U.S. fellowship training can help ophthalmologists all over the world expand their skill set, gain a greater breadth in research and pathology and improve their ability to get a job. However, international ophthalmologists seeking U.S. training face some added challenges and key decisions. To help you choose, YO Info reviewed the major options for clinical and research fellowships and talked to several international medical graduates about their path to a U.S. fellowship.
Two Key Options: Clinical or Research?
Both clinical and research fellowships in the United States are intended to take your ophthalmology training to the next level. However, the two fellowship types take different approaches. Here are some of the key differences between clinical and research fellowships.
Research fellowships (often referred to as an “observership”):
- Require a visa.
- Do not require the applicant to have completed a U.S. residency.
- Require personal financial support or sponsorship from the applicant’s home institution.
- Are more readily available and accessible for international medical graduates.
- Generally last from three months to one year.
- Focus on research and teaching.
- Provide incidental surgical experience. Fellows observe in the operating room, but don’t perform surgery.
- Limit one-on-one patient care activities.
- Follow state medical law in terms of obtaining licensure.
Clinical fellowships:
- Require a visa and more-detailed certification than a research fellowship.
- Require completion of a U.S. residency.
- Generally last from 12 to 24 months.
- Focus on direct clinical experience and patient care. Fellows gets hours of hands-on surgical training.
- Offer the same surgical privileges as a domestic fellow.
- Follow state medical law in terms of obtaining licensure.
- May be partially funded but typically require more substantial personal support than a research fellowship.
- Are more difficult for international medical graduates to obtain.
- Can lead to an employment position within the United States.
The Fellowship Path: How to Apply
There are several routes you can take to pursue the fellowship that is right for you. International medical graduates usually follow one of three paths: SF Match, the International Council of Ophthalmology (ICO) or direct applications through a training institution.
Route 1: Applying for a Clinical Fellowship — SF Match
Clinical fellowships in the United States are typically assigned through SF Match. Most of these fellowships start in July of each year. The formal fellowship-application process normally starts one year before this: typically between the second and third years of residency:
- July before fellowship begins: Register with SF Match and submit applications.
- October to December: Fellowship interviews, if required.
- December: Fellowship match assignments announced.
- July: Fellowship training begins.
Prerequisites. Most, if not all, programs will require international medical graduates to have completed a U.S. or Canadian residency before they apply for a clinical fellowship.
“This can be a real problem,” said Miguel González Andrades, MD, a postdoctoral research fellow at Harvard Medical School. “In cases like myself, where the applicant has completed residency in Spain, he or she will have to do it all over again before applying for the U.S. fellowship.”
Consequently, some international medical graduates choose to apply to programs in the United Kingdom or Australia where their residency training is valid. Dr. Andrades chose to pursue a research-only fellowship in the United States.
Certification. If you graduated from a medical school outside the United States and Canada, you’ll also need to obtain ECFMG® certification.
To be eligible for certification, you must meet the following requirements:
- Complete the application for ECFMG certification.
- Satisfy medical science examination and clinical skills requirements. Currently, you must pass Steps 1 and 2 of the United States Medical Licensing Examination. Step 2 includes two parts — clinical knowledge and clinical skills. (Note: To obtain a state license, you must also complete Step 3.)
- Document completion of all requirements for the final medical diploma.
Licensing. All fellows who plan to treat patients during their clinical fellowship must also secure a medical license from the state in which they will be training. Because medical licenses are issued on a state-by-state basis, licensure requirements vary greatly.
For more information, contact the Federation of State Medical Boards.
Visas. Common visas for international fellowships — both clinical and research — include the J-1 visa, the H-1B visa and the O-1 visa. Visa specifics depend on the individual institution and what visa types they can sponsor.
- If a clinical fellowship does not require call coverage, a simple J-1 may suffice. However, J-1 visas require that you return to your home country after one to two years.
- The H-1B is good for two to three years with one renewal and is oftentimes preferred.
- The O-1 is a special type of medical visa for “aliens of extraordinary ability.” You may qualify if you have a specialized skill set or prominent research accomplishments.
Once you know which visa you need, contact your local American embassy, consulate or U.S. district offices of the Immigration and Naturalization Service.
Funding. Many clinical fellowships don’t offer funding. Therefore, programs often require you to bring financial support from your home institution or other sources. If so, you’ll need to document the availability of sufficient funds to cover expenses, including lodging, food, medical and repatriation insurance and travel.
Route 2: Research Fellowships/Observerships — ICO
The ICO Fellowships Program was organized to help young ophthalmologists from developing countries improve their practical skills in host training centers around the world. These research fellowships carry a significant award amount to cover your travel and living expenses.
ICO currently offers two types of observerships.
Three-month fellowships. ICO Three-Month Fellowships provide exposure to and training in several subspecialties. These research fellowships are intended to be flexible to meet the needs of different countries and individuals. They include up to a $6,000 award to cover expenses. ICO awards about 60 to 80 three-month fellowships each year.
One-year fellowships. ICO-Retina Research Foundation Helmerich Fellowships provide support for one year of ophthalmology training in several subspecialties. These research fellowships are awarded to young ophthalmologists from developing countries who are committed to enhancing ophthalmic education and patient care in their home countries. These fellowships include a $25,000 award. ICO will award three one-year fellowships during 2015/2016.
To qualify for either type of U.S. fellowship, ICO typically requires that applicants:
- Be from a developing country.
- Be under 40 years of age at the time of applying.
- Be a graduate of an ophthalmology residency training program (a U.S. residency is not required).
- Be recommended by the ophthalmology head of a teaching institution or public service hospital in a developing country.
- Be reasonably fluent in the English language.
- Be committed to return to a position at a teaching institution or public service hospital in their home country.
- Pass one or more ICO exams.
The ICO application process typically includes the following steps.
- Choose a fellowship via the ICO website.
- Complete the ICO eligibility check (including supporting documentation).
- Go through ICO eligibility review.
- Apply to a host training center once ICO has accepted your eligibility.
- Wait for host application review and approval.
In addition to meeting ICO’s own eligibility check, you’ll also have to meet your host institution’s own unique requirements. Host institutions often specify certain visas and have other requirements based on state medical law.
For a list of participating institutions in the United States, visit ICO’s fellowship host directory. For additional information about how to apply, visit the ICO’s FAQ page or email fellowship@icoph.org.
Route 3: Research Fellowships/Observerships — Applying Directly
Many institutions — including, for example, the Wills Eye Hospital, the Bascom Palmer Eye Institute, and the Jules Stein Eye Institute, a host program with the ICO — also allow you to contact them directly for observership and research fellowship opportunities. (However, directly arranged opportunities usually do not offer any type of awards.)
As with the clinical fellowships mentioned earlier, each institution will have its own application process and offer a variety of different opportunities — from two-week clinical observerships to one-year research fellowships — so be sure to do your research. You’ll want to pay particular attention to requirements pertaining to visas, licensing and funding.
Visas: Most, if not all, institutions will require that you obtain a visa of some sort. For shorter programs, such as Bascom Palmer’s clinical observerships, a B-1 or B-2 visa (otherwise known as a tourist visa) will suffice. For longer programs, including the one-year research fellowships offered by the Jules Stein Eye Institute, you’ll need to obtain a sponsored J-1 visa.
Licensing: Each state has different licensing requirements. At the Jules Stein Eye Institute, for example, you must obtain a Section 2111 appointment from the California Medical Board if you plan to have any incidental clinical activity during your research fellowship. This allows international fellows to have limited contact with patients (up to 20 percent of the fellow’s time) under the direct supervision of a licensed medical faculty member.
Funding: Most research fellowships and observerships require that you supply your own funding to cover travel and living expenses — either from your home institution, your own pocketbook or other sources. You might also need to document sufficient funds before a visa will be issued. For example, for the Wills Eye’s Glaucoma Research Fellowship, you’ll need to prove that you’ll have at least $40,000 to cover the duration of your stay. In addition, institutions may want to see some type of health and repatriation insurance. At Bascom Palmer, for example, observers visiting for longer than two weeks are required to carry accident and sickness coverage of at least $50,000 with repatriation coverage of $7,500.
Conclusion
Whatever U.S. fellowship path you choose, be sure to give yourself the necessary time so that you don’t have to rush the application process. Though it may seem daunting, in the end, a U.S. fellowship in ophthalmology will be well worth your effort.
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About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.