A fellowship in the USA: Essential information for the Australasian medical graduate

Background: There have been many recent changes to the immigration and educ ational requirements necessary to obtain both clinical and research positio ns in the USA. This paper describes these requirements in detail and examin es the cost of obtaining a position. Methods: An extensive review of Medline and relevant documents from educati onal and immigration bodies is undertaken in addition to personal and peer experience of the processes necessary to fulfil educational and immigration requirements for funded medical positions in the USA. A cost analysis is p erformed based upon the latest charges for exam requirements and visa fees. A 'minimum' cost for fulfilling exam and visa requirements only and a 'lik ely' cost (which represents a more realistic appraisal of the expenses like ly to be incurred) are investigated. Results: This review shows that many recent changes have made the attainmen t of a position difficult and expensive. Much foresight and planning is req uired to obtain the necessary requirements for medical licensure and to obt ain working visa status in addition to the application for the position its elf. The cost analysis reveals that the minimum cost is $4050 (AU$) and the 'likely' cost is $8600 (AU$). Conclusion: Australasian trainees and Fellows need to be fully aware of the difficulties and expenses likely to be encountered in order to make an inf ormed decision with regard to overseas training in the USA.