18 minute read
Chronicling the Paths of Internationally Educated Dentists
By Carrie Pallardy
Dentists from all over the world have come to practice in the United States. That journey, different for each person, is a long and complicated one. They must navigate the logistics of immigration and then throw themselves into the fierce competition for limited slots in dental school programs. While the logistics alone are daunting, internationally educated dentists must also contend with leaving their home countries and establishing their lives in the United States.
Five internationally trained dentists shared their stories with AGD Impact.
Coming to the United States
Different people have different motivations for immigrating to the United States. Sireesha Penumetcha, DDS, MAGD, graduated from M.R. Ambedkar Dental College in Bangalore, India. She had ambitions to become a doctor from a very young age, inspired by her uncle and grandfather. Penumetcha never planned to study or work abroad, but a family work opportunity changed her course when her husband was offered an engineering position in the United States. Penumetcha finished her internship and moved to the United States a year later on an H-4 visa (a visa granted to spouses or dependents).
Mohamed Attia, DDS, MAGD, also set his sights on becoming a doctor when he was a child. As he grew up, he found his passion in dentistry. Attia trained to become a dentist at Alexandria University in Egypt. He earned his dental degree, and then he went through residency programs.
“At that time in Egypt, dentistry was mainly about if you have so much pain and your face is swollen, then you go to the dentist,” he shared. Attia wanted to practice general dentistry, preventive dentistry and cosmetic dentistry, which helped inform his decision to come to the United States in 2004.
That same year — just one year after the United States–led invasion of Iraq — Muhalab Al Sammarraie, DDS, began his dental training at the University of Baghdad College of Dentistry. He graduated in 2009, followed by a rotation and residency program. Al Sammarraie practiced in Iraq for two years.
“Everything flipped upside down after 2003 in Iraq. It became very dangerous. The future was unknown for most people in my generation,” he said.
While training to become a dentist, Al Sammarraie also worked as a human resources manager with the U.S. Agency for International Development. This work gave him the opportunity to apply for a special immigration visa. He arrived in the United States in 2013.
Manasvi Patel, BDS, graduated from dental school in Mangalore, India, in 2019. In 2012, she visited extended family in the United States, an experience that, in part, helped her decide to immigrate. However, Patel’s move was complicated by the timing. She came to the United States in 2021, in the thick of the COVID-19 pandemic.
The logistics of coming to the United States to train in dentistry are complicated. Internationally trained dentists must secure a visa. Nonimmigrant visas allow temporary stays, while an immigrant visa lays the groundwork for permanent residence.(1)
An H-1B visa, for example, is a nonimmigrant visa that allows people to work in a specialty occupation.(2)
Dentists coming to train in the United States may be able to obtain a student visa, such as an F-1 visa. Optional Practical Training allows F-1 students to work in their area of study.(3)
Securing the paperwork and making the physical journey are just the beginning of the long road ahead.
Applying for Programs
Dentists who have been educated in another country but want to practice in the United States can’t just make the move and start seeing patients. Each state has different laws, but there are a few common requirements that internationally educated dentists must meet to practice in the United States.(4) They need to have a degree from a dental program accredited by the Commission on Dental Accreditation (CODA). They need to pass the Integrated National Board Dental Examination, and they must pass a clinical assessment. Dentists who have a degree from a program that isn’t CODA-accredited need to apply for an advanced standing dental education program. Internationally trained dentists can gain their DMD or DDS through one of these programs within two to three years.(5)
The American Dental Education Association Centralized Application for Advanced Placement for International Dentists (ADEA CAAPID) can help internationally educated dentists find programs. The Boston University Henry M. Goldman School of Dental Medicine’s (GSDM’s) advanced standing program is the largest in the United States, accepting 100 students per class.(6)
The application criteria for advanced standing programs can differ. Some programs only accept U.S. citizens or permanent residents, another potential hurdle for internationally trained dentists.
Advanced standing programs also typically require applicants to take the Test of English as a Foreign Language (TOEFL).
GSDM, for example, requires a minimum score of 90 on this test for an applicant to be interviewed, according to Janet Peters, DMD, clinical professor of general dentistry and faculty liaison to the GSDM DMD Advanced Standing program.
Some programs require internationally trained dentists to take a bench test, an evaluation of practical and clinical skills.(7)
With relatively small program sizes, the competition for the available slots in advanced standing programs is intense. “GSDM received over 2,000 applications for its DMD Advanced Standing program last year,” Peters said. “It’s very competitive.”
Patel passed her national boards and the TOEFL and then began applying for schools. “It took me two years to get in. I actually got accepted to Meharry School of Dentistry in Nashville, Tennessee,” she said, and she ended up enrolling in the program.
While she was applying, Patel worked as a dental assistant to gain an understanding of how dental offices worked in the United States. She worked in a general dental office as well as an oral surgery office. She will be licensed by the end of 2025, and her goal is to work in private practice with oral surgeons.
Gaining that clinical experience in the United States, along with strong GPAs, can make internationally trained dentists attractive candidates for advanced standing programs. “We look at the letters of recommendation. We look at clinical experience in their original country. We definitely look for assisting experience in [the United States] because practice is very different here than other countries, and we find that very valuable,” said Peters.
The interview and admissions process and timeline varies depending on the program. The advanced standing program at GSDM has rolling admissions. The program begins interviewing in June, and the first round of acceptances are sent out shortly afterward.
“We’re always looking at our strongest applicants,” Peters explained. “The nature of the rolling admissions process means that some applicants may receive offers of acceptance immediately after they interview, and, for others, it may take four weeks or three months.”
Applicants may also be waitlisted; a slot could open if another candidate is delayed due to visa issues or finances.
Getting into a program is a huge step forward, but internationally trained dentists still face additional challenges. “The next hurdle after getting admitted was the cosigner for the student loans. When you are new to the country, how can you find someone to cosign a $300,000 loan?” said Penumetcha. She decided to move from New York to California to train for her boards there.
“My first job was a miracle. I had called just one company, and the president said she would be on vacation the next week, so she interviewed me in New York, where I was living,” Penumetcha shared. “I got the job and literally moved across the country within two weeks.”
“After finishing the bench test, I was able to do the state boards and get my California license," she said.
The process of applying can be long and frustrating. Al Sammarraie received a rejection letter from an advanced standing program advising him to consider changing careers. He did not leave his chosen profession in his home country even when his personal safety was threatened, and he had no intention of leaving it in the United States. Within a couple months of that rejection, he was accepted by a different program.
Training for Internationally Educated Dentists
Once an internationally educated dentist is accepted to an advanced standing program, they have two to three years of intense study ahead. At GSDM, advanced standing program members spend a lot of time in the simulation learning center.
“They’re doing all the same procedures as the four-year students,” Peters said. “We have a full simulation learning experience before they enter clinic, and then, in their second year, there’s still didactics, rotations and patient care. We prepare them for the boards, the CDCA [Commission on Dental Competency Assessments], the licensing board.”
Internationally trained dentists can also explore the possibility of undergoing their training in a residency program instead of an advanced standing program.
Attia completed a residency in Egypt and then two others when he arrived in the United States. “Every residency program had a different technique and different setting,” he said. “I’m very happy I got that education. It made me who I am today.”
Residency programs allow internationally trained dentists to pursue postgraduate training in a specific area, but this is only an option in a few states. Most states require dentists to have a dental degree from an accredited dental school in the United States.(8)
As internationally educated dentists pursue their path to licensure, they are likely to discover differences between training in their home countries and in the United States. Al Sammarraie noticed a significant shift between studying and demonstrating knowledge.
“In Iraq, we used to memorize things. When I had a test, they would ask me to, for example, talk about biology or a certain topic. Whatever I memorized, I put it there in writing,” he said. “Whereas, in the United States, it’s more about you understanding the concept.”
As Patel works through her training, the approach to patient management and communication has stood out. “Communication is top-notch over here, and I think that’s something that I’m learning and working on,” she said.
Starting to Practice
Understanding the varying state regulations can be a challenge for internationally trained dentists as they consider where to apply for their training and where they will eventually practice. When Attia arrived in the United States, the process was not very clear. “It took a lot of time to figure out … OK, what do I need to do in order to get my license?” he said.
Today, he practices general and cosmetic dentistry in Alexandria, Virginia. Penumetcha runs her practice in Elk Grove, California. Al Sammarraie also practices in California, and he leverages the skills he built in human resources to train other people in the field.
In addition to the rigorous clinical demands of their training, internationally trained dentists must also learn the business of dentistry in the United States.
Many dentists must learn how to work within the U.S. dental insurance system. “In India, we don’t really have the concept of dental insurance. Pretty much everybody pays out of pocket,” said Patel.
Internationally trained dentists may also need to adapt to the administrative aspects of dentistry in the United States. “A surprise was the amount of time we spent on documentation and forms, which seemed very tedious,” said Penumetcha. “We also never received any training on starting a business, so there were a lot of unknowns we had to learn the hard way.”
Preparing for the Experience
The experience of immigrating to the United States is unique to each person who decides to make the journey. Some people leave their home countries for reasons they never expected, while others are following a lifelong dream. Whatever the motivation, internationally trained dentists are faced with the challenges that come with training and getting licensed in the United States while also adjusting to the life and culture of a new country.
Making that kind of massive change can feel isolating. With their families and friends still in their home countries, many immigrants may feel alone. But there are ways to build support networks.
“Reach out to any foreign-trained dentists who pass through the area,” Attia recommended. Connecting with other internationally trained dentists — both those who are in the same early stages of their U.S. careers and those who have long practiced in the states — can help those new to the United States find peers and mentors who understand what they are experiencing and trying to achieve.
U.S. universities attended by internationally trained dentists may also have resources. GDSM, Peters shares, has an international chaplain, a student affairs team and behavioral health resources. The International Students and Scholars Office helps international students obtain necessary paperwork. Universities also have student groups that bring people with shared experiences and interests together.
Al Sammarraie found a community in San Diego. “I found San Diego, which has a large population of Iraqi people. I will still see people who speak the same language, who share some of the same emotions,” he said.
That community grew as time went on. “The dental community was very helpful. In the beginning, [it] was Iraqi people, then it expanded as much as my time in the country expanded. I got to know people from all different countries,” he continued.
While every internationally trained dentist will have their own experience, there are some common success factors — resilience and work ethic chief among them. Adjusting to life in a new country, competing for programs with limited space, and experiencing rejection and setbacks demand a lot.
“At some point, you will question yourself, so you have to be ready for that,” Al Sammarraie said. That resilience, that willingness to persevere, can be invaluable.
“To be able to live and dream with so many abundant possibilities and resources is worth it, and there is no stopping you if you can uproot and travel across the seas with your dreams and hard work in tow,” said Penumetcha.
Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.
References
1. “Student Visa.” Travel.State.Gov, U.S. Department of State, travel.state.gov/content/travel/en/us-visas/ study/student-visa.html. Accessed 1 April 2024.
2. “H-1B Specialty Occupations, DOD Cooperative Research and Development Project Workers, and Fashion Models.” U.S. Citizenship and Immigration Services, U.S. Department of Homeland Security, 25 March 2024, uscis.gov/working-in-the-united-states/h-1b-specialty-occupations.
3. “Optional Practical Training (OPT) for F-1 Students.” U.S. Citizenship and Immigration Services, U.S. Department of Homeland Security, 27 March 2024, uscis.gov/working-in-the-united-states/students-and-exchange-visitors/optional-practical-training-opt-for-f-1-students.
4. Licensure for International Dentists, American Dental Association, ada.org/resources/careers/licensure/licensure-for-the-international-dentists. Accessed 1 April 2024.
5. “Foreign-Educated Dentists.” ADEA: The Voice of Dental Education, American Dental Education Association, adea.org/godental/non-traditional_applicants/foreign-educated_dentists.aspx. Accessed 1 April 2024.
6. “ADEA CAAPID® Programs.” ADEA CAAPID® Program Finder, ADEA, programs.adea.org/CAAPID/programs. Accessed 1 April 2024.
7. Bench Test Prep Course for International Dentists, International Dentist Central, internationaldentistcentral.com/bench-test-prep-course-for-international-dentists/. Accessed 1 April 2024.
8. Dental Residency Programs for Foreign-Trained Dentists, International Dentist Central, internationaldentistcentral.com/dental-residency-programs-for-foreign-trained-dentists/. Accessed 1 April 2024.
My Path to Practicing Dentistry in this Incredible Country
By Hans Sperling, DMD, FAGD, FICOI
I graduated from dental school at Pontificia Universidad Javeriana in Bogotá, Colombia, in 1992. In 1993, after completing the Colombian mandatory one-year clinical practice at a government-sanctioned nonprofit, I enrolled at the University of Texas (UT) Health Science Center at San Antonio in its six-month preceptorship program in oral and maxillofacial radiology.
UT issued me a J-1 visa, which meant, after the program, I was required to go back to live in Colombia for at least two years.
I returned to Bogotá and started my private dental practice in 1994. In 1995, I returned to the United States as a visitor to take the national board exams, then returned to Bogotá afterward. I did the same process for the second part of the national boards. After passing both exams in 1996, I applied to international dental programs at Tufts University, Boston University, University of Pennsylvania, Case Western Reserve University and Loma Linda University. I was invited to interview at each program and had to make multiple trips from Colombia to attend them.
I was accepted to all of the programs I applied to except Loma Linda. I chose Tufts because they offered me a regular student visa, which allowed me a path for a green card. In my opinion, Tufts had the most organized international standing program. The program was supposed to be two years and three months, but I was able to complete all my requirements in 18 months. They allowed me to graduate with the regular class of 1999. (I still had to pay full tuition, of course.)
After graduating from Tufts in May 1999, I took the Florida boards and moved to South Florida, where I began working as an associate at a dental support organization. My employer sponsored me for my working visa. Eight years later, I was able to move on and open my own practice in Hollywood, Florida, where I have been for the last 17 years.
A Challenging Path to Citizenship
When I moved to the United States in 1997, I was married and had an 18-monthold daughter. I had a student visa and my wife had a nonworking visa, so we had no income. I was not a U.S. citizen, which meant that we only qualified for private loans with high interest. A very good friend of mine — a U.S. citizen — was incredibly kind and cosigned for my student loans.
At that time, most of my classmates chose to work part time as dental assistants or hygienists while in school to supplement their incomes. I did not do that because I knew that if I doubled down and applied myself, I could complete my educational requirements early and be able to start working as a dentist much sooner.
This was the right choice for me because, after graduating in 1999, I was able to move to Florida sooner. I had the support of my family and was able to start working as a dentist and make a lot more money than my classmates.
After graduating from Tufts, I received an F-1 visa. This was a one-year visa given to students at the end of their program so they could get practical experience in the United States in their field. After that year, my employer sponsored me, and I was able to obtain an H-1 visa. This visa allowed me to work legally in the United States for three years with a renewable period of three more years. During this time, I was able to apply for a green card. My visa situation meant that I was committed to my employer — good or bad — until I could get a green card. My wife again had a nonworking visa and, by then, we had two children. The first time I applied for a green card, during my first three-year term with the H-1 visa, the application was denied. The stamp on my rejection letter was dated Sept. 11, 2001.
We changed immigration attorneys and applied again.
The second time around, the application was again denied, and we received a letter stating that the decision was irrevocable and final. Our immigration attorney told us that this must have been a mistake, and he proposed we sue the immigration department. We proceeded to file a lawsuit, and, as they reviewed our file, our petition for immigration was approved. That was the most stressful time of my life. I had almost no hope of staying legally in the United States and had begun to consider moving to other parts of the world because economic and political instability made Colombia no longer an option for us.
In 2005, eight years after we first applied, we received green cards.
My American Dream
Everyone must make the decision that best suits their life. I know many dentists who moved to the United States first and then found a way to obtain visas, validated their degrees and got dental licenses. I know people who did not attend formal dental school programs and still got their dental licenses. I know people who went into specialty programs and obtained their licenses, but I also know a lot of people who moved to the United States and haven’t been able to validate their dental degrees at all. I knew, based on my personality, that what I needed to do was move to the United States once I had secured a path to legal immigration and be able to practice dentistry anywhere in the country.
My American dream has come true. Now, I am a proud U.S. citizen. I am happy and grateful that I live and practice dentistry here.
All the hard work and stress trying to get where I am today was well worth it. I have my own dental practice, I work alongside my wife of 31 years, and we have two amazing daughters who have had the opportunity to live and grow up in this incredible country.
