From International Student to Physician Assistant

From International Student to Physician Assistant

Updated: 07/08/2016

You may be an international medical graduate (IMG), a caribbean medical student, or a student from a foreign country (outside the United States) wanting to attend physician assistant (PA) school. While it may seem daunting at first, do not be frightened by the lengthy application process or by the worrisome anecdotal stories you may read about online.

You will need to prepare your materials before throwing an application together. Many international students and international medical graduates see medical school residency matching as a barrier to becoming a licensed provider in the United States, which is why they choose to become physician assistants.

Physician assistants can still practice medicine, but they are not required to complete a residency, which may be very difficult to acquire when there is already such a shortage. In today’s society, many IMGs do not have the upper hand in residency matching over U.S. candidates. In 2007, the National Resident Matching Program (NRMP) published data on “who gets residencies.” Only 25% of residencies went to Non-US Citizens and Graduates of International Schools. IMG compete with American medical students (4th year students) and many students from India who place scores for USMLE step 1 and 2 in the 99th percentile. In 2012, 48,507 students applied for match in the U.S. and 24,034 residencies were available. 65.4% of those 24,034 residencies went to American graduates. Many reasons why IMG do not get accepted to U.S. residencies include: unexplained gaps in training or gaps between graduation and time of application, incomplete USMLE steps or low scores on USMLE exams.

If this is why you want to become a physician assistant, I highly advise you to consider other routes or careers. This is not what the PA profession is for - it is not “easier” to get into PA school or a considered a “cop-out.” If you have heard this, you were told incorrectly. The Medical Society of the State of New York offers guidance for IMGs to obtain residency in New York State. In addition, NYIT College of Osteopathic Medicine offers a bridge program for IMG to become doctors of osteopathic medicine called Emigre Physician Program (EPP).

PA programs can be just as competitive as U.S. medical schools. If you are truly interested in becoming a PA and understand the role of a PA, then I invite you to bring your knowledge and experience to the profession. The journey to becoming a PA is also not an easy one. You will be competing with thousands of other U.S. pre-PA applicants with a plethora of knowledge, volunteer work, patient care, and shadowing experience from all over. It’s no wonder it is so difficult for international students to gain acceptance to PA programs! PA programs have to ensure that you are in it for the right reasons and that you truly understand what becoming a PA is all about. Make sure you do your homework and know exactly what you are getting yourself into before you commit.

Most Frequently Asked Questions:

I am a foreign medical graduate. What are the first steps I need to take to become a PA in the U.S.?

Please visit AAPA’s website on Becoming a PA.

I am a foreign medical graduate. Can I get a PA license with my medical degree?
Answer: No. Texas, and every other state law, requires graduation from an accredited PA program for eligibility.

Medical school is much more difficult than PA school, so why can’t I (the unmatched MD) practice as a PA even though I didn’t pass my USMLE?
PACdan put this in great words “because you did not go to school for it.” The "difficulty" of the PANCE vs. the USMLE is not the concern, rather it is the eligibility to take the exam and practice as a PA. The eligibility to take the PANCE requires one to graduate from an accredited PA program. What if PA graduates took the material they were missing from medical school (about one year's worth) and the USMLEs and did well, should they be allowed to gain residency and practice as a physician? Everything is equal at that point. If your answer is no; then the reverse should also be no. There are training modalities unique to PA programs that prepare one to be a PA, and not a physician; the reverse holds true as well.

Do I have any advantage since I am already a physician in my home country?

No. Holding a foreign medical degree does not give you any advantage when applying to PA schools no matter how long you have practiced.

I am a foreign medical graduate - what are my chances of getting accepted to a U.S. PA program?

As an international medical graduate, you must realize that you are competing against thousands of qualified U.S. pre-PA students with hundreds to thousands of hours of clinical experience obtained within the United States and abroad. In addition, they have U.S. coursework, excellent GRE scores, and outstanding volunteer and shadowing experience as well. If a PA program is going to accept you, you will need to demonstrate to them that you are worthy of a spot in their program just like everyone else. You do not get an upper hand just because you graduated from a medical school in another country. If a PA program is going to train you to become a licensed physician assistant, they need to make sure you will actually become a PA and not utilize their program’s training to take the USMLE exams to help you obtain a residency. If you think for one second that any PA program hasn’t already considered you might be doing this - you are highly mistaken. Almost all PA programs require interviews so that they can determine your intentions and decide if you truly understand the role of a physician assistant and that you have true aspirations to become one.

I am a foreign medical graduate. How can I calculate my GPA from my “scores” since we do not receive letter grades in my country? Will my credit hours be accepted in the U.S.?

Answer: The best answer to this question is - it varies. The PA program’s you plan to apply to will have to evaluate your coursework on an individual basis. Most programs will probably consider your coursework as “electives” since they were not taken within the U.S. For example, Texas requires academic work taken at foreign colleges/universities, or preparatory schools to be excluded from GPA calculations for admission to graduate or post-baccalaureate professional school. However, undergraduate foreign coursework that appears as transfer credit on the transcript of a regionally accredited U.S. college will count toward GPA. Lump sum credit with no specific course or hour identification will not be accepted. Foreign coursework will generally not count toward satisfying any of the required courses/pre-requisites for PA school. A baccalaureate degree is sometimes required for admission and must be from an accredited U.S. or Canadian institution.

Please consult CASPA via their Instructions and FAQ. If you still cannot find answers to your question, call CASPA (617-612-2080) or email caspainfo@caspaonline.org for more information.

How long are my TOEFL scores good for?

Generally, 2 years.

I completed my foreign medical degree clinical hours (year 3 or 4) in the United States. Can I count these as direct patient care experience?

Probably not. But you should check with the PA programs you plan to apply to to make sure. Clerkship hours are probably a better route for healthcare experience hours.

PA schools require healthcare experience - how can I get healthcare experience as a foreign medical graduate?

Clerkships and observerships seem to be better routes for IMG. They consist of a didactic and clinical phase and are prevalent in places like Chicago and New York. However, they may require visas. Visit the International Affairs website for UT Southwestern for more information.

Do PA programs “waive” any of the prerequisite requirements or didactic coursework since I hold a foreign medical degree?

No. I think it is safe to say that nearly all PA programs require you to complete the rpogram in its entirety.

I do not have permanent residency in the U.S. Will this be a problem in PA school?
Some of the factors that could help decide on applying to a particular state are the visa requirements of some medical boards or other requirements like fingerprinting or direct verification of credentials, which usually take a lot of time. The State Medical Board typically issues an unrestricted license to practice medicine only to U.S. citizens and permanent residents. Applicants on non-immigrant visas can only apply for limited license to practice medicine and only in qualified medically underserved areas/health professional shortage areas.

Are there any PA programs known to accept more foreign medical graduates more than others?

University of Washington MEDEX PA Program.

Wayne State University.

How can I obtain a F-1 (Student) Visa?

Getting accepted to a U.S. accredited PA program will help to kickstart the process of getting your F-1 Visa, which is also known as the “student” Visa. This will allow you to study in a PA program, but will not allow you to work. It is good for 4 years.

• Once accepted, get in contact with your financial advisor, financial services department, international department, or registrar at the school you are applying to. These people will help you figure out where you need to send your Visa information.
• Obtain all required documents needed yourself. This may include transcripts or other forms. Do not expect the international department to do everything for you.
• Figure out if your country of residence offers student loans through the government or state/providence. For example, Canada offers student loans and provincial student loans.
• Find your own private loans as soon as you can. Remember, as an international student on a F-1 visa, you are required to pay tuition yourself and are not allowed to apply for financial aid (FAFSA). Banks are a good source for loans.

Are there other ways around the F-1 Visa?

Yes, you can get married to a U.S. Citizen and obtain a green card (for permanent residency)

• MAVNI (Military Accessions Vital to the National Interest) - allows legal non citizens with in demand skills to joint the Army in exchange for expedited US citizenship; move from non immigrant Visa or asylee/refugee/temporary protected status directly to citizenship, especially if you speak more than one language
• Must legally reside in the US more than 2 years prior to joining the Army

• Optional Practical Training (OPT) visas are used as “visa extenders” for students. With this visa, you are able to find job placement up to 12 months after graduating from a PA program and are less expensive than a H1-B visa.
• If the student chooses to engage in pre-completion OPT, he or she may not work more than 20 hours per week while school is in session, but may work full-time during his or her annual vacation and other times when the school is not in session. If a student engages in pre-completion OPT, the student’s eligible period of  post-completion OPT will be reduced by 1 month for every 2 months of part-time pre-completion OPT that is worked when he or she graduates
• STEM Extensions: may extend your OPT 17-24 months if you graduate with a qualified Science, Technology, Engineering or Mathematics (STEM) degree, and are currently in an approved post-completion OPT period
• Canadian and Mexican citizens are able to enter the U.S. temporarily for professional business activities on a TN visa as part of the North American Free Trade Agreement (NAFTA) - however, a PA is not considered a “specialty occupation” under this visa. Thus, PAs would not be eligible for a TN visa.
• The H1-B Visa is usually required for employment in the US as a PA upon graduation. PAs are considered a specialty occupation for this type of visa. For more information, visit the U.S. Citizenship and Immigration Services website. For simple information regarding the different types of visas available, visit the International Affairs website for UT Southwestern.

What are the difficulties in obtaining a H1-B Visa?

• Timing is everything. There is a quota each year for the number of H1-B Visas that are given. The quota periods begin in April and end in October of the same year. You will need to be a competitive applicant for one of these visas as “spots” are known to be filled within weeks of opening dates of the application. You generally file for a H1-B visa in April and your “start” date of employment will be in October of that year. This may not go over well with an employer who wants to hire sooner.
• Cost. Costs affiliated with H1-B visas can be in the thousands. Employers may require you to cover these costs.
• Finding an Employer. Certain employers, such as non-profits and teaching hospitals affiliated with universities, are H1-B quota exempt. This means you are able to apply for a H1-B visa quickly with a start date that is not subject to quota caps.

Are there ways to help me obtain my H1-B Visa?

Yes. Become a competitive candidate while in PA school. Hire a legal representative or immigration lawyer, such as those at VisaPro. Pay the $1,000 premium to expedite processing to get your visa within 2 weeks of sending in your application.

I was accepted to a U.S. PA program, but I do not know the first steps for coming to the United States. What should I do first?

Visit the International Affairs website for UT Southwestern for information. The left hand side of the page has links for what to do before you arrive, bringing your family, day care and school information, ELS courses, finances, and tips for life in the U.S.

CASPA as an International PA Student

Below is some information CASPA asks you about that may be important if you are an international applicant or medical graduate. I have listed this particular information to draw your attention to these fields when filling out your CASPA application. Probably of most importance is the text in red, which I think most students will find helpful to know well in advance before applying.

• Materials Under Another Name - If you are sending any documentation to CASPA where your name is listed differently than it appears on your application, you MUST COMPLETE THIS SECTION . Failure to complete this section can prevent important documents from being matched to your application.
• Examples: maiden names, nicknames, “westernized names” which many international applicants may have, alternate punctuation (your name has an apostrophe or hyphen in it), alternate spacing (your name has 1 or 2 spaces, etc.), known misspellings (if a document contains a misspelling, ex. Gonzales and Gonzalez)
• Demographic Information
• Citizenship status - Select your status as a U.S. citizen, temporary resident, permanent resident, or non-resident. If you are a temporary resident please indicate your Visa status.
• Languages - Physician Assistant students interact with patients from many backgrounds. Indicate any language(s) other than English in which you feel comfortable conversing.
• Residency Claim - Select the U.S. state and list the county in which you currently claim residency.
• Birth Information - Enter your birth date, in the format MM/DD/YYYY. For example, “01” would be listed for the month of January. Also indicate the state/Canadian province, county, and country of your birth. If you were born outside of the U.S./Canada, please select “No State.”
• Secondary (high school) Data - Enter the name of the high school you graduated from and the city where it was located. Select the appropriate state or Canadian province and your year of graduation from the drop-down menu. If you attended high school outside of the U.S./Canada, please select “No State.” If you did not graduate from high school and instead passed the GED exam, please input “GED” for the high school name and the city where you sat for the exam.
• Ethnicity, Race, and Background - Physician Assistant programs fully recognize the importance of diversity in their student body and in the physician assistant workforce. Accordingly, programs strongly encourage applications from persons from all socioeconomic, racial, ethnic, religious, and educational backgrounds and persons from groups underrepresented in health care. Please select any and all of the options in this section which you feel best apply to you. Please note that this section is used for statistical purposes only.
• Academic History
• Institutions Attended
• U.S. State or Canadian Territory Schools - Click on the state or territory in which the school is located to select the college from our database. If your school is NOT listed, select “NOT LISTED US INSTITUTION” or “NOT LISTED CANADIAN INSTITUTION.” Note: French-speaking Canadian schools must be reported as a foreign institution.
• Foreign Schools - Select “NON-US/CANADIAN (FOREIGN) INSTITUTION.”
• Caribbean Medical School Students - ALL Caribbean medical schools, including but not limited to Ross University, American University of Antigua, and St. Matthew’s School of Medicine, are considered FOREIGN institutions. There is no Caribbean Medical School which has U.S. regional accreditation, even if the school has offices in the U.S. and graduates may become licensed in the U.S.  Please read the “FOREIGN OR FRENCH CANADIAN TRANSCRIPTS” section of our FAQ and follow those instructions for reporting your coursework.
• CASPA Coursework Entry Service - CASPA now offers all applicants the option to have coursework professionally entered on their behalf by their specialists for an additional fee. CASPA coursework entry staff is available to enter U.S. undergraduate, graduate, post-baccalaureate, and doctorate coursework. Given the nature of professional, non-U.S./foreign, and planned/in-progress coursework, this work is not eligible for coursework entry and must be entered by the applicant.
• Once your coursework entry is complete, you will receive a notification. It is your responsibility to review the coursework entry for accuracy and approve the entry. If you find any issues with your coursework entry, please submit the issues in writing to the CASPA  email address: caspainfo@caspaonline.org. Wait for corrections to be approved and made before approving your coursework entry. Once you have approved the coursework entry, complete and submit your application. Your application will continue with normal verification.
• Transcripts
• U.S. AND ENGLISH CANADIAN TRANSCRIPTS ARE REQUIRED to be sent to CASPA from all institutions you received college-level credit from, including credits earned as a high school student or those transferred to other institutions. CASPA cannot process your application without receiving all of your transcripts.
• DO NOT SEND FOREIGN OR FRENCH CANADIAN TRANSCRIPTS. CASPA will NOT accept these documents and they will be destroyed. Please see the “Foreign and French Canadian Transcripts” section of our instructions for how to document foreign or French Canadian work.
• DO NOT SEND FOREIGN TRANSCRIPTS. CASPA does NOT accept ANY foreign transcripts, including those printed in English. Do NOT send foreign transcripts to CASPA, as they will be discarded.
• DO  NOT SEND TRANSLATED FOREIGN TRANSCRIPTS. CASPA does NOT accept foreign documents translated into English as this documentation is insufficient. Only an evaluation for U.S. equivalency will be accepted.
• Canadian Students - Canadian schools that provide English transcripts are NOT considered foreign. Please see the U.S./Canadian Transcripts section for how to report your work. Original transcripts from these schools must be sent to CASPA, even if your PA program does not accept Canadian transcripts. CASPA will NOT accept foreign evaluations from Canadian schools WHICH PROVIDE TRANSCRIPTS IN ENGLISH.
• Canadian schools which have transcripts issued in French are considered FOREIGN and must be reported like any other foreign school. Evaluations for these schools should be sent to CASPA. CASPA will NOT accept original Canadian transcripts which are written in French.
• Caribbean Medical School Students - ALL Caribbean medical schools  are considered FOREIGN institutions, even if they have offices in the U.S. or allow U.S. licensing. No Caribbean school has regional U.S. accreditation and cannot be considered a U.S. Institution. Common Caribbean medical schools include but are not limited to: Ross University, St. Matthew’s School of Medicine, and the American University of Antigua. Please list your Caribbean Medical School as a foreign institution and do NOT send Caribbean Medical School transcripts to CASPA as they will be discarded.  You should instead determine if your PA programs will require a foreign evaluation, which may be sent to CASPA, or if your PA programs will accept the original Caribbean transcript mailed directly to the PA program.
• How to Document Foreign Coursework - If you attended a foreign school or earned your degree outside of the United States, CASPA does not require any documentation, but most PA programs DO. The majority of PA programs require that you have your foreign coursework submitted to an evaluation service for a course-by-course U.S. equivalency report.  This report should then be sent to CASPA directly from the evaluation service. Contact the foreign transcript evaluation service as early as possible. The services may take several weeks to process your foreign transcript once it is received.
• International Education Research Foundation (IERF)
• International Education Evaluations, Inc.
• World Education Services
• Josef Silny & Associates Inc.
• Educational Credential Evaluators
• SpanTran Evaluation Services
• Education Evaluators International
• Foreign Credentials Service of America
• Center for Educational Documentation
• Foreign Coursework Evaluation Service - Below is a list of the most common services used by CASPA applicants for the translation and review of foreign transcripts. Please note that this list is not all-inclusive and CASPA does not recommend or endorse any particular service. You should check with your designated programs for final approval on which service you should use as it may be different than those on this list.

• CASPA will send your course evaluation to the schools that you have designated. Please note that if you have ONLY foreign coursework, there will be no GPA calculated.
• Under no circumstances can CASPA forward your foreign transcript to a third party, including returning it to you if you sent it to them accidentally. Any foreign transcripts received by CASPA will be discarded.
• Official TOEFL Scores - Official TOEFL Scores should be mailed to CASPA in paper format. They must be original copies of the test and sent to CASPA directly from ETS. CASPA can NOT accept photocopied, faxed, or electronic TOEFL scores. If you are unsure what the TOEFL is about, please visit the website for more information: http://www.ets.org/toefl
• Please mail all official TOEFL scores to:

CASPA TOEFL SCORES

P.O. Box 9108

Watertown, MA 02471

• CASPA does not hold applications awaiting your TOEFL scores. Once these scores are received, your schools can view them online. Please note that the programs to which you are applying may want these scores by a certain date. You should make sure these are received by any deadline provided by the PA programs themselves.

Important Tips for International PA Students

1. Retake Prerequisite Coursework in the United States. Retaking coursework in the U.S. can actually help you as an international student. Some PA programs may consider you as a U.S. applicant instead of an international applicant if you have completed enough U.S. coursework. This can help your chances of acceptance and enhance your knowledge prior to matriculation.
2. Very Few Spots Are Available to International Students. Typically only 1-2 spots per PA program are offered to international students. This means that you have to be well-rounded and very competitive in all aspects of your application to be considered. The number might also depend on class size of the PA program.  
3. 131 PA programs Currently Accept International Applicants. According to the PAEA Program Directory, 131 U.S. PA programs nationwide will accept international students. This number will continue to grow, so your chances are exceedingly better year after year.
4. Your Type of Visa Matters. No, not your credit card. While in school you will most likely have an F-1 Visa and PA programs realize that you may not be able to work right after completion of your PA program. When you graduate from your program, you have 60 days to secure employment while on a F-1 visa. Many students find employers willing to hire them while on rotations and the employer will often initiate the H1-B visa process for you. If this does not work for you, you can still apply for the Optional Practical Training (OPT) visa 90 days prior to your graduation date and up to 60 days after. If you receive the OPT visa, you have a 12 month extension on your F-1 visa to secure a job to sponsor you with a H1-B visa. With an H1-B visa, you may apply for permanent residency. Many students find it difficult to find employers willing to sponsor them for a H1-B (working) visa and others report that many PAs must commit to working in underserved areas since employers “have to prove they are unable to hire a suitable American candidate.” This may be very difficult or very simple depending on how qualified the other applicants are for the position you apply for. This is a risk some PA programs are not willing to take and will not undergo training of an international applicant who will not potentially be able to provide medical care like a U.S. citizen would. The H1-B visa is employer specific and you must apply for a new one if you switch employers. Some students are also on H-visas, temporary work visas, prior to beginning PA school to acquire health care experience.
5. Work Permits Are Not Needed For Rotations. Since you do not receive any payment or salary/compensation during PA rotations like medical students do, no visa or permit is required during the PA clinical year(s).
6. You May Not Apply to FAFSA with a F-1 Visa. Students on a F-1 visa are required to pay the school the full cost of education by repaying the school system for the full, unsubsidized, per capita cost of providing the education to him or her.
7. Your Attitude Matters. When applying to PA school it is important to realize that you will most likely interview with your program of choice, granted you are offered an interview. Thinking that you are in some way above every other applicant because you hold a medical degree from another country is not the attitude you want to portray in your interview. You need to be humble and understand why you want to become a PA and realize that you are an applicant just like anyone else.

Sources:

http://travel.state.gov/content/visas/english/study-exchange.html

Instructions and FAQ

http://www.physicianassistantforum.com/index.php?/topic/13614-out-of-state-unfriendly/

http://www.physicianassistantforum.com/index.php?/topic/14403-is-pa-a-good-idea-for-an-international-medical-graduate/?hl=international

http://www.physicianassistantforum.com/index.php?/topic/15958-any-international-medical-graduates-applying-this-year/?hl=international

http://www.physicianassistantforum.com/index.php?/topic/12943-international-graduate/?hl=international

http://www.physicianassistantforum.com/index.php?/topic/1521-pa-student-with-no-citizenship/?hl=visa

http://www.utsouthwestern.edu/education/school-of-health-professions/programs/masters-programs/physician-assistant-studies/admissions/international-students.html

http://www.physicianassistantforum.com/index.php?/topic/12903-foreign-medical-graduate/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/12903-foreign-medical-graduate/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/15132-new-to-pa-foreign-medical-graduate/?hl=%2Bforeign+%2Bmedical

http://www.slideshare.net/fbomide/being-a-foreign-medical-graduate-in-us

http://www.acponline.org/about_acp/international/graduates/practicing_in_us/rizvon.htm

http://www.utsouthwestern.edu/education/school-of-health-professions/programs/masters-programs/physician-assistant-studies/admissions/international-students.html

http://www.physicianassistantforum.com/index.php?/topic/10696-fmg-immigrating-to-usa-pa-queries/?hl=%2Bforeign+%2Bmedical#entry143856

http://www.physicianassistantforum.com/index.php?/topic/8817-how-to-apply-being-foreign-medical-graduate/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/8652-i-have-a-foreign-bachelors-degree/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/5064-foreign-medical-student-em-placement-opportunities/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/7627-any-canadian-citizens-in-a-us-pa-programgraduatedpracticing/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/8174-canadian-friendly-pa-schools/?hl=visa#entry106413

http://www.physicianassistantforum.com/index.php?/topic/10780-list-of-foreign-medical-graduate-friendly-pa-schools-for-master-physician-program/?hl=%2Bforeign+%2Bmedical

http://www.physicianassistantforum.com/index.php?/topic/9285-any-pas-practicing-on-a-work-visa/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/4483-international-f1-student-h-1-visa/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/1565-h1b-visa-for-a-pa/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/480-any-physician-assistant-on-a-h1-visa/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/437-anyone-know-any-pas-working-on-an-h-1-visa-worker-visa/?hl=visa

http://www.physicianassistantforum.com/index.php?/topic/437-anyone-know-any-pas-working-on-an-h-1-visa-worker-visa/?hl=visa

http://www.uscis.gov

http://www.cgfns.org

https://www.uscis.gov/eir/visa-guide/f-1-opt-optional-practical-training/understanding-f-1-opt-requirements