Physicians usually complete most or all of their training in the country where they plan to practice. But, what if you’re thinking of mission work or the expert you want to learn from lives somewhere else? This scenario adds many different wrinkles to the fellowship process, but can also prove immensely rewarding. Here’s the perspective of a few YOs who tackled the challenge of studying abroad after finishing their residency in the United States.
Why Study Abroad?
“An international fellowship can give you a much broader view of your profession,” says Aaron Lee, MD, who completed retina fellowships at Moorfields Eye Hospital in London and the University of British Columbia before returning to a U.S.-based job.
A handful of U.S. programs offer international fellowships, but most doctors opting to study abroad go through programs in another country. Arsham Sheybani, MD, completed a glaucoma and anterior segment fellowship at the University of Toronto, then took a job in the United States.
Dr. Sheybani said his overseas fellowship offered “the best possible place for what I wanted to do. My department supported and encouraged my decision to work with Ike Ahmed, as his fellowship is arguably the best combined glaucoma and anterior segment fellowship in the world.”
Study abroad also helped young ophthalmologist John Cropsey, MD, prepare for his long-term goal. Post-residency training abroad helped him transition from residency at Wills Eye Hospital to long-term overseas service. He completed a two-year post-residency program in Kenya through Samaritan’s Purse before moving to Burundi, where he now practices.
The Pros and Cons
Both Drs. Sheybani and Lee said studying abroad enriched their training.
- Many international fellowships can offer a much higher surgical volume compared with U.S. fellowships — due, in part, to health care systems that provide patients with more access to care.
- They can broaden your experience with different models of health care delivery — e.g., the two-tier medical system of the United Kingdom, which involves both the National Health Service and private providers.
- They can also allow for exposure to different ethnic populations and many rare conditions not seen in the United States.
For Dr. Cropsey, overseas training helped equip him for long-term work in a very underserved area. He said his training at Tenwek Eye Unit in Bomet, Kenya was “invaluable” preparation for his current work in Burundi, where he’s expanding the country’s first eye unit.
However, Drs. Lee and Sheybani acknowledged some extra challenges for studying abroad. And unlike U.S.-based fellowships, the process for studying abroad isn’t as clearly defined.
- International fellowships require a lengthy application process, including large amounts of paperwork, complications with obtaining both a visa and medical licensing and the possibility of language testing.
- Although many international fellowships can offer higher surgical volume, some regions may require licensure to operate.
- Living abroad for an extended period of time brings specific life challenges — e.g., what will you do about health insurance, a bank account and a cell phone?
What Are My Options?
To decide if an international fellowship is right for you, start by exploring your options and asking yourself a few questions: What type of patient population am I interested in serving? What type of program do I want? And most practically: What kind of language skills would I need?
You may not need to know a second language, but English-speaking countries may have slightly different terms for certain procedures and idioms. Dr. Lee said American terms like “operating room” and “attending” weren’t used in England. Instead, he learned to say, “theatre” and “consultant.” Pronunciations also differ.
Once you’ve figured out the countries that fit your language skills, you should answer some other basic questions: What weight will the program carry in the United States? How long do I want to spend abroad?
Depending on the program, you could enter a three-month to one-year fellowship in which the entirety of your training is spent in another country. Both Drs. Sheybani and Lee spent a year abroad.
In some countries, you can also apply for an observership. These offer a tutorial opportunity to observe clinical practice under the guidance of senior physicians. They’re generally more flexible in length than a traditional fellowship — ranging from a few weeks to a few months — but don’t offer any direct patient care or contact.
Since the depth of training isn’t comparable, Dr. Lee recommends an observership only for applicants who have completed a full fellowship elsewhere.
How Do I Find Them?
Many Canadian fellowships are included in SF Match. Programs in other parts of the world such as the United Kingdom and Australia aren’t part of any match system. For those, you’ll need to email contacts within the program.
Dr. Sheybani recommends asking your mentors and colleagues whether they can identify international experts for you to contact. By doing so, you'll have a better picture of whether or not these programs take U.S. graduates. He also suggests reaching out to any U.S. fellows who have completed fellowships at your programs of interest. “They will definitely help let you know what you are getting yourself into,” he said.
While doing your research, keep in mind that the structure of fellowships in other countries can be quite different from the U.S. system. In places like the United Kingdom, Canada and Australia, it’s not unusual for physicians to enter into many different fellowships before practicing.
“This can lead to a difference in training philosophies abroad,” Dr. Lee said. “You wouldn’t be expected to learn everything by the end of a U.K. fellowship if there’s an opportunity to do another one later on.”
When Should I Start the Application Process?
Despite your best efforts, you will almost inevitably have delays with visa processing and medical licensing. Therefore, both Dr. Sheybani and Dr. Lee recommend starting the application process at least a year earlier than you would for a U.S. fellowship.
Looking early may also improve your chances of acceptance, if a program only admits one or two foreign applicants.
In terms of the actual application steps, different countries have different rules. Expect the process to vary based on where you are applying.
What Will I Do When I My Fellowship Ends?
“A big misconception that prospective fellows have is that doing an international fellowship will help secure a job in another country,” Dr. Lee said. “However, the ophthalmology job market in countries outside of the United States is highly competitive and restrictive, making it quite difficult for you to establish practice there.”
Assuming you plan to practice in the United States after study abroad, you’ll need to plan for handling interviews and taking the written boards. It can be stressful and time-consuming to fly back and forth to interview for jobs in the United States while attending a fellowship half way around the world.
You also may have to do more legwork in your job search. Dr. Lee said international fellowships may not have the appropriate contacts in the United States to help you find a job.
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About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.