Foreign Residency Experience

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Larry Demco, MD: "I'm Dr. Demco from Calgary, Canada here at the AAGL Conference in San Francisco, and we have a unique opportunity to talk to a resident, Dr. Einarsson, who is originally from Iceland and who's here in the United States training at Baylor College. It's a dichotomy that a lot of us are in that you're from one country and you're trying to learn medicine in another country. Tell me some of the concerns and problems you've experienced."

Jon Einarsson, MD: "First of all, I come from a very small country; only 270,000 people live there so most doctors that graduate from there want to go abroad to get a little bit more of a broader experience for their training so most of Iceland's doctors go either to the United States or to Europe for their training. When you're going to the United States there is a big difference between the way medicine is practiced here and the way it's practiced in Europe. It's a socialist system and the residency training programs there are really not training programs, you're basically hired to work and as you work you get experience and eventually feel competent attending so that appealed to me. I think the most surprising thing or the most different thing that I encountered here was the amount of paperwork and red tape that you have to go through to take care of your patients. It's more here than in Europe, and I thought it was a lot there but it's actually more here."

Larry Demco, MD: "Tell us a little bit about the paperwork that you actually had to go through." 

Jon Einarsson, MD: "There's paperwork as far as just to start your residency then paperwork while you're doing your residency, i.e. in hospitals. But for foreign medical graduates, obviously, it's difficult for American programs to know the quality of medical school that you came from. They don't know what it means to graduate from Iceland or from many other countries in the world so everybody has to take these standardized tests that they have to pass. I think some programs in the United States are hesitant in hiring foreign medical graduates because some of them feel that it reflects poorly upon their program if they have a lot of foreign medical graduates. I'm fortunate, at Baylor they take a different approach and they feel that foreign medical graduates actually compliment their program so they usually take on at least one or two a year there in the OB-GYN department."

Larry Demco, MD: "With the number of people that are foreign graduates that come to be trained here in the United States, what percentage do you think stay and what percentage go back home and bring the technology of America back to their homeland, like Iceland?"

Jon Einarsson, MD: "I know for a fact that probably over 90% of Icelandic doctors will return back to Iceland for a variety of reasons. Part of it is you have strong roots there; it's a very close-knit society because it's so small, and people just they want to go back. The working environment in Iceland is pretty good even though it's socialized medicine, and you do have all the resources that you need there. The pay obviously is not as good as it is here in the states but there are other benefits to it so I think most of them will go back but there are obviously other people that don't have the same living conditions where they come from so they have a higher incentive to try to stay."

Larry Demco, MD: "One of the difficulties even I have from Canada is that you train here with the various instruments and they may not be available in your own country to operate with. Would you like to comment on that?"

Jon Einarsson, MD: "I definitely think the resources here are greater especially in the larger medical centers that have all the toys that you want and more. That's definitely one of the reasons why I wanted to come here because you're kind of at the cutting edge; you're seeing the latest things and you're working with very, very experienced people and that's very valuable experience."

Larry Demco, MD: "Do you think the level of care for the people in Iceland will go up with you returning, and do you think you'll share the expertise that you've learned here with the other colleagues?"

Jon Einarsson, MD: "Yes, definitely, most of the departments in Iceland have people that have trained in different countries. Some of them are trained here, and some of them trained in Scandinavia, England, or other countries in Europe so you get a lot of different kinds of ideas and approaches to things. There is a lot of interaction, a lot of sharing of ideas, and you see a lot of different approaches too."

Larry Demco, MD: "What advice would you have for the residents who might be looking in on this interview to help or guide them in their pursuit in trying to come to the United States for their training?"

Jon Einarsson, MD: "I've actually been helping, I'm now a senior resident at Baylor, and I've been kind of looking at the applications with the faculty trying to determine who to invite and who not to invite for an interview. I was surprised that the scores from the USMLE tests are actually quite important, I guess they're not the only thing, obviously, but they are important because that's like a standardized way of seeing where you're at in your knowledge. So I think that would be one thing and another thing would be to try to come to the United States maybe for a month or two and work with faculty that are known in that field, do well, and get a letter of recommendation from them. I think those two things are probably the most important things in your application that most people look at but obviously it's the overall thing and if you have a lot of research background, for example publications, that definitely can help you too."

Larry Demco, MD: "That's true, I brought one of my residents from Canada here to a meeting and introduced him to a number of the faculty so when his name came up they would have a face with the name. With things like this you benefit and I think this is a reason that residents should come to the annual meeting, meet the people here, and get their names. A face with the name really comes to play big time when they're looking over a list of people to say who they should accept for interviews. I think with my residents we found it very successful, and I think we should encourage our residents and give them support to come to these meetings for that purpose. I'd like to thank you very much for your interview and best of luck in your continued residency. I hope to come to Iceland someday."

Jon Einarsson, MD: "Thank you very much."