Later in Life Doctor MD/DO

[MSK9]

Hmm, that's not 'later in life' as I thought, the individual is only 31 years old.. One of members started their Caribbean MD at an even older age if I recall correctly.  Then you have someone already 54 in another thread thinking of getting a Bachelors and start on their MD journey...

I started at 35 and finished at 39.

[Stonybeach]

It is essential to know that if you decide to go to a foreign medical school historically, getting a residency in the States has been problematic. However, there has been a significant effort to license international medical graduates (IMGs) in many states through supervised internships by board-certified physicians, not in ACGME-accredited residencies. Some states even consider your foreign residency and license history.

"U.S. States Welcoming International Doctors Without Residency Requirements"

https://www.medsmarter.com/blog/u-s-stat...residency/

[MSK9]

It is essential to know that if you decide to go to a foreign medical school historically, getting a residency in the States has been problematic. However, there has been a significant effort to license international medical graduates (IMGs) in many states through supervised internships by board-certified physicians, not in ACGME-accredited residencies. Some states even consider your foreign residency and license history.

"U.S. States Welcoming International Doctors Without Residency Requirements"

https://www.medsmarter.com/blog/u-s-stat...residency/

I need to address your post. It's not an attack on you. It's a correction of the information. For conciseness' sake, I'll break my post down into a small list.

1.) It should be noted that while not ideal necessarily, international schools provide more new physicians per year to the United States than any domestic school. That's just how it is, good, bad, or indifferent. The data is out there.

2.) Within our medical academia, there is an purposeful distinction made between 'IMG' and 'FMG' within the United States matching system (NRMP/SOAP). As far as academia Stateside is concerned, 'IMG' is used to refer to American citizens who attend international schools, while FMG ("Foreign Medical Graduate") refers to non-citizens who require visas to work in the country. IMGs have a high match rate in spite of the stigma attached to attending an international school (again - right, wrong, or indifferent). That article you posted is not a reliable source of information. Not only do they not provide any references for their assertion, they're also trying to see USMLE prep material.

3. Being as both IMG and FMG MUST (no way around this) take all of the same USMLE Step exams (1, 2, and eventually 3) in addition to being certified by ECFMG (education accreditation body for international graduates) in order to work in the States, a physician will, by virtue of these items, be eligible to attend a residency.

4. Physicians coming into the States without having taken the USMLE exams are not eligible to work as physicians in any sense of the term - not even under a licensed attending as an "intern," ACGME accredited program or not. An observership, perhaps. It's neither here nor there, but for the sake of completeness, the attending physician's board certification, as was mentioned in your post, is irrelevant as far as this topic is concerned.

5. Depending on the host country of the school attended, some states may not allow for licensure for the credential provided. This is commonly seen with countries on the international 'bad boy' list, or fly-by-night programs in third world countries. The list of international schools California approves is utilized across most of the country. The 'big four' Caribbean medical schools, are able to work in all US states and territories.

Hope this clarifies things.

M

[Stonybeach]

My point is that states are currently creating legislative processes that potentially accommodate graduates of foreign medical schools through alternative pathways to licensure. I think that begs the question, why? Is there a shortage of home-baked physicians? If residents of a state have a problem with new legislation, they should voice their concerns to their state legislators. The link I provided shows which states are currently involved in legislative reform. If you can find a better link or article, please post it.

[MSK9]

My point is that states are currently creating legislative processes that potentially accommodate graduates of foreign medical schools through alternative pathways to licensure. I think that begs the question, why? Is there a shortage of home-baked physicians? If residents of a state have a problem with new legislation, they should voice their concerns to their state legislators. The link I provided shows which states are currently involved in legislative reform. If you can find a better link or article, please post it.

To your first question, yes. There's been a physician shortage for years. It's a multi-factorial problem. As far as alternative pathways to licensure are concerned, that part of the system isn't determined by state legislature. A physician must be licensed by the National Board of Medical Examiners to practice as a physician. States have their own medical boards but the National level board sets the medical licensure standard (USMLE), which all states base their own licenses on. As someone in the industry who has been through the licensing process, I don't see this changing anytime soon, which I believe is for the best. While the current licensure process is a flawed metric, it is the best we've come up with for physicians to demonstrate clinical competency ahead of them actually putting their hands on patients. The whole idea is to protect patients from incompetent or otherwise unqualified practitioners.

The site you referenced provides no reference for what it asserts, and the opening statement of your post addresses something that isn't really a problem. A cursory search of NRMP match data will tell you what percentage of FMG apply and/or are accepted to residency programs. Of the ones who don't, it is sometimes due to a visa issue, the data of which is also available on NRMP.

[Stonybeach]

"A physician must be licensed by the National Board of Medical Examiners to practice as a physician." The NBME does not license physicians! According to its website it offers "High-quality exams from NBME are built in collaboration with content experts to evaluate applicants’ competence for licensure." You are confused! US States and US Territories regulate their licensing requirements. Yes, many States and US territories require the USMLE steps 1 thru 3 and 1 to 3 years of an ACGME accredited residency. However, US territories such as Puerto Rico accepts USMLE exams but also has its own Revalida which is similar to USMLE but offered in Spanish. The Virgin Islands also uses the SPEX instead of the USMLE. The issue I am bringing up deals with state legislation that has alternate pathways of post graduate that will be accepted by a State. Each State has its own legislation on what kind of residency is required for a foreign medical graduate.


For example,
"New Legislative Changes
To address these challenges and physician shortages, several states have enacted laws offering alternative pathways for IMGs:

1. Arizona:
Starting January 2025, IMGs can receive a provisional license if they have an international medical degree, pass USMLE Step 1 and Step 2 CK, and demonstrate English proficiency. They must work in rural areas for four years under supervision to obtain full licensure."

This is a State legislative initiative that becomes a bill, then is voted on and signed by the Governor and not a Federal! Each State or Territory has its own autonomy in regulating professions to ensure consumer safety. You have to go to the State or Territory and look up the licensure requirements for each and every State!

The FSMB is a good starting point but with all the new legislation coming from different States and Territories, you really have to go the State Medical Board for the State you want to be licensed in!
https://www.fsmb.org/step-3/state-licensure/

[MSK9]

"A physician must be licensed by the National Board of Medical Examiners to practice as a physician." The NBME does not license physicians! According to its website it offers "High-quality exams from NBME are built in collaboration with content experts to evaluate applicants’ competence for licensure." You are confused! US States and US Territories regulate their licensing requirements. Yes, many States and US territories require the USMLE steps 1 thru 3 and 1 to 3 years of an ACGME accredited residency. However, US territories such as Puerto Rico accepts USMLE exams but also has its own Revalida which is similar to USMLE but offered in Spanish. The Virgin Islands also uses the SPEX instead of the USMLE. The issue I am bringing up deals with state legislation that has alternate pathways of post graduate that will be accepted by a State. Each State has its own legislation on what kind of residency is required for a foreign medical graduate.


For example,
"New Legislative Changes
To address these challenges and physician shortages, several states have enacted laws offering alternative pathways for IMGs:

1. Arizona:
Starting January 2025, IMGs can receive a provisional license if they have an international medical degree, pass USMLE Step 1 and Step 2 CK, and demonstrate English proficiency. They must work in rural areas for four years under supervision to obtain full licensure."

This is a State legislative initiative that becomes a bill, then is voted on and signed by the Governor and not a Federal! Each State or Territory has its own autonomy in regulating professions to ensure consumer safety. You have to go to the State or Territory and look up the licensure requirements for each and every State!

The FSMB is a good starting point but with all the new legislation coming from different States and Territories, you really have to go the State Medical Board for the State you want to be licensed in!
https://www.fsmb.org/step-3/state-licensure/

No, sir/ma'am. I'm not confused. I have a basic medical license in multiple states. USMLE (United States Medical Licensing Exam) / COMLEX (osteopathic equivalent, same accreditation) are literally the licensing exams which states use to grant the ability to work in their respective areas. As you stated with Arizona, passing USMLE Step 1 and Step 2 CK are a requirement; the same as an incoming PGY-1 resident/intern.

You can't go to a state medical board without USMLE certification and expect to get a job. It just isn't going to happen.

[Stonybeach]

"A physician must be licensed by the National Board of Medical Examiners to practice as a physician." The NBME does not license physicians! According to its website it offers "High-quality exams from NBME are built in collaboration with content experts to evaluate applicants’ competence for licensure." You are confused! US States and US Territories regulate their licensing requirements. Yes, many States and US territories require the USMLE steps 1 thru 3 and 1 to 3 years of an ACGME accredited residency. However, US territories such as Puerto Rico accepts USMLE exams but also has its own Revalida which is similar to USMLE but offered in Spanish. The Virgin Islands also uses the SPEX instead of the USMLE. The issue I am bringing up deals with state legislation that has alternate pathways of post graduate that will be accepted by a State. Each State has its own legislation on what kind of residency is required for a foreign medical graduate.


For example,
"New Legislative Changes
To address these challenges and physician shortages, several states have enacted laws offering alternative pathways for IMGs:

1. Arizona:
Starting January 2025, IMGs can receive a provisional license if they have an international medical degree, pass USMLE Step 1 and Step 2 CK, and demonstrate English proficiency. They must work in rural areas for four years under supervision to obtain full licensure."

This is a State legislative initiative that becomes a bill, then is voted on and signed by the Governor and not a Federal! Each State or Territory has its own autonomy in regulating professions to ensure consumer safety. You have to go to the State or Territory and look up the licensure requirements for each and every State!

The FSMB is a good starting point but with all the new legislation coming from different States and Territories, you really have to go the State Medical Board for the State you want to be licensed in!
https://www.fsmb.org/step-3/state-licensure/

No, sir/ma'am. I'm not confused. I have a basic medical license in multiple states. USMLE (United States Medical Licensing Exam) / COMLEX (osteopathic equivalent, same accreditation) are literally the licensing exams which states use to grant the ability to work in their respective areas. As you stated with Arizona, passing USMLE Step 1 and Step 2 CK are a requirement; the same as an incoming PGY-1 resident/intern.

You can't go to a state medical board without USMLE certification and expect to get a job. It just isn't going to happen.

"You can't go to a state medical board without USMLE certification and expect to get a job. It just isn't going to happen." That is not what I am saying!
Yes, those are licensing exams, which is obviously not the same as a license! The fact still remains that many States have drafted and are drafting legislation that will permit and allow foreign physicians to do unaccredited residencies that lead to licensure. Do they need USMLE? Absolutely, although with a few exceptions such as Puerto Rico (REVALIDA or USMLES) and Virgin Islands (SPEX)! I can't make it any simpler than that! In the case of Arizona, apparently this legislation takes effect in January of 2025. DO's have osteopathic State medical boards and as far as I know, foreign trained DOs are not accepted for licensing in the USA unless trained in a US DO school receive at least one year of AOA or ACGME accredited residency and pass the COMLEX exams. Allopathic foreign trained physicians are permitted after passing USLMEs and getting ECFMG certified and of course receiving a VISA if required. Certification is not a license!

Here is a link to Illinois law: https://www.isms.org/cme/medical-license...-graduates

Here is a link to Virginia law which requires ECFMG certification (USMLE Steps 1,2) : https://law.lis.virginia.gov/admincode/t...ection210/

Peace! live long and prosper!

[Stonybeach]

Current situation:
1. Shortage of Physicians
2. Greater shortage of residencies to train physicians probably due to lack of funding.
3. States being creative and drafting new legislation to address shortages. i.e., 2 to 4 years of supervised internships by licensed and board-certified physicians.
4. These supervised unaccredited internships lead to licensure if other licensing requirements are met. i.e., USMLE steps 1 through 3 passed, ECFMG certified, TOEFL passed, affidavits by supervising physicians etc., etc.

[MSK9]

Current situation:
1. Shortage of Physicians
2. Greater shortage of residencies to train physicians probably due to lack of funding.
3. States being creative and drafting new legislation to address shortages. i.e., 2 to 4 years of supervised internships by licensed and board-certified physicians.
4. These supervised unaccredited internships lead to licensure if other licensing requirements are met. i.e., USMLE steps 1 through 3 passed, ECFMG certified, TOEFL passed, affidavits by supervising physicians etc., etc.

I can accept this because of #4.