1.3 Fellowship, Academic, Government, Caring for the Underserved, Immigration Issues, International Medicine

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1 1. Making Career Decisions Fellowship, Academic, Government, Caring for the Underserved, Immigration Issues, International Medicine Learning Objectives Describe these careers alternatives and issues: Fellowship Academic Medicine Government Caring for the Underserved Immigration Issues International Medicine Fellowship Fellowship training can be a path to a rewarding career in a specialized clinical area. To help learn whether a fellowship might be right for you, learn how its graduates apply their training. Look for a fellowship program that will give you sufficient clinical experience in the conditions you want to treat, in the procedures you want to perform, and the patients you want to serve. Accredited fellowships offer comprehensive training, while less formal fellowships might be more limited. Find out about your teaching and research mentors, and consider what it might be like learning from them. Ask whether you may contact graduates of the program to learn about their experiences. Ask if you can shadow a fellow during a typical day.

2 Making Career Decisions US Physicians by Practice Type US physicians work in a variety of practice types. Close to half of active, non-federal office- and hospital-based physicians are in practices of five or fewer physicians. 17 Academic Medicine Academic physicians can be employed by a medical school or in clinical settings ranging from large medical centers to small community hospitals. Academic positions in residency and fellowship programs often combine teaching, patient care, research, and administration. Most physicians in academic medicine maintain clinical practices. Community physicians receive clinical faculty appointments for welcoming medical students and residents to their practices.. Academic positions often combine teaching, patient care, research, and administration. Academic physicians tend to work regular hours and call schedules. Physicians who achieve academic tenure enjoy a measure of job 17 Source: Center for Studying Health System Change 2008 Health Tracking Physician Survey. valancy.com

3 1. Making Career Decisions 1.19 security. However, not every academic position is tenure track, i.e., eventually eligible for tenure. Positions funded with grants or similar sources may offer limited job security. Advancement opportunities may include the academic structure, in research, or in health care management. Compensation varies with the program and faculty position. Individual compensation typically includes a base salary plus a performance bonus. Some programs offer compensation for teaching, research, and administrative activities. Government Federal agencies offer employment opportunities both in the U.S. and abroad. Government -employed physicians generally enjoy job security, regular working hours, practice security, excellent professional liability protection, and a comprehensive benefits package. Some positions are eligible for federal medical school loan forgiveness. Compensation is competitive for early career physicians/ Armed Forces Most physicians in the US Armed Forces practice patient care, some work in administration, research, and teaching. A large portion of the military patient population is young and healthy. Depending where based, military physicians may care for dependents of active duty personnel as well as retired military personnel The Armed Forces support teaching programs in unique specialties with the latest technologies, such as aviation, undersea, and nuclear medicine, as well as traditional specialties. Physicians in the Armed Forces are officers and receive pay and benefits corresponding to their rank and medical specialty. Recruiting incentives typically include medical school scholarships, stipends during residency, and student loan repayment. In addition to full time positions, opportunities for part-time military service are available through the Armed Forces Reserve programs. Contact your local Armed Forces Recruiting Office or visit the links below for more information about career opportunities. Army: Navy: Air Force: - interest:health-and-medicine

4 Making Career Decisions Department of Veterans Affairs The Department of Veterans Affairs (VA) employs more than 14,000 physicians in a variety of practice options in large and small communities across the country. The VA boasts of providing a healthy work/life balance through predictable scheduling, reduced paperwork, the elimination of billing hassles, lifting the burden of liability coverage and generous vacation and personal leave. Full- and part-time positions are available at Veterans Administration hospitals located throughout the country. There are opportunities for advancement within the Veterans Administration hospital system. Physicians are eligible to receive Federal retirement benefits. The VA Locum Tenens Program offers tours at facilities across the country with competitive salary and benefits, as well as lodging, meals, and incidentals. Department of Health and Human Services The US Department of Health and Human Services (DHHS) employs thousands of physicians in its various agencies. Areas of specialization include direct patient care, epidemiology, research, and administration. DHHS agencies include: National Health Service Corps The National Health Service Corps (NHSC) loan repayment program (LRP) offers primary health care providers loan repayment assistance in exchange for working (and possibly partial credit for teaching) in rural, urban, and frontier communities with limited access to care throughout the United States known as Health professional Shortage Areas (HPSAs). NHSC clinicians must work at an NHSC-approved site, generally outpatient facilities providing primary medical, dental, and/or mental and behavioral health services, in a Health professional Shortage area (HPSA). HPSAs are located around the country in rural, urban and frontier communities. As of December 2012, physicians practicing full-time for two years in sites with HPSA scores 14+ were eligible for up to $60,000, sites with HPSA scores 0-13 were eligible for up to $40,000. Part time physicians practicing for two years were eligible for half these amounts. Loan repayment grants are not taxable. valancy.com

5 1. Making Career Decisions 1.21 U.S. Public Health Service Commissioned Corps The 1,300+ medical officers in the PHS Commissioned Corps work throughout the Department of Health and Human Services (HHS) and in other Federal agencies and programs. The majority of medical officers are assigned to the Centers for Disease Control (CDC) (34%) Indian Health Service (IHS) (24%), and National Institutes of Health (NIH) (20%). Indian Health Service The unique mission of the Indian Health Service IHS) is to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level. Part of the US Department of Health and Human Services, the IHS serves nearly two million American Indians and Alaska Natives through a network of 45 state-of-the-art hospitals and more than 293 clinics throughout 35 states. Physicians may be employed through the federal civil service, the US Public Health Service Commissioned Corps, or as a direct tribal hire. The IHS LRP awards up to $20,000 per year for the repayment of qualified student loans in exchange for an initial two-year service obligation to practice full time at an Indian Health Program site. The IHS makes additional payments to offset the physician s income tax liability and FICA. Bureau of Prisons Centers for Disease Control - Medical Officers Food and Drug Administration National Institutes of Health

6 Making Career Decisions For more information about US Department of Health and Human Services and other federal government practice opportunities, visit State and Local Government Agencies A variety of patient care and administrative positions are available in state and local government agencies, including health departments, workers' compensation, and rehabilitation bureaus. Patients are those with medical conditions or social circumstances served by the particular agency. Physicians usually work regular hours, with little time on call. Both full- and part-time positions are available. Opportunities for advancement depend on the agency. 3RNet, the National Rural Recruitment and Retention Network is a consortium of agencies such as state offices of primary care or rural health, AHECs, university programs, and non-profit organizations. Members of 3RNet help physicians and health professionals with recruitment and retention to rural and underserved communities throughout the country. Caring for the Medically Underserved A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. FQHCs are community-based organizations that provide comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. In 2010, there were 1,124 FHQC in the United States operating more than 6,000 sites. Health programs funded include: Community Health Centers, which serve a variety of Federally, designated Medically Underserved Area/Populations (MUA or MUP). Migrant Health Centers which provide culturally-competent and primary preventive medical care to migrant and seasonal agricultural workers, valancy.com

7 1. Making Career Decisions 1.23 Health Care for the Homeless Programs which reach out to homeless individuals and families and provide primary and preventive care and substance abuse services, and Public Housing Primary Care Programs that serve residents of public housing and are located in or adjacent to the communities they serve. 18 Immigration Issues: J-1 and H-1B Visas The following information is of a general nature and is not legal advice. Physicians who are in the United States on a J-1 or H-1B visa should seek legal advice from a competent attorney who specializes in immigration law. About one-quarter of the physicians in active patient care in the US, are international medical graduates (IMGs); close to 200,000 physicians. 19. J-1 and H-1B Visas A J-1 visa is an exchange visitor visa, which gives physicians up to seven years to complete graduate medical education (GME) in the US. Upon completion of training, the physician must return to his or her home country for two years, or obtain a waiver of the two-year home residency requirement. The most common method of obtaining a waiver is for the physician to be sponsored by an interested government agency, either federal or state, and obtain a job in a federally designated Health Professional Shortage Area (HPSA), or a Medically Underserved Area (MUA). Under the Conrad 30 program, states establish their own criteria. Physicians must change their immigration status to H-1B temporary professional and work for the sponsoring employer for at least three years. Interested government agencies include: The Veterans Administration (VA): primary care and specialists The Delta Regional Authority (DRA): primary care and specialists, only in certain counties within the Mississippi Delta states Department of Health and Human Services (HHS): primary care only Physician Specialty Data Book, Center for Workforce Studies, November 2012, Association of American Medical Colleges

8 Making Career Decisions The Appalachian Regional Commission (ARC): primary care physicians only, limited to the Appalachian states For more information, visit Job Search Considerations for International Physicians Beware of predators who target international physicians. Avoid recruiters that charge fees to physicians Contact in house recruiters o Directly o practicelink.com o 3rnet.org Ask your employer to o Reimburse your immigration expenses o Sponsor your Permanent Resident Status (Green Card) when eligible International Medicine Both secular and faith-based organizations offer opportunities for physicians in underserved areas of the world, including: Africare American Refugee Committee Catholic Medical Association Catholic Medical Mission Board, Inc. Doctors of the World Doctors Without Borders, USA Esperanca Inc. Health Volunteers Overseas Hospital Albert Schweitzer-Haiti International Christian Medical Outreach International Committee of the Red Cross International Health Volunteers International Medical Corps International Medical Volunteers Association valancy.com

9 1. Making Career Decisions 1.25 International Rescue Committee Interplast Inc. Medical Benevolence Foundation Medicins Sans Frontieres...Doctors Without Borders International Mercy Ships Mission Doctors Association Operation Rainbow Operation Smile Peace Corps Physicians for Peace Project Hope SIM International Surgical Eye Expeditions International UN Office of Coordination of Humanitarian Affairs Relief Web Volunteers in Plastic Surgery World Medical Mission Inc. Lesson Summary 1.3 Fellowships, Academic Medicine, Government Service, Caring for the Underserved, and Immigration Issues Fellowship training can be fully accredited or focused on specific skills. Close to half of physicians practice with five or fewer physicians. Academic medicine blends teaching, patient care, research, and administration in a variety of settings. Federal, state and local governments offer unique opportunities. Caring for the medically underserved may qualify for loan repayment. Jobs that sponsor visa waivers are available in urban and rural communities. Both secular and faith-based organizations offer international opportunities.