United States Otolaryngology Residency: What is Required and How Can Non-US Residents Get a Position

John M. Del Gaudio, MD Professor and Residency Program Director Department of Otolaryngology Emory University School of Medicine Atlanta, GA, USA

Overall Match Results 2008 • • US Medical Graduates – 94% matched Foreign Medical Grads – 55% matched – Most common specialties • Internal Medicine • Family Medicine • Psychiatry • Pediatrics • Preliminary Surgery

2006

2007 2008 2009 US Otolaryngology PGY-1 Positions Available By Year

264

270 273 275

• • • US Otolaryngology Residency Match 2009 Figures Programs 104 Positions offered – 275 Applicants – US Seniors – Non-US seniors 343 51 • Matched – US seniors – 263 (77%) Us non-senior Grads- 5 – US- IMGs 2 (20% non-US seniors) – Non-US IMG 3

Keys to Obtaining a Residency Spot

• • • • • Medical School Performance – Grades – Clinical Rotation reviews – Honors • Alpha Omega Alpha Medical Honor Society USMLE scores Letters of Recommendation Extracurricular activities – Volunteer work – Organizational involvement Clinical rotation at preferred program

Keys to Obtaining a Residency Spot

• Familiarity – Students that perform well on a rotation at a particular program have a better chance of matching at that program than an equally qualified or even better qualified candidate who didn’t rotate there.

– A known quantity compared to an unknown – This factor is more heavily weighted than most other factors in ranking residents in the match

Barriers to Foreign Medical Grads obtaining Oto residency position • • • • Competitiveness of US applicants – – One of most competitive specialties Attract most accomplished medical students Difference in medical school curriculum Concern for communication problems – Language barriers VISA issues – Program unfamiliarity with Visa options • Lack of familiarity of programs with foreign medical grads as residents

VISAS

• J1 (visitor exchange Visa) – Most common – Sponsored by ECFMG – – Maximum of 7 years for training At completion of training required to return to LAST country of residence for 2 years • Waivers possible – Cannot apply for citizenship or green card • H1B (working Visa) – No restrictions – Sponsored by hospital – Can apply for citizenship or green card

OtoMatch.com

Resource for information on obtaining an Otolaryngology Residency position FMG section written by Oswaldo Henriquez, Jr. MD (Emory Oto resident)

Emory OTO Foreign Residents

• JNM- Accepted outside of the match for PGY-2 year when program increased from 2 to 3 residents per year.

– Graduated medical school in Colombia and was performing a preliminary year surgery internship at Emory – Excellent recommendations from Surgery faculty and Otolaryngology residents who interacted with him – Excellent performance as resident, joined Otolaryngology faculty for 1 year – First Otolaryngology Resident to be accepted into the Emory General Plastic Surgery Fellowship program

Emory OTO Foreign Residents

• • OH- PGY-3 at Emory – – Graduated medical school in Caracas, Venezuela Performed 1 year of research in Laryngology at Emory Voice Center • Proved self to be a hard worker, dependable, and a good personality – Successfully matched in Otolaryngology at Emory the following year With recommendations from Oto faculty, his wife was offered a research position in Ophthalmology and matched at Emory the following year

Barriers to Foreign Residency Grads obtaining Oto Fellowship position • Ability to get an unrestricted state license – Unrestricted license allows independent practice • • Permits billing for services Joining faculty as instructor with faculty privileges and responsibilities – Can be on-call independently – Can schedule surgical cases as attending surgeon » Allows better training as the “Teaching Physician” – Restricted state license (Training license) allows supervised training (i.e. resident status) • Can’t bill for services independently, take call, or have junior attending status

• • US Otolaryngology Board Certification Requirements Passed USMLE exams Completed an ACGME approved Otolaryngology Residency Program – Each program can only graduate as many residents each year as they are approved to have by the ACGME – A program may have more residents than approved by the ACGME but only the approved number can take the ABO certification exam each year • Non-categorical residents

Status of Foreign Medical School Grads that Complete US Residency • • Can sit for American Board of Otolaryngology Certification Exam Have the same status as US born graduates of residency programs • Only issue for US practice would be Visa or citizenship

Conclusions

• • • It is difficult, but not impossible, for a foreign medical graduate to obtain a US residency position Familiarity of program with resident is the most important factor – Perform an elective Oto rotation at US program Be familiar with Visa requirements and other barriers