ADVISORY

This advisory is a follow-up to the United States Information Agency (USIA) Statement of Policy (hereafter "Statement") published in the Federal Register on June 30, 1999. On October 1, 1999, USIA was abolished and the Exchange Visitor function performed by the Exchange Visitor Program Services office was transferred to the Bureau of Educational and Cultural Affairs, U.S. Department of State. That Statement sought to outline certain policy issues impacting J-1 Exchange Visitor physicians seeking Educational Commission for Foreign Medical Graduates (ECFMG) sponsorship in a program of graduate medical education or training. The intent was for this Statement to be a compilation of existing policy. Nonetheless, this Statement has caused considerable discussion and reaction. Since the publication of this Statement, representatives of the USIA and ECFMG have held several meetings to discuss your expressed questions and concerns. We write this joint letter to address some of these concerns and to clarify the intent of the Statement and the underlying principles supporting the Exchange Visitor Program for foreign national medical graduates.

Initially, some context is necessary. During the past five years, ECFMG has sponsored an annual average of 10,800 J-1 physicians in clinical training at 1,200 teaching institutions throughout the United States. Over ninety percent of these physicians have participated in programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) or recognized by a Specialty Board of the American Board of Medical Specialties (ABMS). Typically the duration of sponsorship has been the time needed to complete board certification requirements in the given specialty or subspecialty. Less than ten percent of all cases involve variations from the standard criteria.

We understand the dynamic, changing nature of graduate medical education and training. The practice of medicine is becoming highly specialized. Exciting new subspecialties, for which no accreditation or specialty certification exists, have emerged. We appreciate this rapidly changing environment.

In our discussions, we have agreed to the following operational guidelines regarding the participation of foreign medical graduates in the J-1 Exchange Visitor Program:

1. The Statement indicates, "a foreign medical graduate seeking to pursue graduate medical education must apply for a residency program in one of the recognized specialty or subspecialty fields of medicine." In determining what is a "recognized specialty or subspecialty", reference is made to the AMA: Graduate Medical Education Directory, including the on-line edition (insofar as it reflects the accredited program length), the ACGME, the U.S. Department of Health and Human Services (HHS), published guidelines and statements of the appropriate Specialty Board of the ABMS, and the official program description.
   
   
2. This Statement does not suggest that ECFMG is precluded from further sponsorship of physicians in non-standard programs. In accordance with existing Exchange Visitor Program regulations, ECFMG may continue to sponsor physicians seeking graduate medical education or training in a subspecialty that is recognized by the appropriate Specialty Board of the ABMS even though that subspecialty may not be accredited by ACGME. This includes certain fellowships in Obstetrics/Gynecology.
   
   
3. ECFMG may also continue to sponsor physicians in a subspecialty that has been recognized by the appropriate Specialty Board of the ABMS and for which an application for accreditation is pending, as affirmed by submission of a letter from the Accreditation Council for Graduate Medical Education (ACGME).
   
   
4. The Statement continues to permit ECFMG to make reference to the on-line version of the AMA: Graduate Medical Education Directory. When the program duration reflected in the on-line version differs from the accredited length, ECFMG shall sponsor the foreign medical graduates for the accredited length of time. (This item will continue to be reviewed and discussed.)
   
   
5. ECFMG may continue to consider sponsorship of foreign medical graduates for an additional year of training to serve as a Chief Resident if certain conditions are met, i.e., the foreign medical graduate is competitively selected, and the position is eligible for Health Care Financing Administration (HFCA) reimbursement. The residency program director must describe the competitive selection process resulting in the appointment of the Chief Resident and the additional educational experience to be achieved. The appropriate Specialty Board of the ABMS must also endorse the concept of an additional year of training for Chief Residents.
   
   
6. ECFMG may continue to sponsor applicants when the specific requirement for Specialty Board certification by a member Board of the ABMS requires an additional year beyond the accredited length published by ACGME as determined and affirmed by the cognizant specialty/subspecialty board (e.g., practicum years in Pathology and Occupational Medicine).

The dialogue on issues related to this Statement has been open and constructive and is continuing. We appreciate receiving the views of institutions and individuals directly involved in the graduate medical education and training of J-1 physicians. We share your deep commitment to the international exchange of medical and scientific knowledge and value your immense contributions.

ECFMG and the Department of State, in consultation with the Department of Health and Human Services, will continue to review the participation of J-1 physicians in non-standard programs. In the interim, ECFMG will continue to review sponsorship applications based on the same operational guidelines as it had prior to the publication of the Statement of June 30, 1999. The Department of State and ECFMG will continue to confer on unique cases for which there are no established precedent.

Thank you for your continued support and commitment.

Sincerely,

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