Transferring from a European or South American Medical School to the US

If you study Medicine from anywhere around the world outside of the United States (such as Caribbean medical schools, or Europe or South America), talk about the opportunities and salaries available in the US will surely surface.  Internationally, the US is still viewed as the "land of opportunity" and it is appealing for those who have chosen to follow a career in Medicine. Unfortunately, however, there is a very complicated process involved in studying Medicine in the US and you will need much more than a plane ticket to enter the hospital system.  This article covers some of the top 4 essential steps that you must take in order to learn how to adjust to the US Healthcare System if you are coming as an IMG. 

Number 1: Start the Paperwork for Your J-1 Visa As Soon As Possible 

Do not have the false impression that because the US is such a large country, the government offices should have the available resources in place to process your applications quickly.  If this is your first taste of the US, realize that the bureaucratic paperwork is considered to be a nightmare for a reason.  Hospital administrators are notoriously slow for trying to complete paperwork for incoming students and may become a contributor to part of the problem.  Many Residency Programs in the United States do not accommodate IMG candidates but as the doctor shortage continues to plague hospitals around the US, many programs now look for the strongest candidates internationally to fill the void.  There is a good chance that the secretaries have never completed this paperwork before so it is up to you to try to contact them as many times as necessary to make sure that you have all your paperwork in order.  A few of my Canadian friends were beginning Residency in the US and they did not get their J1-visas until 3 days before their Orientation Day after starting the process back in March.  There is only a small window between Match Week and the start of most Residency Programs so make sure that you capitalize on all the time you have, otherwise you may lose your spot in the program.  

Number 2: Review First Aid For the STEPs 

This piece of advice can apply to both types of IMGs that can come and practice in the US.  For those of you who studied and took all the STEP exams in order to qualify for a  Residency position as well as those who have studied and practiced Medicine in their home countries and then who wish to transfer into the US System.  The key piece to remember is US hospitals have different standards of care than any other country in the World.  You may know what the EU recommends as management for an NSTEMI heart attack but that will be different in the way you must manage the patient in the United States.  If you do not realize this before your start, it will become very hard for you to adjust to the system while you are working long days. Malpractice lawsuits do not discriminate between natives and non-natives so you may be dealing with a lot of new stress early on in your practice.  

Two More Essential Tips to Make the Transition Into the US System Smoother 

Number 3:  Be Prepared to Work Hard 

Another key piece of information that you may not realize coming form an International Medical System is the life of a Medical Doctor in the US is not as glamorous or as appealing as you may have seen portrayed on "ER" or "House."  Doctors just starting out in the profession in the US are forced to work long-hours and it can be a tremendous strain on your relationship with family, friends, and spouses.  If you are transferring your entire family over to the US with you as you begin your journey in Medicine, be prepared to not see them a great deal of time for the first few years.  

A colleague of my often compared  practicing Medicine in the US to being deployed overseas if you were in the US Military.  In both circumstances, the families have to be self-sufficient because you will not be able to see them for the majority of the week.  Although there will be opportunities to go home, you may have 1 or 2 hours of face-time with your children and spouse before you need to sleep to do this all over again the next day.  That is roughly the same amount of time you may have to Face-Time or Skype your loved ones if you were stationed on a military base somewhere else.  The sad thing is that in the healthcare setting, most of the doctors are at least in the same zip cope as the hospital.  Although Residency Programs claim they are capping the number of hours a young doctor has to work at 80 hours per week, just realize that that means that they only report the first 80 hours a week.  Chances are, you will be creeping up to at least 100 hours a week in some rotations.  

Number 4:  Adjust Your Mentality of How You May Have Practiced in Your Home Country 

If you have read as far as this part, you may see a striking similarity to Point Number 2. You will need to learn new therapies or management techniques in the US that will not be the same procedure as your home country but Point Number 4 is referring to something else entirely.  For whatever reason, the US is one of the only places on the planet that is a "reactionary health-care system" as opposed to a "preventative healthcare system" in most locations elsewhere.  If this is hard to imagine, I will give you a simple example.  In the US, doctors will not put nearly the same effort into convincing patients to alter their lifestyle that would be done in other countries abroad.  If a patient continues to gain weight and eat fast food, he will be prescribed a concoction of statins and Beta-blockers but in a large portion of these patients, you will be managing him only slightly because a "by-pass" or "stent placement" will be on his horizon very soon.  In Europe, the focus is to prevent the patient for every entering the operating room in the first place.  Doctors will vigorously try to educate the patients to make significant lifestyle modifications.  

The beneficial thing about Europe or South America is that doctors are still very respected in those communities.  A patient will not argue and if a doctor gives a patient a bit of medical advice, they will do everything in their power to make sure that the doctor's will is achieved.  When you enter the US, be prepared to deal with patients who know better than you because they typed some of their symptoms on "Dr. Google" and they are sure they have cancer instead of the disease you diagnose.  They will question you every step along the way and can be difficult to manage because they may stop medications prematurely if they feel that they do not notice a change in their health.  True, this is true for a patient anywhere in the world but once you start getting phone calls treating to "sue you for malpractice"  you will soon realize that there are a lot of opportunities to regret your choice to move into the US system.