada – Royal College Certified Specialist: The Royal College of Physicians and Surgeons options Province Based Specialist with hospital specific license: This is via Postgraduate Education Certificate. This is an option from IMGs from low to middle-income countries like India, China, Brazil, Pakistan, Bangladesh, etc. I will quote this directly from the Royal College of Physicians and Surgeons of Canada website “International medical graduates are candidates who have completed postgraduate residency training outside of Canada or the United States. To be eligible for Royal College exams, candidates do not have to live in Canada or hold Canadian citizenship.” The Royal College of Physicians and Surgeons in Canada further offers three options for IMG’s Approved jurisdiction Practice eligibility route Subspecialty Examination Affiliate Program (SEAP) Check the full guide about the options in Canada and how to be successful using this link: Can IMG doctors work in Canada without residency? Which Country Is Best for IMG Doctors – USA or Canada? After knowing all the pathways of the USA and Canada, the critical question is which one should you be choosing if you had the option of both. Based on seeing IMG doctors in both USA and Canada who have been through all the above pathways here is what I think. IMG from High Income Country Australia & New Zealand Hong kong Singapore South Africa Switzerland UK and Ireland If you are from the above listed countries, the decision comes up to where you want to live. Do you have a family that you would like to stay close by? From the alternate entry path program standpoint, whether you chose USA or Canada, you will ultimately be board certified in the USA and Royal College certified in Canada. So, the eventual outcome does not make a huge difference. However, the USA is much more desirable than Canada for the reasons I have mentioned below. IMG from Low Middle Income Country Afghanistan Angola Armenia Bangladesh Benin Bhutan Bolivia Burkina Faso Burundi Cambodia Cameroon Cape Verde Caribbean Central African Republic China Egypt, El Salvador Ethiopia Guatemala Haiti Honduras India Indonesia Kenya Lebanon Madagascar Micronesia Mongolia Morocco Myanmar Nepal Nigeria Pakistan Papua New Guinea Philippines Senegal Sri Lanka Sudan Syria Tonga Tunisia Uganda Ukraine Uzbekistan Vietnam Yemen Z Zambia Zimbabwe & others If your specialist training is from a low-middle income country, then you are definitely better off with the alternate entry path program in the USA. This is based on my experience and many IMG doctors I personally know of in Canada and USA. The opportunities you have to grow and the support structure is far larger in the USA than in Canada. A huge benefit in the USA is that the alternate pathway will give you board certification by the American Board of Anesthesiology while in Canada the Royal College Certification is largely biased to favor certain countries. Is Being an IMG Doctor in USA Better Than in Canada? In short, being an IMG doctor in the USA is better for one main reason. Irrespective of what country you are trained from, the alternate entry path program offers opportunities to you. At the end of a successful pathway, you are eligible for board certification by the American Board of Medical Specialties. While in Canada, this is not the case. Those who enter the pathway through the province based pathway in Canada, almost never become Royal College certified. On the other hand, the Royal College eligibility is biased towards certain high income countries. Here are some specific differences between USA and Canada. As you see in the table below, the USA scores much higher in all aspects than Canada with the exception of immigration. Although I am not an immigration consultant nor an attorney, based on

Can IMG Doctors Work In Canada Without Residency?

IMG doctors who have completed their residency in their home country have two options to practice medicine in Canada without Canadian residency. The first option is the province-based specialist route, which grants IMG doctors from any country eligibility for a specific hospital-based license. The second option is the Royal College Specialist pathway, which is open to IMG doctors who meet specific criteria established by the Royal College of Physicians and Surgeons of Canada. If you’re an IMG doctor planning to practice medicine in Canada, this information will help you understand your options. These alternate entry path programs are designed for exceptional and specialized IMG doctors who can contribute significantly to the healthcare systems in the USA or Canada. Through these pathways, IMG doctors can work directly as fellows and/or faculty members in Canada, bypassing the need for residency. I’ll share my firsthand experience with both of these pathways in Canada, so let’s dive right in. Dr. Rajeev Iyer, MBBS, MD, FASAAssociate Professor of AnesthesiologyUniversity of Pennsylvania, USA This article is author’s own opinion and does not represent the opinion of University of Pennsylvania or any other organization. Book an Appointment with Dr. Rajeev Iyer

How to Get Into the Alternate Entry Path Without USA residency? IMG Success Guide

You can enter the alternate entry path without a USA residency by showcasing your accomplishments and expressing your interest in becoming a valuable part of the US academic system. This opportunity is available in Radiology, General Surgery, Thoracic Surgery, and Obstetrics & Gynecology. For exceptional anesthesiologists, there’s a fantastic chance to become board certified in anesthesiology in the USA without residency. The American Board of Anesthesiology offers the Alternate Entry Path (AEP) program to support internationally trained and certified anesthesiologists in joining US academic anesthesiology programs. In this article, I’ll explain everything about the Alternate Entry Path (AEP) program. Click here to find out if you qualify for the Alternate Entry Path Dr. Rajeev Iyer, MBBS, MD, FASAAssociate Professor of AnesthesiologyUniversity of Pennsylvania, USA The opinion in this article are authors own and do not represent the opinion of University of Pennsylvania or any other organization. Book an Appointment with Dr. Rajeev Iyer

How to Practice Anesthesia Without USA Residency? Alternate Entry Path Program

There are two ways anesthesiologists can practice as anesthesiologists in the USA without a US residency. Visiting Professors – International physician anesthesiologists visiting the USA for a short time are limited to a hospital. They are not the American Board of Anesthesiology (ABA) board-certified. Alternate Entry Path Program for Primary Certification – This is an official pathway by the American Board of Anesthesiology and as the name says is a pathway for certification in the USA without a USA residency. I will break down each and every step to help you understand this alternate entry path program clearly. I have extensive experience in this topic and have seen colleagues doing it. Let’s jump to find out more. I will limit this post to the Alternate Entry Path Program for Primary Certification in Anesthesiology. Click here to find out if you qualify for Alternate Entry Path What is Alternate Pathway for Primary Certification? The Alternate Pathway for Primary Certification by the American Board of Anesthesiology is a pathway for International Medical Graduates to become board certified and be productive members of the USA anesthesiology system. I will quote this verbatim from the ABA Website. “The Alternate Entry Path (AEP) program allows international medical graduates who are certified by the national anesthesiology organization in the country where they trained and practicing anesthesiology in the U.S. to qualify for entrance into our exam system for primary certification in anesthesiology. A record of documented achievement in teaching and/or scholarship, rather than the potential for future success, is critical to acceptance into the AEP program, as is the ability of the sponsoring department to provide an outstanding academic environment.” What are the requirements for the Alternate Entry Path (AEP) Program? There are two things here: First, be anesthesiology certified in your home country or any other country Have clinical experience in USA or Canada I will explain this in detail below. Anesthesiology Certified in Home Country: This is any country outside the USA. Typically this is your how country or any other country where you can be certified. Let me give you an example. If you are from India, you should have completed anesthesia residency in India or from any other country outside India except the US. This could be the UK, Singapore, Australia, etc., or any others. 2. Anesthesia Experience in the USA: This can be through the following paths in USA and Canada. To my knowledge, experience in Canada has to be clinical. Who is eligible for the Alternate Entry Path Program? Recently American Board of Anesthesiology (ABA) had a press release expanding the AEP program to two different pathways. The ABA has a limit of 4 candidates per hospital/university at any given time. Many years ago, the AEP program had only research experience-based and had a limit of 2 candidates. To me, it appears that the program has been successful and so it has expanded. What are the two pathways for the Alternate Entry Path Program? Clinician Educator Pathway Candidates trained from the following countries are eligible for this Australia & New Zealand Canada Europe Ireland Singapore South Africa United Kingdom If a candidate is from a different home country other than the above but trains here, they are still eligible for entry into the Clinician Educator pathway. I will give you an example. If someone’s home country is let’s say India, China, Pakistan, Bangladesh, etc. and they do anesthesia certification from Canada, Europe, Ireland, or any other country mentioned above, are eligible for this pathway. According to ABA, these countries have training that is similar to the training in the USA. 2. Research and Fellowship Pathway Candidates from any country are eligible for this. I will explain these two pathways in detail below. How do the two alternate entry path program pathways compare? I have put this in a table format. You can see the similarities and differences. Any questions or if something has to be changed, reach me out at drrajeeviyer@gmail.com Where to apply for the alternate entry path program? The alternate entry path program is offered in universities or hospitals that have an ACGME accredited anesthesiology residency or fellowship or both. This is critical because if there are ACGME accredited programs, that particular university of the hospital will have the necessary infrastructure to satisfy the high standards required by the American Board of Anesthesiology which certifies physician anesthesiologists. This is done through a rigorous training process followed by written and oral anesthesia boards. You can find these programs by looking into the American Society of Anesthesiologists residency information by State https://www.asahq.org/education-and-career/asa-resident-component/residency-information-by-state. This is a comprehensive list of places with ACGME accredited training that can potentially offer this pathway. If you can find a program that has candidates in the alternate entry path program either now or in the past you are in luck! How to apply to the alternate entry path program? You should apply to the chair or head of the department of anesthesia asking them if they can support you as a candidate for the alternate entry path program. You should specify the achievements you have done in your CV and how you qualify for the program. Highlight how you can bring academic or teaching excellence into the USA from outside. What are the steps in the alternate entry path program? I have summarized the steps below. Apply to the program Interview Selected – Congratulations Submit the 4-year plan to the ABA with the support of the Department Chair ABA accepts the plan – Congratulations. I want to warn you that there is a high likelihood of rejection since the requirements are set at very high standards. Start the program practicing as a faculty or clinical fellow or research fellow or a combination of these. My experience has been working as a faculty and this will depend on the CV. Semi-annual and annual reviews In-training examinations Successful completion of 4 years Anesthesia Written Boards Anesthesia Oral Boards Board Certified Anesthesiologist –

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