IS CALI APPROVAL REALLY THAT IMPORTANT? I DON'T THINK SO.

[asianTSwantsMD]

In my understanding, cali approval is only important if you are a current student in a foreign med school wishing to transfer to another med school in cali. Getting accepted as a foreign transfer student to even the lowest tier med school in the US is almost impossible unless of course if you are the top 1 student of Oxford or Cambridge or you have discovered HIV/AIDS vaccine.

It is also important if you are an IMG wishing to do clerkship or residency in cali. This is very competitive. Cali clerkships are mostly set aside for students in the Caribbean and Mexico. Most US students pick cali for residency. If there are left for scramble, you will compete with Caribbean and Mexican trained IMG's. why compete for leftovers like a clerkship in Compton or residency in some hospitals in central LA neighborhood?

These are what I deem more important in selecting a foreign medical school:

Is your med school listed under IMED and WHO? IMED for ECFMG certification if you want to practice in America and WHO for volunteering around the world.

Does the hospital your school is affiliated with have cutting edge technology like computed tomography imaging, laparoscopy, cell culture, osteogenesis, medical laser, etc.? You need to be exposed into these technologies so you won't be shocked or look dumb during your residency in the US. Just imagine if you are a resident in pathology and you haven't tried or used electron microscope because what you had in your med school was the simple light ones or you haven't heard of telemicroscopy or microscopy digital imaging. that will really affect your confidence and crush your ego. this ignorance won't be a bliss.

Do you have a good hands-on and exposure in a clinical environment of varied patient population? This will boost your confidence and help you get rid of your inhibitions and phobias. It will give you a good training too in multifaceted doctor-patient interaction and bedside manners. a school hospital of 50-100 beds is not a good place to encounter patients with different cases and learn different diseases.

Does the school prepare you well in basic medical sciences in your first two or three years in the program enough to get above average USMLE 1 score? By the way, you can challenge USMLE 1 after you complete all basic sciences. You don't have to wait after graduation. This is good because those courses/lessons/theories/books are still fresh in your mind.

Does your program have adequate time spent in all clinical rotations? More time spent on patients/hospitals, more clinical knowledge gained. that is if you are not wasting your time.

Will your professors expose or involve you in their research? This is good for resume building. Even if your job under your professor is just to collect patients' data like their names and addresses, take it. You can rename that job to sound clinical in your resume as "clinical data analyst," "clinical case specialist" or simply "clinical research assistant." This is not lying. You are part of a research team, where you happen to have no job specification.

Will the last two or three years of your program really give you a very good clinical knowledge important in USMLE 2? This is where, if you are a student pastry chef, you prove that you can do an almost perfect meringue, and that you are indeed a well-trained chef.

Now, the rotation or clerkship. I would finish all my rotation in my school outside of the US. Then do a 12-week rotation in the US. If you are willing to pay, you can do clerkship anywhere as long as you pass USMLE 1 and/or USMLE 2. Harvard Medical Center, for instance, charges like 10 grand for a 12-week clerkship.

American hospitals are too malpractice lawsuit-conscious. I don't think if they will ever allow you to deliver a baby, not just assist, during your rotation. i heard third year med students in asia and mexico are allowed to perform even c-section and other minor surgeries. those clinical experiences are rare in the US. so finishing a full rotation outside the US is an advantage indeed if you think of medical knowledge and clinical experiences.

For me, US clerkship is important for showing off your clinical knowledge and for your resume. This is the best way to prove to the americans that you are not a product of a medical diploma mill abroad. Rotate only in clinical courses where you can outstandingly show off your clinical skills. For instance, if you are lucky, you can stitch a patient's cut under a US doc's supervision. Your suturing skills and how clean you work, meaning blood, puss, dirty gauze and cottons are not all over, will impress your supervising surgeon. that is one letter of recommendation or preference already that will back you up in your residency application.

Psychiatry is good too. This is a good area where you can literally display your skills in patient charting and patient psychiatric profiling. If you are lucky again, maybe you can discuss psychiatric stuff with your supervisor. I think in this field you can bullpooh pooh a little bit. good area to show off. Just make it sure you know what you are talking about. If you are trying to impress your supervisor about neuropsychiatry be sure that you have a good background in both neurology and psychiatry. you might end up scratching your head.

Medical services in america is patient-oriented. american doctors are paranoid of lawsuits. Bedside manners are important. My sister, who is a cardiologist in nyc, told me that they were taught in med school how to ask proper questions, gesture or touch a patient to comfort him/her, and deal with a patient according to gender, race, religion and social background. I think OB-GYNE is the best for this kind of experience. Women are very particular of bedside manners. they are very appreciative too. even for just a pap smear or a prenatal sonogram, if you treat them good, they will write or tell your supervisor how nice you are. that is indeed a plus point.

Why do you need to impress your clerkship supervisors? You need them as references for your residency. Besides, you need to let them know that you are well trained too like US graduates. american med schools and hospitals tend to look down on IMG's medical training. If they find you to be excellent, in their minds you are one of the few IMG's who should be recommended for a good residency. Residency in the US is through merit, connection and luck. it is possible to do your residency where you do your clekship. that's why you need to have a good rapport with your clerkship supevisors. They might know someone who can help you during scramble.

Which is more important: a letter of recommendation from the dean of your medical school in Poland who has published a lot on Polish medical journals or a part time lecturer/clinical supervisor in a US medical school/hospital who has not even co-publish something? Unfortunately, the latter has more weight. Swallow your pride even if your physiology professor in Poland was a Nobel nominee. That means nothing in the US.

Now after passing USMLE 1 and 2, doing your clerkship, and finishing your residency in the US like all other US-trained doctors, I don't see why you cannot practice in California. California licensing law is legislative in nature. Cali lawmakers can amend it anytime, and licensing laws are open to various interpretation and implementation. For example, the cali board says "Medical Schools Recognized by the Medical Board of California " not "Medical School Programs Recognized by the Medical Board of California." In this case, English MD programs of the cali board approved schools in Poland are not really cali board approved or disapproved because they don't need to have an approval. Cali approves med schools not MD programs.

Take the case of my primary care physician 3 years ago in orange county in southern California as an example. He got his MD from Spartan in the Caribbean. Spartan is not cali approved yet he practiced in cali. I think cali physician licensing is dealt with in a case-to-case basis. That's why it takes 8 months to process a cali physician license application. Unfortunately, only michigan accepts reciprocity

If ECFMG certified an IMG, who graduated from an obscure med school in Timbuktu, he got a very high mark on USMLE 1 and passed USMLE 2 easily, Harvard clerkship gave him good letters of recommendation, and his residency at Yale showed he is very good, what is the business of cali board to deny him a medical license? I just hate elitism.

sorry for the long rant. I just felt like writing something.

[asianTSwantsMD]

first and foremost the state of cali is broke. they are not after of the caribbean-trained docs' coins for application fees. They go for the schools' checks. but the victims are the same-- the students/img's.

cali economy must be on a dive. state gov't is pimpin'. cali has so many regulatory boards. one each for manicure/pedicure, haircut, facial, tanning, massage, etc. I wonder how they regulate 'happy endings.' hehehehe

to get a cali med license? sue the cali board.

Ms. Park, how many Spartan docs working in cali? can they speak up now or are they still gagged by the out of court settlement order?

[shockandawe]

first and foremost the state of cali is broke. they are not after of the caribbean-trained docs' coins for application fees. They go for the schools' checks. but the victims are the same-- the students/img's.

cali economy must be on a dive. state gov't is pimpin'. cali has so many regulatory boards. one each for manicure/pedicure, haircut, facial, tanning, massage, etc. I wonder how they regulate 'happy endings.' hehehehe

to get a cali med license? sue the cali board.

Ms. Park, how many Spartan docs working in cali? can they speak up now or are they still gagged by the out of court settlement order?

asianTSwantsMD wrote: "If a blind man is able to see after an eye operation, is he still blind?"

The answer is: Yes, but only if he is a California state medical board member. -s&a

[Miklos]

There are a couple of misconceptions on this thread that I'd like to address.

1) Schools do not pay huge application fees in order to get approved. They must complete the application, which is a significant burden in terms of man-hours, but the only fee attached is if a site visit is required. If a site visit is required, the med board bills the school for their site visit expenses.

2) The reason closed schools in Afghanistan (for instance) are listed on the med board's site is so that past graduates of those local programs can apply for licensure.

3) The reason that operating Carib. schools are not listed is that they have either a) not applied for approval or b) were turned down.

4) Regarding the California statue on English language programs. It (sadly, no loop hole there) pretty clearly differentiates between native language and non-native language programs. To pretend otherwise, is to ignore reality.

5) Planning legal remedy after attending a non-approved school/program is at best a pipe dream. The medical board (whether fair or not) has statuatory authority to determine whether an applicant meets criteria. In addition, if a person attended a non-approved school, after finishing residency, being in debt a couple hundred k, will they realistically have the financial werewithal to mount a legal challenge?

Answer: highly unlikely.

So, if someone wants to have the option of practicing in California someday, do yourself a favor. Go to an approved school or program and avoid headaches later.

Miklos

[cristagali]

AsiantSwants raises some interesting issue. Of course Miklos makes a very sound arguement also (and is the position of the Cali board to date). To anyone, not on the approved list, have you TRIED to APPLY to the CA Board? What was their response? As I stated earlier, NO HUNGARIAN school is on TEXAS' "approved" list. But there are many Hungarian doctors working in Texas, who had to go through a secondary process. A little longer and cumbersome, but licenses were granted. My question is, has anyone on an individual basis applied for CA letter? What was the outcome? if not successful, what was their position? In the big picture, Cali board says they are protecting the public. But when you review the "approved" school list, you absolutely know thats a joke. I really don't see how it could hold up in a court challenge. But then Miklos is right, who has the time and money to wage war with Cali. But more worrisome is that some states are considering adopting the Cali board list. Maybe the Cali board position will be challenged, but through another states court..I don't know...I'm not a lawyer...Anyway, I'll be long gone before this issue is settled. Hopefully it won't come back to haunt me!!HA!

[asianTSwantsMD]

There are a couple of misconceptions on this thread that I'd like to address.

1) Schools do not pay huge application fees in order to get approved. They must complete the application, which is a significant burden in terms of man-hours, but the only fee attached is if a site visit is required. If a site visit is required, the med board bills the school for their site visit expenses.

application fees cali board is asking from carib schools are for site visit also known as island vacation. do you really think cali board asked the same amount from schools in iraq, ethiopia, bangladesh and other not so developing countries for site visits?


2) The reason closed schools in Afghanistan (for instance) are listed on the med board's site is so that past graduates of those local programs can apply for licensure.

that means school background is not important for licensing; complying ecfmg and passing usmle 1 and 2 and doing residency are. med school in kabul has been closed or semi-closed for decades.

3) The reason that operating Carib. schools are not listed is that they have either a) not applied for approval or b) were turned down.

you forgot c) they have refused to engage in corruption and bribery

4) Regarding the California statue on English language programs. It (sadly, no loop hole there) pretty clearly differentiates between native language and non-native language programs. To pretend otherwise, is to ignore reality.

the loop hole is so glaring. cali licensing laws do not specifically nitpick english or non english MD programs. they approve schools not the language skills of the schools' faculty. what's their method to assess let's say Poland's english MD program? Force all polish professors to take ESL test or TOEFL? what is the policy of the cali board on med schools in India where both hindi and english are used as medium?

5) Planning legal remedy after attending a non-approved school/program is at best a pipe dream. The medical board (whether fair or not) has statuatory authority to determine whether an applicant meets criteria. In addition, if a person attended a non-approved school, after finishing residency, being in debt a couple hundred k, will they realistically have the financial werewithal to mount a legal challenge?

Answer: highly unlikely.

go pro bono. the best way to pay off student loans and get a cali license at the same time is to file a class action lawsuit against the cali board.

So, if someone wants to have the option of practicing in California someday, do yourself a favor. Go to an approved school or program and avoid headaches later.

that is the most unfortunate thing in this issue. the cali board's moronic interpretation and implementation of licensing laws end some student's dreams. i can only afford 6000 dollars a year for all med school and living expenses. I want a med school that is strong in research, with world class professors, and has good clinical facilities.

with my budget and goals, it seems i will end up taking the english md program of a russian pediatric academy. the cali board says english MD programs in eastern europe and russia are not approved. should i listen? no. if i do, then that will be the end of my dream.

My idea of going to med school is not just to finish my degree, pass usmle, do residency and get licensed. i want to maximize my time in med school, learn a lot of things and stay focus on my goal of becoming a pediatric plastic surgeon. medical knowledge and clinical skills, for me, are more important than USMLE or state license.

i don't want to choose a med school using the cali board's idiocy. my mind is set on a russian med school after reading numerous clinical/medical abstracts, journals, and reseach on russian pediatrics/plastic surgery. with or without the cali board's appoval, I want to learn pediatric plastic surgery, microsurgery, tissue culture, osteogenesis (bone replication), non-invasive surgery, use of miniaturized surgical tools, etc.

I think with my 6000 dollars a year for six years, i can learn all these things in a pediatric medical academy in st. petersburg. if in the future cali does not want me, maybe somewhere in africa or asia, i will be needed.

PURSUE YOUR DREAM AGAINST ALL ODDS!



[/b]

[azskeptic]

I support the FSMB's discussions on offshore school inspection which is occuring. Eventually we will need a way to inspect all schools but currently some states,like California, rely on traditional schools that are inspected by the govts for their own students and require inspection of new schools that are designed for Americans. This includes programs designed for Americans by state supported schools like the english ones.

Suing a govt. is a big move. You have to be standing completely on solid ground. I don't believe your argument is there yet. California is very thorough and ethical in the way they do things.

[Miklos]

Your post, to be honest, is a little bit tiresome, especially considering that you've been on this forum only for a handful of days. However, everyone is entitled to be wrong.

There are a couple of misconceptions on this thread that I'd like to address.

1) Schools do not pay huge application fees in order to get approved. They must complete the application, which is a significant burden in terms of man-hours, but the only fee attached is if a site visit is required. If a site visit is required, the med board bills the school for their site visit expenses.

application fees cali board is asking from carib schools are for site visit also known as island vacation. do you really think cali board asked the same amount from schools in iraq, ethiopia, bangladesh and other not so developing countries for site visits?

2) The reason closed schools in Afghanistan (for instance) are listed on the med board's site is so that past graduates of those local programs can apply for licensure.

that means school background is not important for licensing; complying ecfmg and passing usmle 1 and 2 and doing residency are. med school in kabul has been closed or semi-closed for decades.

3) The reason that operating Carib. schools are not listed is that they have either a) not applied for approval or b) were turned down.

you forgot c) they have refused to engage in corruption and bribery

4) Regarding the California statue on English language programs. It (sadly, no loop hole there) pretty clearly differentiates between native language and non-native language programs. To pretend otherwise, is to ignore reality.

the loop hole is so glaring. cali licensing laws do not specifically nitpick english or non english MD programs. they approve schools not the language skills of the schools' faculty. what's their method to assess let's say Poland's english MD program? Force all polish professors to take ESL test or TOEFL? what is the policy of the cali board on med schools in India where both hindi and english are used as medium?

Let's go straight to the California law for clarification. They are posted publicly for everyone's edification. See http://www.medbd.ca.gov/MBC_Regulations.pdf (If they are not there, one can easily look them up under the California law website, if one finds the proper Business and Professions Code.)

The relevant code to this discussion is as follows:

1314.1 International Medical Schools.
(a) For purposes of Article 5 of Chapter 5 of Division 2 of the code (commencing with Section 2100), a medical school's resident course of instruction that leads to an M.D. degree shall be deemed equivalent to that required by Sections 2089 and 2089.5 of the code if the medical school offers the curriculum and clinical instruction described in those sections and meets one of the following:

(1) The medical school is owned and operated by the government of the country in wich it is located, the country is a member of the Organization for Economic Cooperation and Development, and the medical school's primary purpose is educating its own citizens to practice medicine in that country; or

(2)the medical school is chartered by the jurisdiction in which it is domiciled and meets the standards set forth in subsection (b) below.

The regulation then outlines the requirements and then continues...

1314.1 (2) Every seven years, it shall submit documentation sufficient to establish that it remains in compliance with the requirements of this section and of Sections 2089 and 2089.5 of the code.
(g) The documentation submitted pursuant to subsection (f)(2) shall be reviewed by the division or its designee to determine whether the institution remains in compliance with the requirements of those regulations and of Sections 2089 and 2089.5 of the code.
(h) The division may at any time withdraw its determination of equivalence when an institution is no longer in compliance with this section...

What does this mean?

It differentiates between schools/programs that teach their own citizens and those that are set-up on Carib. islands (and other places such as Poland) to teach non-citizens. (You are right about the language; but it goes hand-in-hand with citizenship.)

For purposes of California licensure, the school/program is therefore key.

Accusing the board of corruption is (IMO) childish.

5) Planning legal remedy after attending a non-approved school/program is at best a pipe dream. The medical board (whether fair or not) has statuatory authority to determine whether an applicant meets criteria. In addition, if a person attended a non-approved school, after finishing residency, being in debt a couple hundred k, will they realistically have the financial werewithal to mount a legal challenge?

Answer: highly unlikely.

go pro bono. the best way to pay off student loans and get a cali license at the same time is to file a class action lawsuit against the cali board.

So, if someone wants to have the option of practicing in California someday, do yourself a favor. Go to an approved school or program and avoid headaches later.

that is the most unfortunate thing in this issue. the cali board's moronic interpretation and implementation of licensing laws end some student's dreams. i can only afford 6000 dollars a year for all med school and living expenses. I want a med school that is strong in research, with world class professors, and has good clinical facilities.

with my budget and goals, it seems i will end up taking the english md program of a russian pediatric academy. the cali board says english MD programs in eastern europe and russia are not approved. should i listen? no. if i do, then that will be the end of my dream.

My idea of going to med school is not just to finish my degree, pass usmle, do residency and get licensed. i want to maximize my time in med school, learn a lot of things and stay focus on my goal of becoming a pediatric plastic surgeon. medical knowledge and clinical skills, for me, are more important than USMLE or state license.

i don't want to choose a med school using the cali board's idiocy. my mind is set on a russian med school after reading numerous clinical/medical abstracts, journals, and reseach on russian pediatrics/plastic surgery. with or without the cali board's appoval, I want to learn pediatric plastic surgery, microsurgery, tissue culture, osteogenesis (bone replication), non-invasive surgery, use of miniaturized surgical tools, etc.

I think with my 6000 dollars a year for six years, i can learn all these things in a pediatric medical academy in st. petersburg. if in the future cali does not want me, maybe somewhere in africa or asia, i will be needed.

PURSUE YOUR DREAM AGAINST ALL ODDS!

The best of luck to you.

BTW, going pro bono is probably not an option. After all, who will take a case from a board-certified physician to sue to California Medical Board for free? Even if you find the effort, time and money to sue them, the outcome is unlikely to be in your favor.

Also, there are three approved English language programs in the region. (Charles, Semmelweis and Szeged are all approved.)

Miklos

[Miklos]

AsiantSwants raises some interesting issue. Of course Miklos makes a very sound arguement also (and is the position of the Cali board to date). To anyone, not on the approved list, have you TRIED to APPLY to the CA Board? What was their response? As I stated earlier, NO HUNGARIAN school is on TEXAS' "approved" list. But there are many Hungarian doctors working in Texas, who had to go through a secondary process. A little longer and cumbersome, but licenses were granted. My question is, has anyone on an individual basis applied for CA letter? What was the outcome?

I know a grad from a non-approved English language program in Hungary who is fighting to get a California license. She has completed residency and is board certified, but cannot obtain a license because her program is not approved. Their response, according to her, was as I posted elsewhere:

"Thanks for applying, but unfortunately, the med board cannot evaluate your application, as the program you've attended is not approved."

[azskeptic]

AsiantSwants raises some interesting issue. Of course Miklos makes a very sound arguement also (and is the position of the Cali board to date). To anyone, not on the approved list, have you TRIED to APPLY to the CA Board? What was their response? As I stated earlier, NO HUNGARIAN school is on TEXAS' "approved" list. But there are many Hungarian doctors working in Texas, who had to go through a secondary process. A little longer and cumbersome, but licenses were granted. My question is, has anyone on an individual basis applied for CA letter? What was the outcome?

I know a grad from a non-approved English language program in Hungary who is fighting to get a California license. She has completed residency and is board certified, but cannot obtain a license because her program is not approved. Their response, according to her, was as I posted elsewhere:

"Thanks for applying, but unfortunately, the med board cannot evaluate your application, as the program you've attended is not approved."

also, unless you want an interesting time with other boards, don't apply places where you are going to get denied. You'll be filling out explanations for the remainder of your life as a doctor.

[gawtti]

being from california, i think the board is doing a great job. it is unfortunate that because of a few bad apples that all the legit ones have to suffer. maybe it's discrimination, unethical, unconstitutional, whatever you want to call it. i still feel that the california board is doing a good job. AND, i'm not just saying this because i attend a cali accredited school because i don't.

BUT, if your dream is to become a doctor. don't let this california issue stop you from pursuing your dream. i'm from california and believe me, it's not worth all the hype. like asianTSwantsMD said, go to afirca or asia where they really need doctors.

one more thing, please DO YOUR RESEARCH ON A SCHOOL!! choose it wisely, and if you have the cash. go out and visit the school, talk to the students. i could not STRESS this more. do not go by how cheap the tuition is!!!!!!!! it's the quality that counts!!!!!!!!!

and, 2 of 3 cali approved MD enlgish programs in eastern europe are located in hungary. hopefully, by the time i'm done here we'll be cali approved.