Visas for International Medical Graduates
Written by Julio Cesar Nunes, MD
*Disclaimer: this post is merely informative; individuals should discuss their cases with an immigration attorney.
We all know that International Medical Graduates (IMGs) face additional barriers when applying to US medical residencies. One of them is the matter of immigration and visas. Certain kinds of visas allow clinical training, divided into nonimmigrant and immigrant categories: H-1B, J1, O-1, and EB. In this post, we will discuss the pros and cons of each visa type, how to obtain them, requirements for recertification and maintaining your visa, as well as post-residency legal requirements (or did you think that the paperwork would end with the Match?).
J-1: The “Scholar” Visa
The J-1 is the most used visa by IMGs. It is a non-immigrant visa, meaning you are not allowed to permanently stay in the US with it. This type of exchange visitor visa is centrally sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG), which means that programs don’t have any responsibilities regarding payment of fees and securing attorneys. This visa must be renewed annually, entailing a visit to your home country each year for a consular appointment for renewal of status. Eligibility criteria for the J-1 include ECFMG certification, which requires Steps 1, 2 CK, OET, and application to a Pathway to be done before Rank Order List Day, but ideally before application. An additional requirement for this visa is the “Statement of Need”. Applicants must secure this document from their Department of Health after Match Day, stating that their home country has a need for the specialty they were matched into.
Physicians in this category will face an additional challenge: the two-year home country physical presence requirement. After completion of residency, J-1 holders must leave the US for two years to use the knowledge they gained in training for the benefit of their home country. All physicians must fulfill this requirement before they can reapply for a J1, any work visas, or a Green Card. Of note, getting married to a US citizen does not allow for permanent resident status while in training and will not nullify this requirement. There are only a couple of exceptions for the two-year rule (which are frequently used by J1 graduates!):
- If the applicant can prove that they will suffer from persecution in their home country.
- If leaving the US would bring “proven exceptional hardship” for the applicant’s legal partner and/or children who are US citizens (but keep in mind, the “exceptional hardship” requirement is exceptionally hard to prove!).
- If the physician is considered eligible for a J1-waiver by a government agency, usually under the argument that the applicant will work with underserved communities for at least 3 years. Additional information about the waiver is available at: https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/conrad-30-waiver-program and https://travel.state.gov/content/travel/en/us-visas/study/exchange/waiver-of-the-exchange-visitor/request-by-federal-government-agency.html.
H-1B: The “Professional” Visa
The H-1B is also a non-immigrant visa. It is meant for specialty workers who hold advanced professional degrees (such as physicians!). This type of visa allows for employment in the US for up to 6 years but needs to be renewed every 3 years. The successful applicants will have completed all 3 parts of the USMLE before Rank Order List Day, but ideally before residency applications. For the sake of clarity: applicants seeking this visa need not only Steps 1, 2 CK, and the OET, but also Step 3. But why is H-1B so coveted? It has no two-year home residence requirement! So, you would be eligible to stay in the US after residency without having to worry about a waiver, as discussed with J-1 visas.
Unfortunately, the number of residency programs sponsoring H-1B visas decreases each year. This is happening because the immigration requirements are complex, bureaucratic, and $$$. The employer is responsible for paying all the fees, including attorney honoraria, summing up to $10 thousand dollars per resident, on average. An additional thing is that H-1B employees need to make a certain wage determined by the Department of Labor, which tends to be higher than what many residencies pay across the country, making them ineligible for sponsorship.
Of note, this is a non-immigrant visa but it has a special “possibility to immigrate” condition, which allows for H-1B visa holders to apply for a Green Card if they meet the required criteria. J1 visa holders, on the other hand, are under a “no intention to immigrate” condition, which means they should refrain from seeking permanent US-resident status for the duration of the visa.
Other Visas
O-1A: The “Scientist” Visa. Long story short, this is a visa for “extraordinary scientists” rarely used by residents on clinical tracks. This one is saved for our MD-PhD colleagues with a very extensive collection of publications and high impact in the medical science. Odds are if you need a O-1A visa or are applying for one, you know more about it than I do!
EB Visas: The Green Card. These are immigrant, permanent types of visa that give foreign citizens permission to stay in the US well… permanently. Known collectively as the “Green Card” they are usually obtained by one of the following pathways:
- Marriage: the applicant gets married to a US permanent resident. As long as they are not under the two-year rule of a J1-visa
- Work: the applicant is sponsored by an employer, who is responsible for the payment of all fees. This is unlikely to occur during residency and is reserved for attending positions.
- National Interest: the applicant carries extraordinary skills and they self-sponsor a Green Card. This comes with the justification that keeping their skills is in the best interest of the US. Just being a physician does not give an applicant automatic eligibility, and successful applications will usually be accompanied by extensive research, awards, and letters of recommendation from nationally and internationally renowned scientists.
More information about visas for International Medical Graduates is available at https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas.
