Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Ohio Association of Medical Staff Services.

Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMGCopyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®®). All rights reserved.). All rights reserved.

Ohio Association of Ohio Association of Medical Staff Medical Staff

ServicesServices(OAMSS)(OAMSS)

November 4, 2005November 4, 2005


Educational Commission Educational Commission forfor

Foreign Medical Foreign Medical GraduatesGraduates

William C. KellyWilliam C. Kelly

Director, Credentialing & Director, Credentialing & Records ServicesRecords Services

®


ECFMGECFMG®® Private, Non-Profit Private, Non-Profit

OrganizationOrganization Organizational members:

• American Board of Medical Specialties• American Medical Association• Association of American Medical

Colleges• Association for Hospital Medical

Education • Federation of State Medical Boards

of the United States, Inc. • National Medical Association


ECFMG ECFMG CertificationCertification

Assures residency program directors and Assures residency program directors and the US public that the international the US public that the international medical graduate (IMG) has met minimum medical graduate (IMG) has met minimum standards to enter US residency programsstandards to enter US residency programs

Prerequisite for all IMGs for:Prerequisite for all IMGs for:– Entry into ACGME-accredited GMEEntry into ACGME-accredited GME– Taking USMLE Step 3Taking USMLE Step 3– State licensureState licensure– J-1 visa sponsorship / ECFMGJ-1 visa sponsorship / ECFMG


What is an IMG?What is an IMG? An An international medical graduateinternational medical graduate

(IMG) is a physician who received (IMG) is a physician who received his/her basic medical degree or his/her basic medical degree or qualification from a medical school qualification from a medical school located outside the U.S. and Canadalocated outside the U.S. and Canada

• Citizens of the U.S. who have completed Citizens of the U.S. who have completed their medical education in schools outside their medical education in schools outside the U.S. and Canada are considered IMGsthe U.S. and Canada are considered IMGs

• Non-U.S. citizens who have graduated from Non-U.S. citizens who have graduated from medical schools in the U.S. and Canada are medical schools in the U.S. and Canada are notnot considered IMGs considered IMGs


TOTAL IMS/GsTOTAL IMS/Gs

ECFMG CertifiedECFMG Certified

GMEGMEPass Step 3Pass Step 3

Medical LicensingMedical LicensingBoardsBoards

NRMPNRMP

ECFMG ApplicantsECFMG Applicants

ECFMG CertifiedECFMG Certified

USMLE TakersUSMLE Passers


IMGs in United IMGs in United States Physician States Physician

WorkforceWorkforce

Residents = 25%Residents = 25%

Practicing Physicians Practicing Physicians = 25%= 25%


Rationale for Rationale for ECFMG ECFMG

CertificationCertification• Medical education varies with Medical education varies with

respect to content, quality and respect to content, quality and durationduration

• No universal standard to No universal standard to determine equivalencydetermine equivalency

• Assesses product of the medical Assesses product of the medical education systemeducation system


Current Examination Current Examination Requirements for Requirements for

ECFMG CertificationECFMG Certification

• USMLE Step 1 Basic Medical USMLE Step 1 Basic Medical ScienceScience

• USMLE Step 2 Clinical KnowledgeUSMLE Step 2 Clinical Knowledge

• USMLE Step 2 Clinical SkillsUSMLE Step 2 Clinical Skills

(or ECFMG CSA)(or ECFMG CSA)


Current Medical Education Current Medical Education Credential Requirements for Credential Requirements for

ECFMG CertificationECFMG Certification• Complete a medical school curriculum of at Complete a medical school curriculum of at

least four academic yearsleast four academic years• Medical school and graduation year must be Medical school and graduation year must be

listed in the listed in the International Medical Education International Medical Education DirectoryDirectory ( (IMEDIMED). ). IMEDIMED is maintained by is maintained by FAIMER, a non-profit foundation of ECFMGFAIMER, a non-profit foundation of ECFMG

• Document completion of all requirements for, Document completion of all requirements for, and receipt of, final medical diploma and receipt of, final medical diploma

• Medical diploma and final medical school Medical diploma and final medical school transcript must be verified by ECFMG directly transcript must be verified by ECFMG directly with the medical schoolwith the medical school


Standard ECFMG Standard ECFMG CertificateCertificate

• Issued to applicant once he/she has passed Issued to applicant once he/she has passed USMLE Step 1, Step 2 CK, Step 2 CS (or USMLE Step 1, Step 2 CK, Step 2 CS (or CSA), and after receipt of final medical CSA), and after receipt of final medical diploma diploma andand primary source verification of primary source verification of diploma and transcriptdiploma and transcript

• Required to enter ACGME accredited Required to enter ACGME accredited residency programs in the United Statesresidency programs in the United States

• Required to sit USMLE Step 3Required to sit USMLE Step 3

• Prerequisite for unrestricted licensure in all Prerequisite for unrestricted licensure in all statesstates


ECFMG Standard ECFMG Standard Certificates IssuedCertificates Issued

9525

12127

10297

11814

5652513259345429

9164

6010

0

2000

4000

6000

8000

10000

12000

14000

1995 1996 1997 1998 1999 2000 2001 2002* 2003 2004**

* The availability of exam results for some examinees taking the CSA during the fall of 2002 was delayed until January 2003, due to the integration of the Atlanta test center into ECFMG’s CSA operations. The number of certificates issued in 2002 is lower, and the number of certificates issued in 2003 higher, than these numbers would have been if this delay had not occurred.

** The availability of exam results for some examinees taking Step 2 CS during the initial months of test administration was delayed until early 2005. As a result, the number of certificates issued in 2004 is lower than it would have been, had this delay not occurred.


ECFMG Standard Certificates ECFMG Standard Certificates IssuedIssued

(Percentage US Citizens)(Percentage US Citizens)

9517

6%

12124

6%

10297

8%

11814

9%

5653

22%

5133

27%

5934

26%

5429

26%

9164

17%

6010

23%

0

2000

4000

6000

8000

10000

12000

14000

1995 1996 1997 1998 1999 2000 2001 2002* 2003 2004**

Total

US Citizens

* The availability of exam results for some examinees taking the CSA during the fall of 2002 was delayed until January 2003, due to the integration of the Atlanta test center into ECFMG’s CSA operations. The number of certificates issued in 2002 is lower, and the number of certificates issued in 2003 higher, than these numbers would have been if this delay had not occurred.

** The availability of exam results for some examinees taking Step 2 CS during the initial months of test administration was delayed until early 2005. As a result, the number of certificates issued in 2004 is lower than it would have been, had this delay not occurred.


ECFMG Certificates ECFMG Certificates IssuedIssued

by Country of by Country of Citizenship*Citizenship*

(Top 10 Countries – 1958 to (Top 10 Countries – 1958 to 2004)2004)IndiaIndia ChinaChina

United StatesUnited States EgyptEgyptPhilippinesPhilippines IranIranPakistanPakistan GermanyGermanyUnited KingdomUnited Kingdom KoreaKorea

*Citizenship is as of time of entrance into medical school


ECFMG Certificates ECFMG Certificates IssuedIssued

by Country of by Country of Citizenship*Citizenship*

(Top 10 Countries – 1999 to (Top 10 Countries – 1999 to 2004)2004)UUnited Statesnited States IranIran

IndiaIndia NigeriaNigeriaPakistanPakistan SyriaSyriaChinaChina ColombiaColombiaPhilippinesPhilippines LebanonLebanon

*Citizenship is as of time of entrance into medical school


ECFMG Certificates IssuedECFMG Certificates Issued by Country of Medical by Country of Medical

SchoolSchool(Top 10 Countries – 1958 to (Top 10 Countries – 1958 to

2004)2004)IndiaIndia EgyptEgyptPhilippinesPhilippines MexicoMexicoPakistanPakistan Dominican Dominican

RepublicRepublicGermanyGermany South KoreaSouth KoreaUnited KingdomUnited Kingdom GrenadaGrenada


ECFMG Certificates IssuedECFMG Certificates Issued by Country of Medical by Country of Medical

SchoolSchool (Top 10 Countries – 1999 to (Top 10 Countries – 1999 to

2004)2004)IndiaIndia PhilippinesPhilippinesPakistanPakistan ChinaChinaDominicaDominica GermanyGermanyGrenadaGrenada IsraelIsraelNetherlands AntillesNetherlands Antilles NigeriaNigeria


Most Common Visas TypesMost Common Visas Typesfor for Foreign National

Physicians in U.S. GME in U.S. GME• F-1 F-1 “Student”“Student”• H1-B H1-B “Specialty Occupation “Specialty Occupation

Worker”Worker”• J-1 J-1 “Alien Physician”“Alien Physician”• J-2 J-2 “Dependent”“Dependent”

J-2 is defined as the spouse or J-2 is defined as the spouse or minor child of J-1 visa holderminor child of J-1 visa holder

• O-1 O-1 of “Extraordinary Merit”of “Extraordinary Merit”


J-1 Exchange Visitor J-1 Exchange Visitor ProgramProgram

• Established by Congress in 1948Established by Congress in 1948

• Administered by the U.S. Department of State Administered by the U.S. Department of State • Regulatory Purpose:Regulatory Purpose: “. . . to provide foreign “. . . to provide foreign

nationals with opportunities to participate in nationals with opportunities to participate in educational and cultural programs in the United educational and cultural programs in the United States and return home to share their States and return home to share their experiences and to encourage Americans to experiences and to encourage Americans to participate in educational and cultural programs participate in educational and cultural programs in other countries.” in other countries.” 22 CFR 6222 CFR 62

• Many colleges and universities serve as sponsor Many colleges and universities serve as sponsor for other “J” categories of participation; ECFMG is for other “J” categories of participation; ECFMG is the only sponsor for clinical training in the “alien the only sponsor for clinical training in the “alien physician” categoryphysician” category


ECFMG: Program Sponsor for ECFMG: Program Sponsor for All All

J-1 Physicians in Clinical J-1 Physicians in Clinical TrainingTraining

22CFR§62.27(b)22CFR§62.27(b)• ECFMG sponsored J-1 = “alien physician” ECFMG sponsored J-1 = “alien physician” category category

• Temporary, non-immigrant visaTemporary, non-immigrant visa

• Full-time educational training (GME program)Full-time educational training (GME program)– not employmentnot employment

• Two-year home residency obligation, Two-year home residency obligation, INA INA §212(e)§212(e)

• Seven-year maximum for progressive trainingSeven-year maximum for progressive training


J-1 Visa Sponsorship:J-1 Visa Sponsorship: An Integrated Process An Integrated Process

U.S. Department of State (DOS)

U.S. Department of Homeland Security (DHS)

Student & Exchange Visitor Information System (SEVIS)

ECFMG Exchange Visitor Sponsorship Program

(EVSP)

Regional Advisor

Host InstitutionTraining Program Liaison (TPL)

Program Director

J-1 Physician


Roles andRoles and Responsibilities Responsibilities in the in the

J-1 Visa Sponsorship ProcessJ-1 Visa Sponsorship Process• DOS and DHSDOS and DHS oversee J-1 program and visa oversee J-1 program and visa

processesprocesses

Track J, F, M visa holders in the Track J, F, M visa holders in the SEVISSEVIS databasedatabase

• ECFMG, through its EVSP ECFMG, through its EVSP Regional AdvisorsRegional Advisors,, evaluates applications andevaluates applications and approves visa approves visa sponsorship sponsorship

Interfaces with Interfaces with DOS DOS andand DHS DHS in in SEVISSEVIS trackingtracking

• Host Institution/ Host Institution/ TPLTPL cooperate with ECFMG in cooperate with ECFMG in providing on-site monitoring of J-1 physiciansproviding on-site monitoring of J-1 physicians

• J-1 physicianJ-1 physician and J-2 dependents must comply and J-2 dependents must comply with all pertinent immigration laws and with all pertinent immigration laws and regulationsregulations


What is “SEVIS”What is “SEVIS”SStudenttudent andand EExchangexchange VVisitor isitor IInformationnformation

SSystemystem

Data exchange with DHS/DOSData exchange with DHS/DOS Tracks immigration activities of all non-Tracks immigration activities of all non-

immigrant students and exchange immigrant students and exchange visitors ( J, F, M visa holders and visitors ( J, F, M visa holders and dependents) dependents)

Accessed by Consulates, Embassies, Accessed by Consulates, Embassies, ports-of-entry and other DHS agencies ports-of-entry and other DHS agencies

ECFMG creates and updates SEVIS ECFMG creates and updates SEVIS records for J-1 “alien physicians”records for J-1 “alien physicians”


J-1 Physician: Terms and J-1 Physician: Terms and Obligations of J-1 Obligations of J-1

SponsorshipSponsorship• J-1 physician must have a pre-defined J-1 physician must have a pre-defined

educational plan and objective for coming educational plan and objective for coming to the U.S. as evidenced by a full-time to the U.S. as evidenced by a full-time contract for training in an approved contract for training in an approved program of graduate medical educationprogram of graduate medical education

• J-1 physicians and J-2 dependents must J-1 physicians and J-2 dependents must comply with all U.S. laws and regulations comply with all U.S. laws and regulations pertaining to foreign nationalspertaining to foreign nationals


J-1 Physician: Terms and J-1 Physician: Terms and Obligations of J-1 Obligations of J-1

SponsorshipSponsorship(continued)(continued)• J-1 physician must demonstrate sufficient ties J-1 physician must demonstrate sufficient ties

to the home country and intention to return to the home country and intention to return home upon completion of traininghome upon completion of training

• All J-1 physicians and accompanying J-2 All J-1 physicians and accompanying J-2 dependents must return to the country of dependents must return to the country of most recent legal permanent residence for a most recent legal permanent residence for a minimum of two years upon completion of minimum of two years upon completion of training training Two-year obligation must be fulfilled or Two-year obligation must be fulfilled or

waived before J-1 is eligible for a change in waived before J-1 is eligible for a change in U.S. visa status per §212(e) of the U.S. visa status per §212(e) of the Immigration and Nationality Act, as Immigration and Nationality Act, as amendedamended


Comparison of Top Three Comparison of Top Three Source CountriesSource Countries

Number Sponsored by Academic Number Sponsored by Academic Year*Year*

2003-20042003-2004 2004-20052004-2005PakistaPakistann

154154 IndiaIndia 192192

IndiaIndia 142142 CanadaCanada 169169

CanadaCanada 131131 PakistaPakistann

157157

* In first year of sponsorship with start date between June 30 and July 31


National Resident National Resident Matching Program Matching Program

DataData20042004 20052005

Total IMG Active ApplicantsTotal IMG Active Applicants 7,6867,686 7,6457,645

Percent MatchedPercent Matched 53%53% 55%55%

US Citizen IMG Active US Citizen IMG Active ApplicantsApplicants

2,0152,015 2,0912,091


Non-US Citizen IMG Active Non-US Citizen IMG Active ApplicantsApplicants

5,6715,671 5,5545,554



Top Specialties for J-1 Top Specialties for J-1 Physicians*Physicians*

SPECIALTY COUNT % of TOTAL I nternal Medicine 2865 43.1 Pediatrics 708 10.7 General Surgery 454 6.8 Psychiatry 386 5.8 Family Practice 358 5.4 Pathology 249 3.7 Neurology 222 3.3 Anesthesiology 171 2.6 Obstetrics & Gynecology 155 2.3 Diagnostic Radiology 136 2.0

*Sponsorship Period July 1, 2004 through June 30, 2005


Total Number of J-1 Physicians Total Number of J-1 Physicians Sponsored in Top Countries of Sponsored in Top Countries of

National Origin*National Origin*

*Sponsorship Period July 1, 2004 through June 30, 2005

IndiaIndia 1,0221,022PakistanPakistan 723 723CanadaCanada 565 565LebanonLebanon 390 390PhilippinesPhilippines 327 327SyriaSyria 295 295GermanyGermany 184 184JordanJordan 178 178EgyptEgypt 168 168 PeruPeru 144 144


J-1 Sponsorship for J-1 Sponsorship for GME*GME*

0

2000

4000

6000

8000

10000

12000

1992

- 93

1993

- 94

1994

- 95

1995

- 96

1996

- 97

1997

- 98

1998

- 99

1999

- 00

2000

- 01

2001

- 02

2002

- 03

2003

- 200

4

2004

- 200

5

Continuation

I nitial

* Sponsorship period July 1 through June 30


Top States with J-1 Physicians*Top States with J-1 Physicians*

*Sponsorship period July 1, 2004 through June 30, 2005

191

198

214

306

333

395

399

410

451

1168

0 500 1000 1500

New Jersey

Connecticut

Florida

Massachusetts

Michigan

Ohio

Texas

Illinois

Pennsylvania

New York


EVSP Resources EVSP Resources ReviewReview

• EVSP HomepageEVSP Homepage @ @ http://www.ecfmg.org/evsp/index.htmlhttp://www.ecfmg.org/evsp/index.html for access to:for access to:– EVSP EVSP Reference GuideReference Guide – EVSP EVSP Fact SheetFact Sheet– Application MaterialsApplication Materials– Updates and Memoranda Updates and Memoranda

• U.S. Department of State Exchange VisitorU.S. Department of State Exchange Visitor ProgramProgram @ @ http://exchanges.state.gov/education/jexchangeshttp://exchanges.state.gov/education/jexchanges

• U.S. Citizenship and Immigration ServicesU.S. Citizenship and Immigration Services @ @

www.uscis.govwww.uscis.gov• U.S. Department of Homeland SecurityU.S. Department of Homeland Security @ @

www.dhs.gov/dhspublicwww.dhs.gov/dhspublic


ERAS Program at ERAS Program at ECFMGECFMG

Designated Dean’s Office Designated Dean’s Office for International Medical for International Medical

GraduatesGraduates

In Partnership with the In Partnership with the AAMCAAMC


Request an ERAS Request an ERAS TokenToken

• Applicant requests token on-line, Applicant requests token on-line, via ECFMG OASIS at via ECFMG OASIS at www.ecfmg.orgwww.ecfmg.org

• Token: $75Token: $75• Token generated typically within Token generated typically within

24 hours 24 hours • Applicant acquires token, via Applicant acquires token, via

OASIS AccountOASIS Account


Work on ERAS ApplicationWork on ERAS Application

• Applicant fills in Common Application Applicant fills in Common Application Form (CAF) , creates personal Form (CAF) , creates personal statement/s and transmits both to the statement/s and transmits both to the ERAS Post OfficeERAS Post Office

• ““MyProfile” can be updated at any MyProfile” can be updated at any time by the applicanttime by the applicant

• ECFMG downloads program list and ECFMG downloads program list and LoR name listLoR name list


Register with the MatchRegister with the Match

• Applicant Registration Deadline with Applicant Registration Deadline with NRMP: December 1NRMP: December 1– ““Independent Applicants”Independent Applicants”– Participation in “Residency Match”Participation in “Residency Match”– $50 late registration fee $50 late registration fee

• Go to Go to “www.ecfmg.org/eras”“www.ecfmg.org/eras” – ““Post-Match Scramble” for information Post-Match Scramble” for information

about the Scrambleabout the Scramble


ERAS OverviewERAS OverviewFive components:Five components:1.1. My ERAS onlineMy ERAS online

– Applicant completes residency applications; requests letters Applicant completes residency applications; requests letters of recommendation (LoRs) and USMLE transcripts, selects of recommendation (LoRs) and USMLE transcripts, selects programs, assigns documents to programsprograms, assigns documents to programs

2.2. Dean’s WorkstationDean’s Workstation– Scan and attach documents (LoRs, medical school Scan and attach documents (LoRs, medical school

transcripts, Dean’s letters, photo)transcripts, Dean’s letters, photo)3.3. Program Director’s WorkstationProgram Director’s Workstation

– A tool to print or review applications; sort application pool A tool to print or review applications; sort application pool by program criteriaby program criteria

4.4. ERAS Post OfficeERAS Post Office– Documents transmitted to and received from the ERAS Post Documents transmitted to and received from the ERAS Post

OfficeOffice5.5. ADTS: Applicant Document Tracking SystemADTS: Applicant Document Tracking System

• Tracks the status of applicant’s ERAS materials; lists Tracks the status of applicant’s ERAS materials; lists applicant’s applied-to programs; records dates applicant’s applied-to programs; records dates documents were uploaded by designated dean's office, documents were uploaded by designated dean's office, records date the program downloaded each document. records date the program downloaded each document.


4 Document 4 Document CategoriesCategories

Applicant SubmitsApplicant Submits• Dean’s Letter / MSPEDean’s Letter / MSPE• Medical school transcriptMedical school transcript• Color Photograph: 2.5” x 3.5”Color Photograph: 2.5” x 3.5”• Letters of Recommendation, Letters of Recommendation,

including Fifth Pathway including Fifth Pathway Certificate and California Status Certificate and California Status Evaluation Letter.Evaluation Letter.


ECFMG Status ReportECFMG Status Report

• Will show exams passed for Will show exams passed for certification, but no scores.certification, but no scores.

• Sent to *all* programsSent to *all* programs• Will be updated automatically Will be updated automatically

for new Steps and certification.for new Steps and certification.• Included in Token Fee of $75Included in Token Fee of $75


USMLE TranscriptUSMLE Transcript• Fee is $50 per Fee is $50 per

applicant/seasonapplicant/season• Request and pay at MyERASRequest and pay at MyERAS• Applicants assign to ProgramsApplicants assign to Programs• Updated automaticallyUpdated automatically• Auto-resend option, at Auto-resend option, at

applicant’s requestapplicant’s request


ERASERASSTATISTICSSTATISTICS

From June 1, 2004 to May 31, From June 1, 2004 to May 31, 20052005

• Total Number of Tokens Total Number of Tokens Requested:Requested: 15,520 15,520

• Total Number of Applications in Total Number of Applications in Dean’s Workstation:Dean’s Workstation: 15,098 15,098

• Total Number of ApplicationsTotal Number of Applications Transmitted:Transmitted: 197,045 197,045


ERAS Comparative Statistics ERAS Comparative Statistics As of October 30, 2005As of October 30, 2005

• Tokens RequestedTokens RequestedOctober 2004: 13,967October 2004: 13,967October 2005: 15,536October 2005: 15,536

Increase of 11%, to dateIncrease of 11%, to date• Number of Applicants in Dean’s WorkstationNumber of Applicants in Dean’s Workstation

October 2004: 13,279October 2004: 13,279October 2005: 14,882October 2005: 14,882

Increase of 12%, to dateIncrease of 12%, to date• Documents TransmittedDocuments Transmitted

October 2004: 128,704October 2004: 128,704October 2005: 133,761October 2005: 133,761

Increase of 3.9%, to dateIncrease of 3.9%, to date


Reminder for Program Reminder for Program AdministratorsAdministrators

Report Changes in ACGME Program Report Changes in ACGME Program I.D due to:I.D due to:– MergersMergers– Program ClosuresProgram Closures

Report Changes to: AAMC – ERASReport Changes to: AAMC – ERAS • AAMC – ERAS Contact InformationAAMC – ERAS Contact Information

– Phone: 202.828.0413Phone: 202.828.0413– E-mail: E-mail: [email protected]@aamc.org


How to Contact ERASHow to Contact ERASE-mailE-mail

E-Mail: E-Mail: [email protected]@ecfmg.org TelephoneTelephone

215-386-5900215-386-5900FaxFax

215-222-5641215-222-5641

Anna Iacone, ManagerAnna Iacone, [email protected]@ecfmg.org


www.ecfmg.www.ecfmg.orgorg

ECFMG website provides access to ECFMG website provides access to important updates, application important updates, application materials, and publicationsmaterials, and publications• ECFMG Information BookletECFMG Information Booklet• USMLE Bulletin of InformationUSMLE Bulletin of Information• International Medical Education DirectoryInternational Medical Education Directory• The ECFMG Reporter The ECFMG Reporter • The ECFMG CorrespondentThe ECFMG Correspondent


CONTACT INFOCONTACT INFO William C. Kelly, DirectorWilliam C. Kelly, Director

Credentialing & Record Credentialing & Record ServicesServicesECFMGECFMG

3624 Market St., 43624 Market St., 4thth Floor FloorPhiladelphia, PA 19104Philadelphia, PA 19104Phone: (215) 823-2277Phone: (215) 823-2277

Fax (215) 386-9767Fax (215) 386-9767Email: [email protected]: [email protected]

Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Ohio Association of Medical Staff Services.

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