FELLOWSHIP WITHOUT / BEFORE RESIDENCY: PART 1

Not all roads in life are one ways ! A residency is not the only way for IMGs to get entry into the medical scene in US - an alternative 'short-cut' for IMGs to do fellowships without first doing a residency does exist- of course you need to have a Post Graduate MD in the field in your home country first.

What ! Vacant Fellowship Positions in US with all this competition for residencies ? Yes, there are and you may find vacancies in even high competition specialties like Radiology too...not easy of course, but definitely possible after efforts (may get tougher as more IMG home-country-Post Graduates consider this option). For example, in 2006, only 54% fellowship positions in Radiology were filled - See the official statistic here


We shall look into the technicalities in a subsequent post, here lets analyze some reasons why fellowships are not always a choice for people after completing a residency in USA.


1. Economics ! Thinking in the shoes of the AMGs (American Medical Graduates) - Fellowships are a low-pay committment for AMGs after 3-4 years of Residency and with average post-medical school loans of $120,000/- to $150,000/- with accruing interests, a lot of them get out into the job-market to start earning the big bucks to settle off loans, get a house.etc. And once you get wired into a high-income lifestyle, family, etc., it's not that easy or sometimes even economically impossible to take a pay-cut. Contrast this to the comparatively minimal loans, if at all, that IMGs from low-cost medical school countries have. I am in no way suggesting that there aren't many AMGs doing fellowships, there are plenty. But this post rather attempts to explain why some fellowship vacancies still exist when logic would suggest the opposite given the high competition for residencies.

2. J1-Visa Issue: Those with J1 visas might prefer a waiver-job to fellowship since waiver-jobs are tougher to come by. The practical choice is often to get that green card in hand first and then consider fellowships later in life, rather than risking 2 years back in home countries. In fact, IMGs on J1 have been known to quit fellowships when a waiver job comes by.


3. H1-Visa Issue: Those with H1b visas too may consider first doing a job to get the labor certification required for green card eligibility, rather than being forced to leave the country at the end of 6-year and returning back after a year to reset the H1b visa tenure clock. (usually fellowships do not grant a labor certification). Again, in both visa cases, as life settles off with starting a family and lifestyle builds around the 150,000/$ a year salary, it's not always easy to revert to a low-pay fellowship lifestyle ( around 45,000$ to 60,000$ a year, depending on the city).


These facts apart, there is a general consensus that the IMG mindset is wired to make them more likely to take up fellowships than the AMGs.


Q. Are USMLE Scores Needed For such Direct Fellowships ?
A. Yes - In fact You need to Be ECFMG Certified before starting the fellowship. Read about ECFMG Certification Here.

Q. Which Visa is offered for such Fellowships ?
A. J1 is more commonly offered - though H1 is not impossible. H1b visa needs Step 3 scores just like for Residencies.

Q. Does this J1 for Fellowship have the 2-year home country residence requirement ?
A. Yes - any ECFMG Sponsored J1 will have that requirement. Read More about that Here.


Enuf food for thought Eh ?




So what AFTER completing such Fellowships - can you practice in USA ? The details are a little fuzzy yet - but do read some analysis on Fellowships Without Residencies - Part 2




Also Read:
- Visa Basics for IMGs