Useful Tips to get that US Fellowship
05 November 2004
1. Type of fellowship e.g. stroke, neurophysiology etc
2. Reputable institutions and research them on the internet including medical licence requirements for that state. Some states require completion of a US based neurology residency, completion of USMLE Step3 or BE/BC (Board Eligible / Board Certified). Fellowships often advertised in journal NEUROLOGY. Being an AAN (American Academy of Neurology) member provides access to extensive list of available fellowships. Note as of June 2003, J1 visa sponsorship is only allowed for ACGME (Accredited for General Medical Education) programs: this severely narrows opportunities for overseas applicants.
Obtain USMLE & TOEFL
Application forms can be obtained from ECFMG either via the internet or by phone. Factor in 6 months to obtain these qualifications. It takes 6 weeks just for them to process the application. The application requires letters from parent medical school and medical registration board. Steps 1 & 2 cost approximately $USD750 for each step and CSA costs $USD1200. Steps 1 & 2 exams can be done in Sydney but not in Melbourne.
CSA can only be sat in Philadelphia, USA and is now compulsory to obtain for a J1 visa. Application forms require stamps and signatures from certain officials from your medical school; the wrong official's signature will result in rejection of your application. Anecdote: my CSA application was rejected on the basis I asked the clinical dean (Prof McColl) at Royal Melbourne Hospital medical school to sign for this but his signature is not recognized by ECFMG; subsequently, I went to Melbourne University and got the medical school manager's (Kaye Lincoln) signature before my application was accepted.
TOEFL (Test of English as a Foreign Language) can be done in Melbourne or any capital city. You cannot apply for CSA till you have sat the TOEFL and sent the scores to ECFMG. There is a charge $US24 for ETS (English Testing Service) to send the results to ECFMG; ECFMG also charge a further $US25 to accept your results. The whole procedure is a complete rip-off.
Do not hesitate to contact these various departments to check on progress of your application. FedEx courier service is the fastest ($AUD60) but most expensive way to send your applications and documents; delivery time is 3 days and the parcel location can even be tracked on the internet. Slightly cheaper is the EMS courier service via Australia Post: 5 day delivery time, $AUD30 cost and not able to see your parcel location on the internet. Normal post takes about 3 weeks.
phone: 0011-1-609-771-7100 for ETS (English Testing Service)
Getting that Fellowship
There are essentially 2 ways to get that fellowship.
First method is the least noble, not based on merit and only suitable for the brown-nosers of the profession. Hopefully, one does not need to sink to such lows. Basically, ask the boss to speak to a "friend" to swindle a position.
Second method requires the applicant to compete against his US counterparts: nothing beats one-to-one competition. However, US professors prefer US trained doctors so Australians are at a distinct disadvantage. The major advantage is that if successful in obtaining that position, the applicant receives the same stipend and benefits as any American at that same level.
*do not apply without USMLE scores. Scores that rank in the 98th centile or better never fail to impress.*
For dignified applicants, start writing and emailing to the directors of that subspecialty e.g. do not write to Chief of Neurology for the stroke fellowship but to the director of stroke (unless the Chief is also director of stroke unit). Attend the annual AAN meeting usually held in May: there is one evening where interviews are held for fellowships during this conference. Organize to meet potential employers during this conference; email them 2 months prior. Whilst in the US, it might be worth a visit to your potential work institution after the AAN meeting and highlights to the potential employer that there is significant interest and the proactive nature of the applicant. Program directors are always impressed by this. This is an opportune time to do the CSA whilst in the US.
State clearly to the potential employer what you hope to gain, goals, expectations and intention to return to Australia at the end of the training e.g. for a neuromuscular fellowship: regular supervised EMG sessions, discussion and review of interesting cases at end of day, attendance at myasthenia, nerve trauma, muscular dystrophy, general neuromuscular and motor neuron disease clinics, and completion of one significant research project involving transcranial magnetic stimulation.
Once again, visit the ECFMG website and obtain application forms for that J1 visa. The amount of paperwork required is extensive. Processing cost is $USD140. Turnaround time is 4-6 weeks.
A letter from the Federal Department of Health is required stating that there is a need for Australian neurologists to be trained in that particular subspecialty and that the applicant intends to return to Australia. The person to contact for this is:
Department of Health and Ageing
Workforce Distributions Program
GPO Box 9848
phone: (02) 62895903 or (02) 62891555
fax: (02) 62891352
Massachusetts Medical Licence
Processing fee is $USD50 and $USD25 for ECFMG to release USMLE results to Massachusetts Medical Board. The application for this can be found on the internet but it is far easier for the host institution to organize this.
A letter of good standing is required from the Medical Practitioners Board of Victoria. Cost is $50. Make sure that the letter of good standing is packaged in an envelope sealed by the medical board.
University transcripts and letter of MBBS diploma verification is required from the university (Melbourne University Administrative and Transcripts Department phone: (03) 83446016 fax: (03)93472520) Cost is $40. The verification has to be in a University sealed envelope.
An assurance of good standing from your current program director i.e. Professor of Neurology. At least this bit is free of charge.
For further information, refer to article written by Prof Gary YC Lee: USA Fellowships Guide: How to do it.
In a worst case scenario, then consider the ask a friend to swindle you a job option. Do not let colleagues, parents or spouse know how low you have sunk. (I really have no tolerance for such people and strongly believe fellowships should be awarded on merit).
The 2 hardest components are obtaining the position and the J1 visa. The whole process of finding a US fellowship, Step 1 & 2, CSA and J1 visa will take 18-24 months. Clearly a process not for the faint hearted. I can be contacted via my website if you need further assistance, phone numbers or email addresses in finding or dealing with these various departments. My fellowship was delayed for 3 months due to various bureaucratic hassles.
Amendment: My fellowship is unlikely to begin as I have not been issued with a J1 visa. The UK (United Kingdom) maybe a better option. Although not as well resourced as the US, their clinical skills are outstanding and more than compensate for this.