Essential Questions for Non-US Citizen IMGs in Addiction Medicine Residencies

Why Your Questions Matter as a Non‑US Citizen IMG in Addiction Medicine

As a non-US citizen IMG (international medical graduate) pursuing addiction medicine, the questions you ask programs are as important as the answers you give. For foreign national medical graduates, the stakes are higher: you must align training quality, visa feasibility, long‑term career goals, and your personal safety and stability in a new country.

Thoughtful, well‑researched questions:

• Show you understand addiction medicine as a complex, evolving field
• Demonstrate maturity about immigration, licensure, and long‑term planning
• Help you avoid surprises about visas, salary, call, supervision, or scope of practice
• Let you compare programs beyond their websites and brochures

This guide gives you concrete, specific questions to ask programs—including what to ask the program director, faculty, fellows, and coordinators—tailored to a non-US citizen IMG interested in addiction medicine fellowship or addiction‑focused residency training.

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1. Strategy First: How to Prepare Your Questions

Before you list questions, you need a strategy. You will get limited interview time and multiple stakeholders (program director, faculty, current fellows, coordinator). Plan different questions for each group.

Clarify Your Priorities as a Non‑US Citizen IMG

Make a quick list of your top 5 priorities. For most foreign national medical graduates, these often include:

1. Visa sponsorship and stability (J-1 vs H-1B, chances of renewals, institutional policy)
2. Substance abuse training depth (inpatient, outpatient, methadone, buprenorphine, harm reduction, co-occurring psych)
3. Supervision and independence (how much you actually do, especially if you have prior experience abroad)
4. Board eligibility and licensure (ABPM/ABPN pathways, state-specific rules for IMGs)
5. Long‑term career and immigration (job prospects, academic vs community, research experience)

Use these priorities to choose which interview questions for them matter the most to you.

Organize Questions by Audience

You will not ask everything to everyone. Organize like this:

• Program Director: Vision, training quality, outcomes, institutional support, visas, policy
• Current Fellows/Residents: Real culture, workload, call, how the program treats IMGs and non‑US citizens
• Faculty / Core Teaching Staff: Education quality, supervision, research, subspecialty exposures
• Program Coordinator / GME Office: Visa process details, onboarding logistics, contracts, benefits

Have a written list, but don’t read it word-for-word. Select 4–6 strong questions for each person you meet.

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2. Essential Questions About Program Structure & Addiction Medicine Training

As someone targeting addiction medicine fellowship or addiction‑focused residency pathways, you must understand the substance abuse training you will actually receive.

Core Questions About Training Scope

Ask the program director or key faculty:

1. “How is addiction medicine integrated into your curriculum across the year?”

   • Follow‑up: “What percentage of my clinical time would be directly in addiction-related settings?”

2. “What types of addiction treatment settings will I work in?”
   Try to confirm exposure to:

   • Inpatient consultation-liaison for substance use disorders
   • Outpatient addiction clinics (hospital-based and/or community)
   • Opioid treatment programs (methadone clinics)
   • Office-based opioid treatment (buprenorphine, naltrexone)
   • Detox units (inpatient withdrawal management)
   • Dual-diagnosis or co-occurring psychiatric and substance use clinics

3. “What kinds of substances and patient populations do fellows/residents most commonly see here?”

   • Useful to see whether the program’s predominant focus is opioids, alcohol, stimulants, or a broad mix
   • Ask: “Do we see adolescents, pregnant patients, or justice-involved populations?”

4. “How do you teach evidence-based treatments for substance use disorders?”

   • Medication-assisted treatment (MAT/MOUD)
   • Motivational interviewing, CBT, contingency management
   • Harm reduction strategies (naloxone distribution, syringe services programs)

Questions About Clinical Autonomy & Supervision

As a non‑US citizen IMG, you may already have robust experience abroad. You want a program that will respect this while ensuring you practice safely under US norms.

Ask:

5. “What level of clinical autonomy do fellows have in managing complex addiction cases?”

   • Follow‑up: “How does autonomy increase over the year?”

6. “How are new international graduates oriented to US clinical, documentation, and prescribing systems?”

   • This is especially important if you are unfamiliar with US EMR, DEA regulations, or state PDMPs.

7. “Do fellows/residents get their own panel of patients they follow longitudinally?”

   • Longitudinal addiction care experience is critical for learning relapse prevention and chronic disease management.

Questions About Didactics & Interdisciplinary Learning

Addiction medicine thrives on interdisciplinary care: psychiatry, internal medicine, family medicine, social work, pharmacy, nursing, and legal/public health.

Ask:

8. “What structured didactics or case conferences do you have specifically for addiction medicine?”

   • Journal clubs, case discussions, morbidity and mortality, ethics rounds
   • Involvement in state or regional addiction medicine ECHO programs

9. “How do fellows interact with other disciplines—psych, internal medicine, emergency medicine, social work, peer recovery coaches?”

   • Programs with strong interdisciplinary integration usually provide richer learning and networking.

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3. Visa, Sponsorship, and IMG-Specific Questions You Must Ask

For a non-US citizen IMG or foreign national medical graduate, immigration realities can determine whether a program is even feasible. You should never assume that a program “probably supports visas.” Confirm explicitly.

Critical Visa Questions for the Program Director or Coordinator

1. “Which visas do you currently sponsor for trainees in this program (e.g., J-1, H-1B)?”

   • Clarify: “Has this changed in the last few years?”
     Programs can change policy when hospital leadership or legal guidance changes.

2. “Have you had non-US citizen IMGs in the program in the last 3–5 years? On what visas?”

   • Follow‑up: “Is there any difference in how you structure training or scheduling for IMGs?”

3. “If you sponsor H-1B, do you support both initial H-1B petitions and extensions if needed?”

   • And: “Do you allow moonlighting on H-1B (if state law and institutional policies allow)?”

4. “Is the institution’s GME office experienced in working with foreign national medical graduates?”

   • You want to know if they understand ECFMG pathways, DS‑2019 issuance, and timelines.

5. “Are there any institutional caps or limits on how many J-1 or H-1B trainees you can have at once?”

   • This matters if they say “we support H-1B” but rarely actually file them.

Questions About Timing, Licensing, and Exams

For many non-US citizen IMGs, logistical problems arise around exam timing, ECFMG certification, and state licensure.

Ask the coordinator or director:

6. “What are your deadlines for ECFMG certification and required USMLE/COMLEX scores to finalize a contract?”

7. “For this state, what are the main license or training permit requirements for international graduates?”

   • Some states require a specific number of USMLE attempts, specific score thresholds, or certain number of years of training.

8. “Have you had any recent fellows/residents whose start date was delayed because of visa or licensing issues? How did the program handle that?”

This tells you if they are realistic and flexible or if they might cut you from the program if paperwork is delayed.

Long‑Term Immigration and Career Trajectory Questions

Addiction medicine often leads to public sector, academic, or community-based positions. For a non‑US citizen IMG, post-training visa options (J-1 waiver, H-1B sponsorship, O-1) are crucial.

Ask (usually to the program director or a senior mentor):

9. “Where have your recent non-US citizen graduates gone after training—in terms of both jobs and visa pathways?”

   • Did they get J‑1 waivers in underserved areas?
   • Did any transition from J‑1 to academic H-1B?

10. “Do faculty here help fellows explore J-1 waiver options or academic positions that can sponsor H-1B?”

You are not asking them to guarantee sponsorship; you are learning whether they are familiar and supportive.

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4. Questions to Ask About Culture, Support, and Career Development

The “hidden curriculum” of a program—how people really behave, how IMGs are treated, how addiction work is valued—may matter more than official brochures.

What to Ask Current Fellows/Residents

These peers will give you the most honest answers. Use your time with them wisely.

1. “How supportive is the program of non-US citizen IMGs? Do you feel there is any difference in how IMGs are treated?”

2. “Has anyone had visa or licensing issues while here? How did the program respond?”

   • You want to hear, “They worked with the GME office and found solutions,” not “They blamed the trainee.”

3. “What is the real workload like in addiction rotations?”
   Ask specifics:

   • Average number of consults or patients per day
   • Documentation burden
   • After-hours call frequency
   • Backup support when cases are overwhelming (complex withdrawal, suicidality, homelessness)

4. “Do you feel emotionally supported in handling difficult addiction cases and patient deaths?”
   Burnout risk is high; you want:

   • Debriefing opportunities
   • Faculty mentoring
   • Formal wellness resources

5. “Is there stigma toward addiction medicine within the broader institution?”
   Programs that truly respect addiction medicine will:

   • Treat addiction consult recommendations seriously
   • Support MOUD prescriptions
   • Avoid dismissive language about patients with substance use disorders

Questions About Education and Feedback Culture

Ask fellows and faculty:

6. “How approachable are attendings and program leadership when you have clinical or personal concerns?”

7. “How is feedback delivered? Do you get regular, actionable evaluation about your progress in addiction medicine skills?”

8. “If a trainee is struggling—clinic load, personal stress, or adjusting to the US system—how does the program respond?”

You are looking for concrete examples of support, not generic “we’re very supportive” statements.

Questions to Ask Program Director About Professional Development

9. “What opportunities exist for trainees to attend addiction medicine conferences or courses (ASAM, AAAP, state-level meetings)?”

10. “Are fellows encouraged to gain DATA 2000/X-waiver equivalent training or other certifications? How do you support that?”
    Even though federal waiver requirements have changed, many programs still provide structured MOUD training.

11. “What mentoring structures are available, especially for non-US citizen IMGs who may be new to the US academic system?”

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5. Research, Scholarship, and Career Planning Questions

If you’re interested in academia, policy, or quality improvement in addiction medicine, you’ll want to probe scholarly opportunities.

Questions for Faculty and Program Director

1. “What types of addiction-related research or QI projects are current fellows involved in?”

   • Clinical trials (e.g., new MAT approaches)
   • Health services research
   • Implementation science in harm reduction
   • Policy/advocacy projects

2. “Are there structured expectations for scholarly activity, such as presentations or publications?”

3. “How easy is it to find a research mentor in addiction medicine or related fields (psychiatry, internal medicine, public health)?”

4. “Do fellows/residents get protected time for research or QI? How much?”

Questions About Long‑Term Career Outcomes

5. “What are the typical career paths of your graduates—clinical practice, academic medicine, public health, administration?”

6. “For non-US citizen IMGs, how many have successfully secured US-based jobs in addiction medicine after graduation?”

7. “Do you provide any formal or informal advising about job search strategy, negotiation, and understanding US employment contracts?”

These answers help you evaluate which program will best prepare you for life after training, not just the fellowship or residency years themselves.

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6. Practical Logistics, Fit, and How to Phrase Your Questions Professionally

Even strong candidates sometimes harm their impression by asking questions that are easily answered on the website or that sound like they are only focused on salary or location. You should absolutely consider lifestyle and finances, but phrase these in a professional, balanced way.

Smart, Professional Ways to Ask About Schedule and Workload

Instead of “How many hours do we work?” try:

1. “Can you describe a typical week for a fellow on the main addiction rotation?”

   • Ask: “Approximate patient volume, clinic vs consults, and after-hours responsibilities?”

2. “How are weekends and nights structured for addiction medicine coverage? What kind of backup is available?”

3. “How much administrative support do fellows have—e.g., support for prior authorizations, referrals, and social services coordination?”

Asking About Salary, Benefits, and Living Situation

Ask the coordinator or current trainees:

4. “Are your salary and benefits aligned with institutional GME standards? Are there any additional stipends for call, conferences, or relocation?”

5. “For someone new to the US, are there resources to help with housing, banking, and basic logistics in the area?”

6. “How do most fellows/trainees commute? Is it realistic to live without a car, or is driving essential?”

Tailoring “Interview Questions for Them” to Addiction Medicine and Your Background

You want each question to show that you’ve thought seriously about:

• Addiction medicine as a specialty
• Your identity as a non‑US citizen IMG
• Your long‑term pathway to practicing in the US

Examples of polished, high‑yield questions that integrate all three:

• “Coming from an international background where addiction care is often fragmented, I’m particularly interested in integrated models. How does your program coordinate addiction treatment with primary care, psychiatry, and social services?”

• “As a foreign national medical graduate, I’m also thinking about long‑term stability in US practice. What patterns have you seen in terms of post-fellowship job prospects and sponsorship options for non-US citizens?”

• “What aspects of your program’s substance abuse training are you most proud of, and what are you currently working to improve?”

These show insight, maturity, and a genuine interest in how the program is evolving.

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7. Sample Question Lists by Interviewer Type

To make this concrete, here are ready‑to‑use question sets you can adapt.

What to Ask Program Director

• “How do you see addiction medicine evolving in this institution over the next 5 years?”
• “How do you measure the success of your addiction medicine training—what outcomes do you track (board pass rates, jobs, research, patient outcomes)?”
• “What specific support is in place for non-US citizen IMG trainees, both in terms of visa processes and academic adjustment?”
• “What changes have you made to the program based on fellow/resident feedback in the last few years?”
• “If I joined your program, what qualities would you expect from me to make the most of the training here?”

What to Ask Faculty

• “From your perspective, what makes trainees particularly successful in addiction medicine here?”
• “How easy is it for trainees to get involved in your research or QI work?”
• “Do you see any gaps or challenges in addiction care delivery at this institution that trainees can help address?”

What to Ask Current Fellows/Residents

• “What surprised you most after you started here—good or bad?”
• “If you could change one thing about the addiction medicine training, what would it be?”
• “Do you feel the program is transparent and fair in handling evaluations, remediation, and promotion?”
• “How does the program respond when someone is overwhelmed or burned out?”

What to Ask Coordinator / GME Office

• “Can you walk me through the typical visa timeline for incoming non-US citizen IMG trainees?”
• “What documents do you usually need from IMGs, and by when, to avoid delays?”
• “How does the institution handle onboarding for international graduates—orientation, benefits setup, IT access, etc.?”

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FAQ: Common Questions Non‑US Citizen IMGs Have About What to Ask Programs

1. Is it acceptable to ask detailed visa questions during the interview?
Yes. For a non-US citizen IMG or foreign national medical graduate, visa feasibility is essential. Ask politely and specifically, especially when speaking with the program director or coordinator. Example: “As a non-US citizen, I want to be sure I could train here without administrative surprises. Could you share which visas you sponsor and any recent experiences with international trainees?”

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2. How many questions should I ask each interviewer?
Aim for 3–5 thoughtful questions per interviewer, calibrated to the time you have. It’s better to ask a few meaningful, open‑ended questions than to rush through a long list. Prioritize visa, training quality, addiction exposure, and culture.

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3. Should I ask about salary, call schedule, or vacation, or does that look bad?
You should understand these details, but ask in a professional, balanced way, and usually not as your very first question. Phrase it around understanding workload, wellness, and feasibility. For example: “To better understand the day-to-day life here, could you describe the typical call structure and how time off is scheduled?”

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4. What if I forget to ask something important during the interview?
You can send a brief, focused follow‑up email to the program coordinator or director. Mention your appreciation for the interview and ask 1–2 specific remaining questions. This is common and not viewed negatively if done respectfully and concisely.

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By preparing purposeful, well‑researched questions to ask residency and fellowship programs, especially about addiction medicine training and visa realities, you position yourself as a thoughtful, serious candidate. As a non-US citizen IMG with a strong interest in substance use disorders, your questions are your best tool to evaluate whether a program will not only train you well, but also support your journey to a stable, meaningful career in addiction medicine in the United States.