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Q: medicare rules covering training ( Answered 4 out of 5 stars,   0 Comments )
Subject: medicare rules covering training
Category: Reference, Education and News > Teaching and Research
Asked by: eshilpa-ga
List Price: $55.00
Posted: 01 Oct 2002 18:52 PDT
Expires: 31 Oct 2002 17:52 PST
Question ID: 71412
externship programs in teachinghospitals for american citizens who
graduated from foreign medicl schools is there any medicare or any
rules ?for it?can we charge for it?
Subject: Re: medicare rules covering training
Answered By: silviares-ga on 15 Oct 2002 16:57 PDT
Rated:4 out of 5 stars
Hello eshilpa-ga 

Let me start by defining the different type of medical education
position at teaching hospitals so that you are clear on the type of
position to look for.
I found this information at one of the International Medical Graduate

1. RESIDENCY - This is a formal, paid graduate medical education
position in an accredited graduate medical education program. For most
of us, this will have to be in an M.D. hospital. Successful completion
of a residency allows the graduate to apply for a full license to
practice medicine in one of the states.

2. EXTERNSHIP - This is essentially a residency position that is
unpaid, and is not for credit. In an externship, you can generally
have contact with patients to some extent, perform some procedures,
etc. However, you usually cannot work as the house officer, or write
formal orders. Generally, you need some type of malpractice insurance
to get an externship.

3. OBSERVERSHIP - This is an unpaid, non-accredited position. You
essentially attend rounds, watch other residents work, attend
lectures, etc. You do not really participate and you cannot touch
patients. You basically learn by observing. You may or may not need
malpractice insurance to get an observership. This is the most common
type of position.

As you see externship is by definition unpaid and you probably have to
pay for your malpractice insurance. On the other side some teaching
hospitals require you to pay for observership.

There is no formal way to find and observership or externship. The
reason for this is that they are not formal positions. It is more a
situation where you are allowed to be there, at the discretion of the
program and medical education directors. Externships are better, but
is easier to get an observership.

These positions are only going to be found in a teaching hospital. If
a hospital does not have any type of graduate medical education
program, there will be no observership or externship possibilities

The first thing that you will have to do is to identify the teaching
hospitals that are close to you. Next, you need to see if they offer
training in the specialty that you are interested in.

When you have decided which kind of position you want you can take a
look at the  International Medical Graduate Institute web
IMGI is an online resource center for the international medical
graduate (IMG).
IMGIs focus is to help the IMG (U.S. and non U.S. citizens) with the
complex process of coming to the United States to practice medicine.
IMGI is a network that has cataloged the most important information
relevant to the IMG into one site. They also offers personalized
consultation and referrals.
Their site is full or information and I suggest you to take a look
since you might find special cases that apply to you.

They have a page on Externship/Observership stuff
from which I gather some of the following information.

" Fist of all they suggest that Veteran's Hospitals are the Best
Choice for an Observership.
Other Hospitals that you should contact for Observership are:

DC General Hospital, Washington, DC
Emory University
Harbor Hospital, Baltimore, MD
Providence Hospital, Washington, DC
VA Medical Ctr., Washington, DC
University of Miami, Miami, FL

Few places like the Mayo Clinic, Rochester, MN have actual established
observership programs called Visiting Physicians program, look up
their website. Also Mount Sinai Hospital, Miami, FL has a paid
Observership program wherein you pay around $300 per month for the

Start the process by calling or e-mailing every hospital in your
immediate area for any positions available. Try University hospitals,
teaching affiliates (VA), community hospitals. Make sure they
understand that you do it for free and that you'll pay your own
insurance in case you get an Externship.

Getting an Externship/Observership unfortunately involves a lot of
trying at many different places. There will be a lot of rejections but
you need to be persistent. Programs are very often troubled by lots of
IMGs like you trying for Externships/Observerships, so it is very
unlikely that you can get a position only by sending in your resume or
even by calling them. You should go personally make an appointment and
meet the program director. Go meet all the doctors concerned, try to
add a personal touch, try to impress them, show them that you can
speak good English.

It is better to do Externship/Observership in the specialty you are
going to apply for residency - OB/GYN or Radiology but in case you are
unsuccessful, experience in Internal Medicine or Surgery will be quite
useful too.

About the duration, obviously the longer your experience the more
valuable it will be. A minimum of 4 weeks in the specialty of your
choice is recommended because the faculty who will be giving you the
letters of recommendation need to know you well in order to give you
favorable LoRs.

If you are absolutely unable to find a clinical experience in a
teaching hospital, try to obtain a voluntary research position in a
hospital, where you will have a mentor who will be able to write a
letter of recommendation. Most University hospitals have research
programs. Write or meet the chairman and request for a research

Conducting research at a hospital will often give you an entry into
the hospital. Make yourself known to everyone, develop good contacts,
try to attend clinical meetings/grand rounds and if you are lucky you
might get good LoRs or they may allow you to eventually do an

Unfortunately, if you are unable to get a research position too, go
for volunteering at the nearest teaching hospital and develop good
contacts, it may be your ticket to an Externship/Observership. Many VA
hospitals have programs for volunteers."

The IMGI site also suggest what is called mini residency

"Dear colleagues, observership programs are offered by many programs
especially big university programs. During observership you can visit
the hospital and do rounds with the clinical faculty and residents.
But its not very helpful for getting residency. There is another thing
called mini residency, the following hospitals offer this programs and
I thought it might help all of foreign medical graduates:

Primary care neurology: State univ of New York: SUNY
Univ of Rochester, AIDS program
Univ. of Kentucky
Univ of Miami (mount sinai, miami)
Emory univ., atlanta, georgia 

Going back to your original question doesn't look like there is any
rule for Externship/Observership. However if your final target is to
obtain residency then you can follow the steps and the timetable on
the IMGI site at
You probably can skip step 9 (Apply for a VISA) since you are a

I hope this answer your question or at least gives you enough
information to start understanding the process. I will be happy to
help you further in case something is not clear.

I also want to point you to a site with a list of teaching hospitals
it will be useful to you when you decide to apply.

To answer your question I used the following searches
"teaching hospital externship"
"teaching hospitals"

Good luck

Clarification of Answer by silviares-ga on 15 Oct 2002 17:20 PDT
Hello again

I forgot to point you to some articles that threat specifically the
problem of foreign graduate and Medicare. I couldn't find any rule or
restriction applying to you but you can read them since they seem to
be very informative on the subject.

eshilpa-ga rated this answer:4 out of 5 stars
did better job than me in looking up the answer

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