Fellows Survival Guide

International Medical Graduates – Planning for an Infectious Diseases Fellowship

The PIDS Training Program Directory lists programs that may be able to accept international medical graduates, and the types of visas they sponsor. Clinical education necessary to enter fellowship programs must be completed in an ACGME-, ACGME-I, or certain other accredited or approved residency programs (ACGME Program Requirements for Graduate Medical Education in Pediatric Infectious Diseases).

A fellowship program, however, may accept an “exceptionally qualified” international graduate who does not have training in an accredited residency, but who has (1) completed a non-ACGME accredited pediatric residency program outside the continental United States, (2) demonstrated excellent clinical skills throughout their training, and 3) who has other special qualifications, such as advanced clinical or research training in pediatrics, research publications or scholarly presentations, or who have held leadership positions during or after residency. It is important to emphasize your exceptional qualifications in your fellowship application. Applicants must obtain Educational Commission for Foreign Medical Graduate (ECFMG) certification, which requires passing the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 CK examinations (usmle.org). Note that some institutions also require you to pass the USMLE Step 3 examination.

An effort should be made to pass these exams on the first attempt and to achieve above average scores (>230). Applicants must have excellent spoken and written English and the ability to adapt to practice in a modern and complex environment. If possible, you should complete one or more clinical rotations in the US or Canada to experience these medical systems in person. Reference letters should be obtained from physicians very familiar with your work, ideally those who have supervised US electives or who have trained in North America themselves. Reference letters should not be generic, but specifically address your individual strengths and qualifications.

Before you apply to a fellowship program you should understand your options for visa sponsorship. Most programs offer “exchange visitor” J-1 visas that are sponsored by the ECFMG. To apply for a J-1 visa you must pass the USMLE Step 1 and Step 2 CK examinations or the COMPLEX-USA equivalent. Applicants must provide a statement from their home government that indicates that there is a need in that country for persons with training in Pediatric Infectious Diseases (Statement of Need).  J-1 visa holders must also return to their home country at the end of their fellowship training for at least 2 years before they are eligible to apply for another visa to work in or immigrate to the United States. It is possible, but difficult, to obtain a waiver of the two-year home-country physical presence requirement (see “Life after Fellowship”, subsection 7). J-1 visas are issued on a yearly basis and can be extended up to a total of seven years.

The H-1B visa is a temporary worker visa that is sponsored by an employer. An advantage of this visa is that you are not subject to the two-year home country physical presence rule and may stay and practice medicine in the United States immediately following your fellowship. Disadvantages include greater costs to employers and caps on the number of H-1B visas issued annually; not all programs offer H-1B visas. To apply for an H-1B visa you must pass the USMLE Step 1, Step 2 CK, and Step 3 examinations. An H-1B visa is valid for 3 years and can be extended for another 3 years. Spouses/partners and children under 21 years of age may obtain visas to accompany you to the United States during your training.

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