International Issues: My visiting fellowship in the United States

The neurology residency program in Spain includes within its 4 years a 9-month period dedicated to elective rotations.¹ Most residents stay in the same hospital or move to one nearby. Very few choose to go abroad. In fact, some departments do not allow residents to do external rotations, but more often residents themselves are not aware of this opportunity and do not take advantage of it. In my case, I had the opportunity to visit the Neurological Institute of New York and the Columbia University Medical Center of New York–Presbyterian Hospital, which ranks among America's best hospitals.²

Specifically, I spent 3 months in the Division of Stroke and Critical Care, doing what is called a “visiting fellowship,” which consisted of attending and participating in the clinical and scientific activities carried out in the division. Unlike what I expected, it was very easy to get in touch with the faculty of the department and to schedule my months of rotation there. It was as easy as sending a letter with my resume explaining my field of interest.

When I arrived from Spain, I found innumerable differences. The first, and most noticeable one, is the health system, which in Spain is publicly funded and free to everyone who normally lives in Spain, while in the United States it is essentially private. Apart from doctors and nurses, American hospitals use physician assistants, who are health care providers who perform medical tasks and procedures with the supervision, …