Applying to The U.S. for Training

Ramon F. Soto, MDACP Governor, Venezuela

I’ll try to summarize what an ordinary young graduate from Venezuela, and possible from any other Latin American country, will have to endure if he (she) wishes to go to the U.S. for postgraduate training, fellowship, visitor observership, or to participate in refreshing courses in any medical branch.
The first thing to do is to obtain an American Visa, which will be different depending on the graduate’s purpose. A type J-1 visa will allow the candidate to work as resident earning a salary for up to 7 years, if all other requirements are met. A type F-1 visa will permit the candidate only to study or do a fellowship for a shorter lapse, without getting any payment, and as an observer without any intervention nor responsibility in the patient care. Finally, with a B-1/B-2 tourist visa the candidate could remain in US for up to six months to study or do a short fellowship, again without payment and patient responsibilities. The chances of getting any kind of visa will depend on the US immigration policies in force at the time the petition is formulated; and not infrequently it is rather tough to obtain one.
If the graduate plans to do a residency in any American hospital it is mandatory for him (her) to pass: 1) The TOEFL examination of English language proficiency with an score above 550. This examination usually is not a problem and most applicants find it rather easy to pass. 2) Step 1 and Step 2 medical knowledge tests. 3) The Clinical Skills Assessment. Once the candidate has approved these examinations he (she) can obtain the certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) Subsequently, he (she) can register on the Electronic Residency Application Service (ERAS), in order to be able to publicize his (her) credentials and aspirations, make them known to the employers (hospitals, universities, etc) and to respond to any call, like coming for an interview. Finally, through the computerized Residency Matching Program his (her) priorities are matched with those of the employers interested in his (her) services. The candidate’s eligibility for any given post will depend on the compatibility of both priorities.
Once all this complicated process is successfully completed and the candidate is accepted for a residency, he (she) is in a good position to apply for a visa. Usually the problems graduates come across after they start working are the same faced by their American peers, and have little to do with their condition of foreigners. An important regulation, which is frequently by-passed, is that the graduate must return to his country of origin at the end of his training in the US.
On returning home after his training the professional and academic future of graduates will depend in large measure on what condition he went to US. In Venezuela most graduates go on their own initiative and have no pre-established connection, like hospital, public health service, or university, to come back to after they finish training. So, as soon as they are back they have to start looking for a job or settle down as private physicians. This uncertainty of what to do after getting home has been a strong deterrent for our young physicians trained in the US to come back, and an incitement for them to remain there. Of course, the minority who were sent abroad by the medical or academic institutions where they worked rejoin their original positions as soon as they return. However, it does happen that some of these graduates desert their Venezuelan position and prefer to stay in the US. The number of IMGs from LA nations living and working in the US is very large and is on the rise. It is a professionally notorious and prosperous community and includes many distinguished professors, clinical investigators and practitioners. In Florida, for instance, there is an Association of Venezuelan Doctors of Florida.
For those foreign graduates coming to the US with other purposes than doing residency training the panorama is different in many ways. Visa and other requirements are less stringent, and as they cannot earn a salary to cover their living expenses the big problem is funding. Many support themselves, but the majority have to depend on a stipend or grant awarded by a variety of institutions and foundations from the US or other countries. The American College of Surgeons has a well structured program of short fellowships. In LA arrangements have been established between regional medical institutions and American universities, to enable young physicians to come to the US for intense activities in educational and refreshing courses. At the American College of Physicians efforts are being made to reinstall their former program of mini-fellowships for graduates from foreign countries.
Brief bio:
Ramon F. Soto was born in Venezuela. He graduated from the Complutense University, Madrid, Spain and his postgraduate training in internal medicine was in London, Great Britain. Back in Venezuela he joined the Faculty of Medicine at the Central University of Venezuela, in Caracas, where he served for 30 years until retirement in 1986. Since then he has been very active as a full time general internist in private practice in Caracas. Dr. Soto became a Fellow of the American College of Physicians in 1982, and has been serving as Governor for its Venezuela Region since 1997, and as a member of the International Subcommittee since 1999.”