This training does not cover third-party companies that offer paid USCE.

For those of you seeking that information, the American Medical Association has put together this handy list for free:

https://www.ama-assn.org/education/international-medical-education/observership-program-listings-international-medical

Please note that the AMA does not endorse any of these places.

Now, should you pay for externships? 

It really depends.

Do you have more time than money?

If so, you should set up your own USCE and supplement with paid experiences only if you have to.

Do you have more money than time? Then you are stuck paying for clinicals.

Make sure that you use a company which is very specific about exactly what you are getting and whether a letter is guaranteed or not.

I have heard horror stories of IMGs who have signed up for programs that guaranteed them hands-on hospital rotations.

Then they showed up and were in a private physician office, and maybe they got to attend hospital conferences and rounds if the physician had a teaching hospital affiliation. 

This combination of inpatient and outpatient offers hands-on patient care in the private practice clinic only. When you're in the hospital, you're just an observer.

This is absolutely OK, if you know that's what you're signing up for.

But, there are sometimes so many students on a rotation that the learning experience is poor. You don't get a chance to demonstrate your skills, which makes for a weak letter of recommendation.

These hybrid "hands-on observerships" or "gray area externships" delivered via third-party companies usually come at a high cost. 

But there's no reason why you can't try to set up clinicals yourself using the resources in this training, if you have enough time.