USA Fellowships Guide: How to do it
05 November 2004
post-fellowship research training in the United States of America: A practical
Increasing numbers of Advanced Trainees from Australia and New Zealand have chosen to undertake post-fellowship research in the United States in recent years. To most trainees, this period of training is a once-a-lifetime opportunity to conduct full-time research in a specialised field of their choice. A productive performance during this period can provide the foundation for future career development.
The active and resourceful medical research atmosphere in the United States makes it an attractive option. However, the transition from working in a clinical job at home to becoming a research fellow in a foreign country is neither simple nor easy. The cultural differences, financial sacrifice and the tedious details of immigration and relocation inevitably create significant stresses. In addition, one should not underestimate the psychological adjustment needed when changing overnight from being a senior registrar to becoming "the lowest animal" in the laboratory.
While the majority of trainees considered their research experience in America pleasant and productive, some returned disappointed and dissatisfied. Adequate planning and organisation are vital to ensure that this period of training provides an enjoyable experience of both professional and personal development. This article, based on our own experience and that of many other Fellows from Australasia, focuses on the process of arranging, and settling into, a research position in the United States. We provide a practical guide on how best to tackle the immigration and relocation process and also address common problems trainees encounter during the transition (1).
Stage 1: Exploring the options
Start planning as soon as you begin your advanced training. There is often strong competition for clinical or research fellowships in well-known centres and positions are often filled a year or two in advance. The application process can be long and frustrating. In both of our cases, initial inquiry to commencing research in the United States took over two years to organise.
Many factors may influence to where you apply. Considerations should include your research interests, career goals, availability of funding and, in many cases, personal preferences of a particular location (e.g. proximity to family). Identify the leading researchers and institutes in the field you wish to pursue. Your supervisor and peers who have been overseas can often provide valuable personal contacts for initial inquiry.
Next, send your curriculum vitae to the institutes and explain why you are interested to work there. State your goals, academic interests, intended duration of stay and available funding (if any). Be prepared for blunt dismissal, as competition is fierce at prestigious centres. Most institutes will offer acceptance provided you bring your own funding. Consider this an opening gambit as most units can offer at least partial funding but are reluctant to do so, particularly to a foreign graduate with limited research experience whom they have never met. If the reply is short of total dismissal, be positive, write back and see what can be negotiated.
Stage 2: Making a choice
If you are lucky enough to have options, take the following factors into consideration:
The research program
Consider the size of the research program. Larger units have better resources and funding, but more research fellows sometimes means more competition for the available resources and promising projects. Large laboratories may also have more internal politics and personality conflicts. Smaller programs offer more individual freedom but may lack interdisciplinary support.
Base your decision on how well the unit can allow you to achieve your goals rather than on the name of the institute. Leading centres often have many world class researchers which provide more opportunities for collaboration and a rich social and academic environment. However, some Fellows who worked at large centres had their work curtailed to fit in with the need and overall direction of the unit, making it difficult to earn appropriate recognition. It can also be frustrating having to compete with a large number of fellow researchers for projects, funding and first-author publications.
In the USA, the leading researchers tend to be more spread out than in Britain, where elite academics tend to cluster in a handful of famous faculties. There are distinct advantages to working in smaller but well-established institutes. Exposure to, and your relationship with, your supervisor and co-workers will be closer and often more productive. Many of the smaller but well set up units also have proportionately more available funding and laboratory facilities. Rankings of the American universities, medical schools, hospitals and their subspecialties are available (refer to www.usnews.com) as a rough guide to their standards and reputation amongst peers.
The prospective supervisor
You must be comfortable working with the supervisor you choose. Famous researchers are not necessarily good teachers. Also, many renowned physicians spend a considerable amount of time lecturing around the world and some trainees find that they hardly ever see their supervisors. On the other hand, working with a prominent researcher may help establish your own career.
Consider the funding provided carefully; not just the salary but also removal allowances, financial support for experiments, and travel grants for conferences. Ensure that funding is secured for the whole duration of your fellowship. Find out whether your contract covers medical indemnity insurance and health insurance for you and your family. In America, these two items can cost a substantial portion of your income.
As a rough guide, you will need a minimum of US$20,000 (if single) or US$30,000 (for a couple) a year to survive. Beware that the cost of living varies greatly across America; those going to New York, San Francisco or Boston will need more. The following Web sites can provide an idea of the living expenses in America: www.rent.net, www.apartments.com, www.nowleasing.com, www.aptsforrent.com.
Stage 3: Preparations while arranging a position
The process of arranging a position takes time. While waiting, take the United States Medical Licensure Examinations (USMLE) which may require up to 12 months of preparation. Although licensure is not required for laboratory research, it allows you to work as a resident or Fellow (equals to registrar status) in an approved program and the options of undertaking locum clinical work or participating in drug trials to supplement income.
If your work is laboratory-based, learn the basic bench skills before going overseas. Even simple things like how to use a centrifuge or do southern blots will provide a head start. Seldom will scientists in a busy laboratory have the time and patience to guide you through every basic step. Experience in writing manuscripts is helpful when it comes to applying for research grants.
Stage 4: Funding and budgeting
Funding from Australasia is competitive. The scholarship officer of your local university can often provide a list of available scholarships. Apply early and to as many sources as possible. Specialist professional societies, such as the Thoracic Society of Australia and New Zealand, may also have useful information. It is worthwhile to gain access, through your university or medical school, to one of the grant search engines (such as SPIN) which provides up-to-date information on scholarships available worldwide. Check for other financial aids at www.finaid.org and www.grantsnet.org. Once you have established yourself in your new position, most hosting institutions will continue to fund your work in subsequent years.
Most research fellows enter the United States on a J1 visa. Research scholarships from overseas are exempted from US withholding tax for subjects on J1 visa. Scholarships from approved US institutions are taxed at 14% and all other income at 28%. Spouses are granted J2 visas that entitle them to a work permit. However, the application process for the permit can be lengthy and the permit has to be renewed annually. If you are given an H1 visa, your spouse is not eligible for a work permit. Also, H1 visa requires re-application each year with no guarantee that it will be granted. Details on taxation regulations for overseas scholars can be found at www.irs.ustreas.gov.
Stage 5: Obtaining a research degree
A research degree is often required nowadays to obtain consultant positions in Australasia. Formalising your post-fellowship research into a degree program will help you to stay motivated and focused.
Consider enrolling for a MD or PhD with your medical school in Australia or New Zealand. Some universities may allow you to undertake part or whole of your research in America under joint supervision. This requires a lot of organisation and you must be certain that all parties involved (the university PhD program committee and both your supervisors in America and at home) are comfortable with the concept.
Most American universities offer excellent and well structured MSc and PhD courses. The PhD courses in most centres involve two years of course work followed by two to three years of research. The course fees, however, are often beyond the financial capabilities of overseas students, although scholarships and stipends may be available
Stage 6: Obtaining the entry visa
Obtaining the entry visaSome institutions will arrange your visa for you; many do not. If such is the case, apply at least six months in advance. Write to the Education Commission for Foreign Medical Graduates (ECFMG) for the application documents (3624 Market Street, Philadelphia, Pennsylvania 19101-2685, USA). Instructions can be found on their Web site, www.ecfmg.org. It is essential that you follow the checklist to avoid unnecessary delay. It is very important to obtain the required letter from the Minister of Health's office in the specified format. Not having passed your USMLE examinations may complicate the process. You must also show proof of adequate health insurance coverage.
When your application is approved, which may take several months, you will be sent an IAP-66 (pink) form that you can take to the local US Consulate. If you are bringing your family to the USA, remember to include their visa applications and the marriage and birth certificates. With the accompanying fee, you can usually obtain your entry visa within one week. This will need to be renewed yearly by a similar but less complicated process.
Following expiry of a J1 visa, you are subject to the "two year home-stay requirement", i.e. you must return to your home country for two years before you are allowed to return to the USA for further study or employment. Marriage to an American citizen or giving birth in America will not exempt you from this requirement. An informative booklet entitled, If you want to study in the United States, can be obtained from your local Fulbright office. (Contact the NZ-US Educational Foundation, Level 4, Norseman House, 120 Featherston Street, Wellington, NZ.) Useful information on immigration regulations can also be obtained at the Web sites of the US Immigration and Naturalization Services (www.ins.gov), and the US Institute of International Education (www.iie.org).
Stage 7: Things to arrange before leaving Australasia
Temporary accommodation in the United States can be expensive. Local real estate agents (called "realtors") can help to shortlist suitable units according to your need, even before you arrive (e.g. www.mindsprings.com, www.nowleasing.com). Some universities offer housing assistance for both on-and off-campus accommodation.
Keep your credit cards. Until you have established adequate credit history in the United States, which takes six months or more, it is difficult to obtain one in America. If you need to transfer funds from home, electronic money transfer is more reliable than bank drafts. Proof of your insurance history, both car and house, will help you set up insurance in the United States. Check if your hospital offers staff insurance packages, which can drastically reduce your insurance costs. The Uni-Care Travel Insurance Service (firstname.lastname@example.org) provides competitive rates for New Zealand scholars training abroad.
It commonly takes several weeks to find a car by the time you have negotiated all the obstacles. Arrange to rent one for your first three weeks in the United States, before you leave home. It is twice as expensive to do so after arrival! An international driver's licence (can be obtained from the Automobile Association) will allow you to drive for a short period while you apply for an American licence.
Shipping even the essential items can be expensive. Sea-mail is subject to enormous variation in delivery times - from six weeks to six months. We found that airfreight is significantly cheaper than sea-mail and is delivered within a week
Stage 8: On arrival in the United States
Step 1. Apply for your social security card as soon as you arrive. It is essential to every step of daily life in America - from taxation to buying a car, from opening bank accounts to joining a gym. Apply in person and allow two weeks for processing.
Step 2. While waiting for your social security card, look for accommodation. Realtors can provide up-to-date information on vacancies and special offers.
Step 3. Open a cheque ("checking" in America) account. Surprisingly, most monthly bills are still paid with cheques in America. A letter from your employer to confirm your identity and income is essential.
Step 4. Get your driver's licence. You need to pass both the written and road tests. In most States you cannot buy a car without car insurance, and you cannot obtain car insurance without a licence.
Step 5. Your spouse should apply for their work permit as soon as you receive your social security number. Allow three to six months. The necessary document and application forms (I-765) can be downloaded from the Web site of the US Immigration and Naturalization Services at www.ins.gov.
Step 6. Find a car. Depending on your finances and your duration of stay, leasing instead of buying a new car may be more economical. You can check out the car prices on the Web (e.g. www.localcars4sale.com, www.carsite.net or www.carsdirect.com).
Stage 9: Psychological aspects
Cultural shock is inevitable and is often maximal after you have settled in, around the six-month mark. Homesickness is the disorientation and confusion one feels when leaving a familiar environment for an unfamiliar one and the associated loss of established identity, relationships, financial and psychological security. Symptoms are often non-specific and may include psychosomatic behaviour, hostility towards host nationals, excessive concerns over delays, and a great longing to return home. At times, doubt of whether coming to America was a wise decision is also very common.
Do keep an open mind and avoid being judgmental. Share your frustration of the immigration processes with other expatriates. Do remember that our governments put up as many bureaucratic barriers for overseas-qualified physicians when they migrate to Australasia.
Homesickness improves with time, with establishment of confidence in the new work environment and development of social links. The amount of time required to adjust depends on the ability of the individual to adapt and the extent of changes/losses incurred from the move.
The transition is often more difficult for your partner, particularly if they cannot obtain a work permit or is unable to find employment. The feelings of isolation and frustration are common. Financial difficulties will exacerbate this.
Develop a social network locally as soon as possible. Make an effort to mix with the locals and learn to appreciate American football! Keep yourself busy and be physically active.
E-mail is essential to stay in touch with home.
Research is carving your own path, which is very different from following set schedules as in Basic and Advanced training. This, together with the stress associated with the transition from clinical practice to research science, will require a lot of adjustment. Talk to colleagues about their experience and be prepared mentally.
In summary, the post-fellowship overseas training is a unique learning opportunity. Start planning early. Visit the institute and meet with your prospective supervisor(s) before making your final decision. The immigration process is tedious and frustrating - be patient. Maintain a positive outlook and focus on the opportunities rather than the frustrations. If you do so, you will more than likely find it a worthwhile and enjoyable cultural as well as academic experience.