Pathway to Practice Medicine in

USA
Emanuel B Kristianto, MD
Board Certified Family Physician
* University of Gadjah Mada, Medical School
1988 - 1995
* University of Southern California, Family
Medicine Residency 2002 - 2005
* Kaiser Permanente, Senior Partner
Physician, 2005 - present
 ECFMG
(Educational Commission Foreign Medical Graduates)
www.ecfmg.org
Foreign medical graduates: 25.9% total US physician

Obtained Medical Degree from World Directory Medical School

Pass examinations within 7 years periods (UGM meets quality, take

prep-course)

USMLE Step 1 Basic Science (Eligible 3rd MS, $1060, Prometric,

Jakarta)

USMLE Step 2 CK (Eligible 3rd MS, $1060, Prometric, Jakarta)

USMLE Step 2 CS (Eligible 3rd MS, $1565, US only, standard pts,

visa letter)

Certified by ECFMG($125 certificate, $250 diploma verification):

eligible for Work-Study Visa & ACGME Residency Programs.
 Work - Study Visa
Special Visa, considered as working while study

Average Resident Salary: $55.300/year

Special Work-StudyVisa:

J-1 Visa: Exchange Visitor, Home Country Sponsored, ECFMG,

Required 2 years home country return, easier to get, Special
Waiver (Work in Public Health or Federal Gov facility.

H-1B Visa: Convertible to Permanent Resident, US Institute

Sponsored (Needy Area), Apply to USCIS, Complicated and
may required Immigration Attorney.
 ACGME Residency Program
www.acgme.org
ECFMG Certified, ObtainVisa, apply to Residency
programs

Residency Program Directory: www.ama-

assn.org/go/freida

Apply electronically www.ecfmg.org/eras

Interview if selected, then proceed with Match program

National Resident Matching Program www.nrmp.org

2018 Matching: 30,323 positions, 29040 filled, 6862

IMG (24%), 1283 unfilled available post match
(scrambling day)
Residency, State Licensing, and
Board Certification
After competed internship (PGY-1): USMLE Step
3 $850

Apply State Medical License: California $1200

Completed Residency: Apply for Board

Certification Examination. ABFM.
www.theabfm.org. $1250

Start working as practicing licensed physician

 Physician Stats
Active physician USA 2018: 968,743

Primary physician: 48% (467,447) / Specialist (52%): 501,296

Solo Practice 19%, Group Practice 39%, Employee 42%

There are 29.4 physician for every 10,000 population

Primary care: 3500 patients/year (18 patients/d), Specialist 2700

patients/year (12 patients/d)

Expenditure for physician and clinical care services 2017: US$698

billion

Average Annual Salary: Primary care $223,000, Specialist $329,000

Average time spend per patient visit: 13-24 minutes

 Healthcare USA
Healthcare provider: Physician, and Hospital

Healthcare Payor:

Private Health Insurance

Employer sponsored Health Insurance

Government sponsored Health Insurance

Medicaid: Low income health insurance

Medicare: All retiree 65 years older, or disabled

 Healthcare
Reimbursement
Fee for service: Perform service, bill insurance,
payment

Capitation: Payment per capita contracted

New trend: Integrated Health Maintenance Institution

Physicians forming group, own hospital, clinic and

ancillary service and function as Health Insurance

Preventive and primary care based

Pioneer: Kaiser Permanente (www.kp.org)

 Kaiser Permanente
www.kp.org
Founded 1945 by Henry Kaiser and Sidney Garfield,
MD

39 hospitals, 684 clinics, 22,013 physician, 12,200,000

patients members.

Profitable when serious disease is prevented at early

phase with healthy life style promotion, progressive
chronic disease management, and cancer screenings

Physician become partner after 3 years, base salary,

healthy panel management bonus, and profit sharing
distributable
 Thank you
Health System Lecture
International Medical School Program

Universitas Gadjah Mada

October 4, 2018