As a surgeon who
is a graduate of Libyan medical schools, I am very happy to see
many ambitious young Libyan doctors coming to the United States
seeking residency and higher education. This number is getting larger
on daily basis. Currently there are over 100 young physicians who
have arrived with scholarships from the Libyan government. I am
sure there is a similar number or more of graduates who came without
scholarships. In any case, some issues have arisen and I would like
to touch on them.
First of all, the incoming doctors rightfully expect some help from
us, the Libyan physicians who reside and practice in the United
States of America. They need help with orientation to the American
culture, with housing, buying a car, having a cell phone, opening
a bank account, and most importantly help with obtaining residency
and academic enrollment. We will be happy to offer our assistance
as much as we can.
Most have a good grasp of the English language and have researched
their move to the states. Others learn from colleagues after their
However, there are so many doctors who were shocked upon arriving
here at the amount of regulation that is required, and the need
to pass qualifying examinations to become eligible for residency.
These are facts and each medical student coming to the USA for graduate
studies must be aware of.
All foreign medical graduates must pass certain qualifying medical
examinations prior to acceptance to training programs in the United
States. Some Libyan doctors have asked why there is a need for such
examinations. Their desire is to obtain training and return to their
beloved country. They also say that they do not wish to practice
medicine in the United States; and most plan to return home as soon
as they finish training.
However, rules are rules, there are several entities that are involved
in medical and surgical training. Graduate medical education, state
medical boards, Medicare, educational commission for foreign medical
graduates (ECFMG), and the different specialty boards all have requirements
For any medical graduate, an educational license is needed to start
residency in any teaching hospital. Passing the different parts
of the USMLE is necessary to obtain that license. Finishing training
in good standing in a training program is necessary to take the
specialty board examination and become a board certified physician.
The ECFMG is the governing body that deals with foreign medical
graduate certification to allow those physicians to obtain the needed
documentation to start training with educational state license.
following information is the first step in understanding the
There are many medical and surgical specialties available for a
clinical career. I will mention general surgery and internal medicine
In the United States, the minimum training period for general surgery
is five years. A young doctor from Libya may come to the United
States with the hope that he/she will start immediately. Reality
shows the road is long and full of hurdles. This real road is as
The candidate may take some English courses, or for the best scenario
the young physicians will begin Kaplan medical courses to review
material necessary to pass the USMLE.
This is a broad overview of the material the medical student has
studied in medical school. So if the Libyan graduate has finished
medical school four to five years ago, the candidate will need to
warm up to sitting for 10-12 hours a day studying this material.
Once he/she feels ready to take the test, the exam is scheduled.
Usually one must wait for several weeks before receiving test results.
In any case the three exams are needed before one is considered
for the match:
2. USMLE2 which is two parts (2. CK = clinical knowledge and 3.
CS = clinical skills). http://www.usmle.org/index.html
Once one passes the required examination, then and only then is
that physician ready to apply for residency. ERAS then come into
the picture: The
Electronic Residency Application Service (ERAS®) .
ERAS have a cut-off date for filing the application as well as expenses
involved. Potential residents need to familiarize themselves with
this service. Usually it is in the second half of the calendar year.
One must apply to the different programs via ERAS and wait for replies
to find out who will offer an interview. The interview process goes
from November to early February.
If one is lucky, one will have several interviews, then at the end,
candidates can rank the programs and wait for the match results
(National Resident Matching Program)
No one can guarantee the match outcome. The match service examines
the wishes of the applicants against the wishes of the programs
and produces a list of the individuals and their posts. Both individuals
and programs respect and abide by that list.
The list is usually produced by the middle of March every year.
It usually takes one to two years to finish the examination and
the matching process.
In the United States the academic year starts in July. SO the raining
usually starts July first and the training year ends June 30 each
In the United States, general surgery forms the core of training
for most of the other surgical specialties. After you finish general
surgery you have the choice of cardiac and thoracic surgery, trauma,
critical care, minimal invasive, colorectal, vascular, transplant
surgery and surgical oncology fellowships to mention a few. The
fellowships usually range between one and three years.
Urology, orthopedic surgery, neurosurgery, and plastic surgery have
their own programs and match from the start.
One follows essentially the same steps as for general surgery. The
length of training is three years. Then one can decide if there
is a desire to enter a fellowship in one of the medical subspecialties.
Pulmonary and critical care, cardiology, gastroenterology, nephrology,
transplant nephrology are all examples of such fellowships. They
usually are about three years in length.
This is a simple overview of the process and I hope others may add
to it so the process become clear to our young doctors.
Having said that, I can think of the following points as basis to
help and guide our colleagues who are coming to the United States
for residency and higher education:
1. As consultants in the United States, we should work hard to establish
observership programs to accommodate serious young doctors. Observerships
help by orienting the potential applicant to the American health
system and patient care. It also gives the potential applicant a
chance to interact with American physicians and observe doctor-patient
relationships as well as doctor-doctor relationships.
2. As a consultant, one may make oneself available by speaking to
these young physicians and advising them about the process
3. As a consultant, one can help with structuring personal statements
and curriculum vitae. We all know that both are important for the
quality of the application.
4. Helping to secure an interview or a residency spot would be great.
The latter is difficult in most cases.
5. It is the duty of Ibnosina Medical
Association members to assist these young doctors by attempting
to answer their questions to the best of our knowledge.
Again these are just quick ideas that came to mind. I hope others
may add to this and continue to help advancing the career of these
young doctors. I hope the best for all of you.
About The Author
Dr. Elmahdi A. Elkhammas, is a Libyan transplant Surgeon who is
working in Columbus, Ohio, USA.
He contributed this article to The Tripoli Post.