Solving the Problem of Not Getting Required Green Book Clinical Rotations

I'm considering med schools in Europe, Caribbean, and Asia. I was just advised to go to an expensive Caribbean school, like St. George's, because the school has excellent relationships with hospitals to make sure students obtain the "Green Book" rotations necessary to get licensed. My friend said lesser schools don't have the proper relationships with hospitals to get the Green Book rotations. As a result, their students cannot get the Green Book rotations and are left out in the cold for residencies and getting licensed.

What can a student do to get the authorized Green Book rotations if they attend a school with limited relationships with U.S. hospitals???

This seems to be a deal breaker for becoming a doctor.

Does anyone know of a work-around on this for FMG students to get all the Green Book rotations they need???

Thanks!!

If you're in Europe, your number of Green rotations will vary depending on the school you attend. If you are at a school with only EU rotations (like me), then you will only have a few US rotations anyway, and you can set them up at a Green location. They are out there, and it's not impossible to get them. Also, if you are not using the rotations for credit (i.e., completing them during vacation periods, etc.) then it is a complete non-issue, because the EU rotations that count toward your degree are automatically accepted in every state. If the EU rotations are all you use for the completion of your degree, and your vacation rotations are used solely to garner USCE and they don't show up on your transcript, then it really doesn't matter one whit.

FWIW, Green rotations are not the ONLY way to get residency and get licensed. Blue rotations (osteopathic) will also fit the bill for a majority of states. However, if you are hung up on 50 state approval and licensing opportunities, AND you are going to use the rotations as part of the credit for your medical degree, then it is better to go Green. Does that make sense?

Hmm. I'm confused. Are the Green Book clinical rotations required to get accepted into a residency program or to get licensed?

My friend told me not to go to a med school with a clinical relationship with Jackson Park Hospital in Chicago. He said that I could only get FM, IM and maybe Obgyn there. He said I could NOT get Psych, Surgery, Peds there and that this would keep me from getting licensed.

I don't get it. I just checked out the Wash State Board of Medicine. It doesn't say anything there about clinical rotations, only about "post graduate clinical training" which I understand is a residency.

Are you saying that if all I do is a few Green Book approved rotations at Jackson Park Hospital, that might be good enough to be selected for a residency program? Is it that a FMG's chances for being selected to be a resident are enhanced if the FMG has the full load of "core Green Book" clinical rotations? That is what it is looking like to me.

What are you doing with respect to clinical rotations DD? Does Sophia have relationships with US hospitals? Are you planning on applying for residencies with all/none of the clinical rotations?

Thanks!

Hmm. I'm confused. Are the Green Book clinical rotations required to get accepted into a residency program or to get licensed?

No... not even close. There are a small number of people who match with NO USCE at all (fewer all the time, of course, but it still happens), and others who match with Blue or neither-Green-nor-Blue. The problem comes in when lower-tier schools set up all of their USCE at non-Green sites, to meet the clinical requirements for their degree program. This can lead to issues later in some states that require US clinicals-for-credit to be completed at Green locations. (I don't know which states, frankly, but they are out there.)

My friend told me not to go to a med school with a clinical relationship with Jackson Park Hospital in Chicago. He said that I could only get FM, IM and maybe Obgyn there. He said I could NOT get Psych, Surgery, Peds there and that this would keep me from getting licensed.

That's oversimplified, but there is some truth to it, if the JPH is not Green (I have no idea either way, frankly), and/or if you decided to complete all of your rotations there, even though some of them were not Green.

I don't get it. I just checked out the Wash State Board of Medicine. It doesn't say anything there about clinical rotations, only about "post graduate clinical training" which I understand is a residency.

It's not an issue in every state. It's only SOME states. Again, if you go to the Carib, it would be worth going to a school with all Green clinicals-for-credit. If you go elsewhere, and you only complete a few rotations in the US during vacations, and they are not for credit in your degree program, then it's not going to make any difference at all. What matters is what is counted on your transcript... if it shows up there, make it Green. If not, and you are doing all of your for-credit clinicals overseas, no biggie. (Extra USCE work is extra work, Green, Blue, or otherwise. It probably won't be as good a rotation if it's not Green, reputation-wise, though. Bear that in mind.)

Are you saying that if all I do is a few Green Book approved rotations at Jackson Park Hospital, that might be good enough to be selected for a residency program?

IFF your other clinicals-for-credit are completed overseas, and you do a few at JPH, and JPH is Green? Essentially, yeah. Although it kinda depends on whether you are gunning for primary care or a ROADS specialty, of course. But again, it depends on whether the Green rotations are counted as part of your credits for medical school, or whether you are doing them as additional work because you are a motivated son of a gun.

Is it that a FMG's chances for being selected to be a resident are enhanced if the FMG has the full load of "core Green Book" clinical rotations? That is what it is looking like to me.

That is certainly the case if you are doing all of your clinicals in the US (as is the case with the Carib schools). Since the Carib schools do clinicals at US hospitals (with some exceptions), then they all should be Green to optimize your licensing chances around the country. If you are not doing all rotations in the US, however, then it's another monkey entirely.

What are you doing with respect to clinical rotations DD?

Loaded question. However, I have been contacting places to make my own arrangements with Green programs. No problems so far if you look around enough. One of my classmates just came back from a (very expensive) rotation at a Harvard teaching hospital, which is a lovely shade of Ivy Green.

Does Sophia have relationships with US hospitals?

Hell, no. And don't get me started... I will either started yelling obscenities or crying, neither of which will be pretty. Suffice it to say that the school has been literally gift-wrapped opportunities for US hospital relationships at highly-respected Green university hospital locations, and they have completely screwed the pooch on more than one occasion. It's, um, a sore topic... but trying to get people who grew up in the East Bloc to take initiative is a very frustrating experience. Hey, you can't FORCE people to accept a birthday cake if they are bound and determined to eat a saltine with poop on it, you know?

Are you planning on applying for residencies with all/none of the clinical rotations?

I am applying with none of my OFFICIAL rotations being in the US. This means that they are, by default, accepted. (Except that my school is not California approved, so those states are out. It is what it bloody well is.) The USCE on my applications this Fall will come from vacation-period and/or other clinical experiences/observations in the US. None of them will count toward my medical degree. I hope that makes sense to you... it's a very convoluted issue.

Thanks!

No worries, pallie!

Thanks DD. This seems to have an ironic result: if you're an FMG, you're better off taking all your clinicals at the foreign med school because they won't be rejected at licensing time by a state that requires all Green Book?

Is there a tradeoff because to be attractive to residency programs an FMG would want letters of recommendation from US docs that would be obtained by doing US clinical rotations?


Thanks!

Se

Yes, there is a trade off, because most programs will want to see USCE. That is why the USCE is so important, but you need to keep in mind whether it is for credit from the medical school or not. If it is, you absolutely want Green. If not, it is less of a concern, but still good to go Green. (Remember that there are still docs in residency who didn't have Green rotations, but they are limiting their license options for later somewhat.)

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What are you doing with respect to clinical rotations DD?

Loaded question. However, I have been contacting places to make my own arrangements with Green programs. No problems so far if you look around enough. One of my classmates just came back from a (very expensive) rotation at a Harvard teaching hospital, which is a lovely shade of Ivy Green.

So it IS possible for a med student to make the arrangements with the clinical hospital and you've had success "self-placing" into clinical rotations in the US?

The reason I ask is that my friend, who matched from SABA last year, told me that he didn't think it would be possible for the student to reach out to a clinical hospital to set up a rotation himself. According to him "the hospital doesn't know you from a hole in the wall." It's a factor for me because if I decide to go to FU (Philippines), the total cost is $40K, but they only have selected rotations at Jackson Park. On the other hand, SABA costs $100K, but they assure that I will get 100% US Green Book clinicals which increases likelihood of residency.

Best,
Tom

Originally Posted by lawmed

So it IS possible for a med student to make the arrangements with the clinical hospital and you've had success "self-placing" into clinical rotations in the US?

Yes, it is absolutely possible. Some places are very expensive (Harvard, Brown, etc.) and others are very reasonable. You have to look around, though, because there are a lot of places that will ONLY accept students for a rotation if they have a standing relationship with the foreign school, and others that accept no foreign students at all. In fact, it does seem that a lot of places are starting to move in that direction (not allowing foreign students to complete rotations, or limiting them to observerships), which is disconcerting.

Originally Posted by lawmed

The reason I ask is that my friend, who matched from SABA last year, told me that he didn't think it would be possible for the student to reach out to a clinical hospital to set up a rotation himself. According to him "the hospital doesn't know you from a hole in the wall."

The hospital doesn't know you from a hole in the wall, but that doesn't mean that they will not allow you to rotate there. Again, it is NOT every hospital that will allow this, but it is absolutely possible. You need permission from your medical school, current transcripts, and to be approved by the US hospital. It's not rocket science, but it does require some effort and research on your part.

Originally Posted by lawmed

It's a factor for me because if I decide to go to FU (Philippines), the total cost is $40K, but they only have selected rotations at Jackson Park. On the other hand, SABA costs $100K, but they assure that I will get 100% US Green Book clinicals which increases likelihood of residency.

The 14-year-old in me just loves that you are considering a school called "FU." It really depends on what you are after. SABA would get you integrated the most into US hospitals, and get you more contacts. FU would cost a lot less, and you would need to set up your own rotations with Green sites. It's all doable, but it depends on your cost-benefit analysis of the situation. Frankly, I think you will probably match no matter where you go, with your CV and apparent work ethic.

The hospital doesn't know you from a hole in the wall, but that doesn't mean that they will not allow you to rotate there. Again, it is NOT every hospital that will allow this, but it is absolutely possible. You need permission from your medical school, current transcripts, and to be approved by the US hospital. It's not rocket science, but it does require some effort and research on your part.

This is really where the rubber meets the road DD. Students pay schools like Ross and St. George's $150K+ so that they can get the core rotations at quality hospitals on time. I never understood why someone would pay so much when they could just go to PUMS or Lublin. Now it all becomes clear.

My sister works at a hospital. I talked to her about this today. She says her hosptial has relationships with 3 FMG hosptials, Ross, AUC, and St. Matthews. She says that the schools pay her hospital $400/week per student for the rotation experience. She says they are sort of uncomfortable about it because the students "are not the best". She also said that the students must carry malpractice insurance and that the med schools cover that. She says she doesn't think the hospital would accept a student from a med school that didn't have an affiliation agreement because of the malpractice issue and because of the legal consequences if there was some kind of problem. Is it possible for med students to obtain their own malpractice insurance for a clinical rotation? I may try to open this up for wider discussion. Has the malpractice issue come up in your rotation discussions?

That is why there is an application process, and the hospital can tell you NO. In fact, I dare say that getting the rotation on your own offers the hospital the good opportunity to select the best foreign-trained students to rotate there, as opposed to simply having to accept the students because their school is paying them money. (And again, many hospitals simply will not allow a foreign student to rotate through... in fact, some other hospitals/universities WILL allow it for a foreign medical student who is actually a foreigner, but will NOT allow it for a US citizen studying medicine overseas. Sucks to be a citizen in that regard.)

Yes, malpractice insurance is required, and it is the student's own responsibility to purchase it (if your school has no active role to play in the US rotation, as is the case here at my school). Naturally, this is not a problem if you plan ahead -- hell, students from overseas have been completing clinical rotations for a very long time, there is no need to reinvent the wheel.

The malpractice issue is probably one major reason that some hospitals will now only allow a clinical observation, and not an actual, hands-on, clinical elective. However, there are ABSOLUTELY schools that will allow FMG students to rotate through, even if they are from non-affiliated medical schools. There is no question about that. Will it be the case in ten years' time? I don't know.

However, if you do your research and submit a good CV and application, you will be able to find Green places to rotate. It might be expensive, but if you are studying overseas at a school with non-US electives, you will only be completing a few of them, anyway. Well worth the effort and expense, IMHO, if you need the USCE.