Orientation about Visas ??

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Hi all ..

I'm an IMG, planning to get into a residency program in USA. I've been reading about the different types of Visas but I don't know anything about them.

I heard about B-1, J-1, and something like B1H !

Can anyone help me by giving me a short orientation to define the different types of visas, please?

Thanks in advance ..

hadi

Basically, there are two types of visas you can obtain to allow you to train in the US. One is the "J" visa (also called the J-1), and the other is the "H" visa (also called the H1b).

The J Visa

The J visa is an "exchange visitors" visa. The idea is that you get to come to the US for training, and then take that training back to your home country to improve the health care / teaching in your home country. I believe J visas are only available for clinical medicine and medical research. The basic facts are as follows:

1. It is easy to get. There is no limit to the number of J visas issued. The ECFMG is the sole source of these visa in the US. They have a very helpful website here.
2. In order to get this visa, you need:
   1. To obtain an ECFMG certification (which proves you attended a qualified medical school outside the US/Canada)
   2. Pass Step I and Step II CS/CK of the USMLE
   3. Obtain a contract for a PGY position in the US
   4. Provide a Statement of Need from the Ministry of Health of the country of most recent legal permanent residence, regardless of country of citizenship. This statement provides written assurance that the country needs physicians trained in the proposed specialty and/or subspecialty. It also serves to confirm the applicant physician's commitment to return to that country upon completion of training in the United States.
3. The statement of need can usually be obtained in your home country, or sometimes requested in a consulate. It can be easy or hard to get this letter, depending on your country of origin.
4. The fees for these visas are inexpensive, and no lawyer is required.
5. Spouses / children obtain a J-2 visa, which allows them to work/study in any capacity (i.e. they are a full work visa)
6. The visa holder is required to return to their home country for a minimum of 2 years after the visa expires.
7. The only exception to this rule is the J Visa Waiver program -- if a J Visa physician obtains a job which qualifies for a waiver, and they work in that position for a certain period of time (I believe it's 3 years), they become exempted from the "return home" requirement. These positions are rare, often poorly compensated, and potentially less than ideal. They only exist because US physicians will not fill them.
8. You cannot moonlight on a J visa.
9. A J visa is only good for 7 years. This covers most residencies and fellowships.
10. You can only change specialties once on a J visa, before the end of the PGY-2 year.

The H Visa

An H visa is a true work visa. It allows a non-US citizen to hold a professional position which requires significant training. H visas are commonly used by physicians and by IT professionals. Because of the "Home Country" issue with the J visa, they are often preferred by non-US citizens training in the US. However, they have some other issues. Basic facts:

1. They are much more difficult to get. There is an annual limit to the number of H visa's available in the US. Last year, this limit was 65,000. It's extremely complex, but last year all of the visas were given away many months before they would be valid. Current practice suggests that it may take 6-9 months to get an H visa, if one is obtainable at all.
2. They are much more expensive and complicated. Usually you need to hire a lawyer to make it all happen, which costs $$$. There is a $1000 premium processing fee, which really isn't optional if you want to start your training anywhere near July 1st. This site has a list of all the documents / paperwork you will need to generate.
3. Some residency programs refuse to sponsor H visas because of all of the work involved.
4. Non profits and Universities are immune to the cap, and hence can always get an H visa. However, an H obtained outside the cap is only transferrable to another institution immune to the cap.
5. In order to get an H, you will need to pass all THREE steps of the USMLE (unlike the J, where you only need Step 1 and 2). Realistically, you should have passed all three before even applying for a residency position if you wish to try to get an H visa.
6. You can transfer your H Visa anytime you want, although it usually takes 2-3 months to do so.
7. If you get hired in the US into a permanent job (i.e. NOT residency) on an H visa, your employer can sponsor you for permanent residency. This is one of the easiest paths to citizenship. Note I said "easiest", not "easy". This is the major advantage of the H visa. Note that if your H is obtained outside of the cap, this will only work for an employer who is University / Non profit.
8. Your H visa is only good for 6 years (actually it's good for 3 years, and renewable once). This can be a big problem if you decide to do a complex fellowship (like interventional cards, which is 3+3+2 = 8 years in most institutions now).
9. Dependents (Spouse / children) obtain H-4 visas. They cannot work in the US on these visas at all.
10. You can moonlight on an H1-b visa if you can obtain a full license (which depends by state).

Thank you very much aProgDirector ..

This was more than enough !!

Hello aProgDirector. Thank you for explaining the different visa options IMGs like me will have to consider in order to practice medicine in the US.


I'm going to be applying for the 2009 match, and trying to get a head start on the process. I'm a Canadian citizen, and did my 4 years of medical school in Asia.

I have been looking through various programs' websites and a lot of them say: we do not sponsor visas. Does this mean that IMGs are automatically not eligible to apply to their program? Can I, the IMG, offer to pay for the processing of the visa? Does this basically mean that I am now limited to looking for residency programs who only sponsor visas?

Thank you very much again for your help.

Originally Posted by canuckmd

Hello aProgDirector. Thank you for explaining the different visa options IMGs like me will have to consider in order to practice medicine in the US.


I'm going to be applying for the 2009 match, and trying to get a head start on the process. I'm a Canadian citizen, and did my 4 years of medical school in Asia.

I have been looking through various programs' websites and a lot of them say: we do not sponsor visas. Does this mean that IMGs are automatically not eligible to apply to their program? Can I, the IMG, offer to pay for the processing of the visa? Does this basically mean that I am now limited to looking for residency programs who only sponsor visas?

Thank you very much again for your help.

If a program does not sponsor visas, then only US citizens or those holding green cards or otherwise able to work in the US can apply. US Citizens can be IMG's also. If they don't offer visas, then offering to pay won't get you far -- the J visa is already completely paid for by the applicant.

Will a student(Canadian) need to pass step 3 for the H1B visa even if he/she is a US graduate?

Originally Posted by M.Furfur

Will a student(Canadian) need to pass step 3 for the H1B visa even if he/she is a US graduate?

Yes. All H1b visas require all three steps of the USMLE.

However, if you are a Canadian citizen enrolled in a US medical school, you will be on an F Visa. An F visa allows you to complete your internship on OPT status. Thus, you can take Step 3 and apply for an H visa during your internship, rather than having to get it all done prior to the internship year.

Can one start with an OPT status and then switch to J-1?

Originally Posted by M.Furfur

Can one start with an OPT status and then switch to J-1?

Yes, you can always switch to J-1 from any visa type. Once you are on a J-1, there is no going back (except for the J Waiver program)

aProgDirector, thank you for all your accurate and helpful replies. If only all program directors were as knowledgeable about these issues as you! My question is also about the H1B/J1 residency issue: I will be a Canadian attending a US medical school next year, and I've been perusing some residency websites just to see what the visa issues are like. Many say that international medical graduates can only be considered for the J-1. However, as a Canadian from a US medical school, I would not be considered an IMG, would I?

So, in your experience, are these "J1-only" residency programs willing to sponsor Canadians from US med schools for an H1B?

Also, what kind of credentials (Step scores/grades) are needed in order for a program director to be willing to go through the hassle and sponsor an H1B, rather than take a US citizen? And for those individuals doing their internship on OPT (which is my plan), in that case not having a Step 3 score prior to residency interviews would not be a problem, if one is looking to attain the H1b visa?

This information would be helpful, as this can allow me to prepare, and know what goals I need to attain, in order to be competitive for an H1B.

You are not an IMG, as you are attending a US medical school.

Many programs will consider an H for a foreign grad in your position. You'll have to ask. Visas are usually sponsored by the GME office (rather than the residency program itself) so sometimes this is out of our control.

You'll be on an OPT visa for the first year. You are correct that you'll need to take Step 3 for the H visa. You might want to consider taking it between med school graduation and internship, if possible. You won't need Step 3 for interviews.

Originally Posted by PistolPete

aProgDirector, thank you for all your accurate and helpful replies. If only all program directors were as knowledgeable about these issues as you! My question is also about the H1B/J1 residency issue: I will be a Canadian attending a US medical school next year, and I've been perusing some residency websites just to see what the visa issues are like. Many say that international medical graduates can only be considered for the J-1. However, as a Canadian from a US medical school, I would not be considered an IMG, would I?

So, in your experience, are these "J1-only" residency programs willing to sponsor Canadians from US med schools for an H1B?

Also, what kind of credentials (Step scores/grades) are needed in order for a program director to be willing to go through the hassle and sponsor an H1B, rather than take a US citizen? And for those individuals doing their internship on OPT (which is my plan), in that case not having a Step 3 score prior to residency interviews would not be a problem, if one is looking to attain the H1b visa?

This information would be helpful, as this can allow me to prepare, and know what goals I need to attain, in order to be competitive for an H1B.

I would like to post these 2 somehow complicated cases..I appreciate any input.

If I match into a Prelim year, do 1 year Prelim, then fail to match at any program the following year, will that necessarily mean I have to leave the states for 2 years?

A certain program offers 6 months clerkships for final year students or graduates, but requires J-1 visa, which they say is often subject to the 2 year rule. Say I get enrolled from Jan-june in that program, then hopefully match and attend a PGY-1 in July. Will that work?

Originally Posted by rox

I would like to post these 2 somehow complicated cases..I appreciate any input.

If I match into a Prelim year, do 1 year Prelim, then fail to match at any program the following year, will that necessarily mean I have to leave the states for 2 years?

A certain program offers 6 months clerkships for final year students or graduates, but requires J-1 visa, which they say is often subject to the 2 year rule. Say I get enrolled from Jan-june in that program, then hopefully match and attend a PGY-1 in July. Will that work?

I'm not a visa lawyer, so take this with a gain of salt:

Here's the quote from the US Gov visa site:

Two-Year Foreign Residency Requirement

An exchange visitor is subject to INA 212(e) requirement, if the following conditions exist:

• The program in which the exchange visitor was participating was financed in whole or in part directly or indirectly by the United States government or the government of the exchange visitor's nationality or last residence;
• The exchange visitor is a national or resident of a country designated as requiring the services of persons engaged in the field of specialized knowledge or skills in which the exchange visitor was engaged for the duration of their program (Exchange Visitor Skills List 9 FAM 41.62, Exhibit II);
• The exchange visitor entered the United States to receive graduate medical education or training.

If the exchange visitor is subject to INA 212(e) requirement, he or she cannot change his or status to that of H, L, K, or immigrant lawful permanent resident (LPR) until he or she has returned to his/her home country for at least two-years or received a waiver of that requirement.

This answers both questions.

Once on a J-1 visa, you are subject to the 2 year rule. This prevents you, in those two years, from applying for an immigrant visa. You can still apply for a tourist visa, and you could apply for another J visa (which is a non-immigrant visa). If you get a second J, I think the two year requirement clock is reset (i.e. you won't owe 4 years).

The J-1 student visa is a different beast. You are not subject to the 2 year rule, as long as you are not obtaining "Graduate Medical Education". If you're getting "Undergraduate Medical Education" (which is a medical student rotation) then you're not bound by the 2 year rule. I could see a program considering your training as GME, and hence the 2 year rule attaches -- in that case, the answer is the same as above -- you can always get another J.

Thank you aPD. Your reply really clarified many things that I didn't know in the past.

So attending this 6 months clerkships program as GME will be subject to the INA 212(e) requirement, but won't prevent me from applying for another J-1 visa for residency if I match later. In addition, it won't prevent me from applying for B-1 or F-1 visa later. Right?

Also, I avoided sending applications to universities that require J-1 visa for their final year electives(obviously as Undergraduate Medical Education). So there should be no reason to avoid them. Right?

Originally Posted by rox

Thank you aPD. Your reply really clarified many things that I didn't know in the past.

So attending this 6 months clerkships program as GME will be subject to the INA 212(e) requirement, but won't prevent me from applying for another J-1 visa for residency if I match later. In addition, it won't prevent me from applying for B-1 or F-1 visa later. Right?

Also, I avoided sending applications to universities that require J-1 visa for their final year electives(obviously as Undergraduate Medical Education). So there should be no reason to avoid them. Right?

Correct on all counts, although I again suggest you review this with a visa lawyer as it's always more complicated than it looks.

Hello APD,

I got another question concerning the J1-Visa.
I´m still a medical student entering my final year in August 2008, and I´m planning on applying for medical electives in Pediatrics (and maybe Internal Medicine).

As I have read so far some programms (like MSSM) require you to get a J1-Visa, while other accept a B1-Visa.

If I understand it correctly, the J1-Visa for Undergraduate Medical Education (final year electives) does not fall under the 2 year rule.
But if I apply for a Residency later (after passing all 3 Steps of the USMLE), would it prevent me to apply for an H1B Visa?

Regarding the J1-Visa for a Residency, as I have read there is still the possibility to avoid leaving the country for 2 years by working in an underserved area.
Could you give me a rough idea what I would have to expect if I worked in an underserved area as a Pediatrician?
Which places for example are underserved areas?
In Germany, we have a lack of medical professionals especially in East Germany, because after the Berliner Mauer fell many people went to live in the western parts.
There is also a great demand for medical doctors in small rural communites.
Is this comparable to the underserved areas in the US?

Thank you for your help.

Originally Posted by aProgDirector

Correct on all counts, although I again suggest you review this with a visa lawyer as it's always more complicated than it looks.

Thank you aPD.

Originally Posted by MaxMoonMD

Hello APD,

I got another question concerning the J1-Visa.
I´m still a medical student entering my final year in August 2008, and I´m planning on applying for medical electives in Pediatrics (and maybe Internal Medicine).

As I have read so far some programms (like MSSM) require you to get a J1-Visa, while other accept a B1-Visa.

If I understand it correctly, the J1-Visa for Undergraduate Medical Education (final year electives) does not fall under the 2 year rule.
But if I apply for a Residency later (after passing all 3 Steps of the USMLE), would it prevent me to apply for an H1B Visa?

Regarding the J1-Visa for a Residency, as I have read there is still the possibility to avoid leaving the country for 2 years by working in an underserved area.
Could you give me a rough idea what I would have to expect if I worked in an underserved area as a Pediatrician?
Which places for example are underserved areas?
In Germany, we have a lack of medical professionals especially in East Germany, because after the Berliner Mauer fell many people went to live in the western parts.
There is also a great demand for medical doctors in small rural communites.
Is this comparable to the underserved areas in the US?

Thank you for your help.

A J-1 for UME (Still enrolled in medical school, away elective, not paid) does not prevent you from getting an H1b in the future.

You can stay in the US after finishing training on a J1 via the J1 waiver program. In this program, each state is allowed to define "underserved" areas, and give out a maximum of 30 J-1 waiver positions. Accepting one of these positions converts your J1 to an H1, and you must work at the position for 3 years. After that, you have an H1 which you can then transfer and apply for a green card (via an employer sponsored process).

Not all states offer J1 Waiver positions. Although there are (I'm sure) some reasonable J1 positions, there are stories of nightmares as you can't leave your job for three years, no matter how they treat you. One recent story is here.

Thank you so much everyone (especially aPD) for this very helpful thread. Does anyone have a list of residency programs that offer the H1B visa or any previous thread with such info? Also, how difficult is it to get a residency position with H1B visa if you are a non-US citizen(non-Canadian) graduate of a US medical school? For instance, do you have to stand out from other US medical grads (higher boards scores, publications, etc)?

Originally Posted by Nattoyum

Thank you so much everyone (especially aPD) for this very helpful thread. Does anyone have a list of residency programs that offer the H1B visa or any previous thread with such info? Also, how difficult is it to get a residency position with H1B visa if you are a non-US citizen(non-Canadian) graduate of a US medical school? For instance, do you have to stand out from other US medical grads (higher boards scores, publications, etc)?

Non-US citizen graduates of US Medical schools do equally well in the match. Perhaps for the most competitive slots there might be programs that don't want to bother with a visa, but this will be very rare. Again, as mentioned above, as a non-US citizen in a US school on an F visa, you'll be able to do most of your internship on an OPT visa and then likely transition to an H1b.

Any list of H1b friendly programs is suspect. Things change all the time, and these lists are usually designed for IMG's looking for an H1b, which is very different from your situation.

Just to update with new info. If you are on F-1 you are actually allowed to select the start of your OPT status within 60 days of your graduation date. This way the OPT will allow you to do a full year of internship and then get your H1B for the next 6 years.
New changes done last week will also allow you to stay on OPT if your employer has filed an application for you even if the OPT has already expired.

H-1B Cap Gap:
An F-1 student on OPT whose employer has filed a timely application for an H-1B on the student's behalf will be able to stay in the U.S. and continue working between the OPT expiration date and the H-1B start date. This would apply to all students on OPT and not just those in STEM fields who are eligible for an extension.

Slight correction. If you are a foreign citizen but graduate from an U.S. medical school, you are eligible for H1B immediately upon graduation. You are exempt from step 3. H1B requires you to be a "professional" and as a physician, you are considered "professional" if you either hold an American M.D. degree (as simple as that) or hold a foreign M.D. degree AND have to had passed USMLE step III.

However, realistically, if you have graduated from an U.S. medical school, you still want to use OPT anyway for your intern year because 1) use OPT for one year means you have 6 more years of H1B to use (1+6) and 2) by the time you found out where you matched, it is difficult for you to get an H1B visa approved in time to start your internship. By contrast, you can get an OPT approved without knowing where you will be because you are technically still on your student visa.

But the implication is that by Jan of the following year, you can get your residency program to apply your H1B already without having passed Step III yet. Don't wait. You are eligible to apply for your H1B up to 6 months in advance. Start planning that a month in advance (i.e. seven months before because most residency program sits on your paperwork forever before talking to the lawyer) so your lawyer get the application out on that first day eligibility. You will save yourself $1000 in premier processing fee doing so.

Yes, you can moonlight on H1B. But most places you want to moonlight at won't want to bother to get you a concurrent H1B work visa. Realistically, that's just not possible.

A few years ago, Harvard-affiliated programs, UCSF and University of Washington were H1B friendly. UCSD is a J1 visa only place. Not sure about it now.

For Canadians coming down to the U.S. for medical school, you should consider going back to Canada for residency. Doing residency in the U.S. and go through this work visa hassle is not worth your time.

A few of my attendings did J1 waivers and they made lots of money (but were really bored). I guess they were lucky. It could have been worse for them!

For all intents and purposes, Canadians are treated as like all other foreign citizens in the U.S. There are no benefits for Canadians. In fact, physicians are excluded from TN visa's. So H1B and J1 are the only options for them. The only thing that distinguishes Canadians is that they don't need a formal visa stamp in their passports (unlike other foreigners who need to get their consulates to add visa stamps in their passport which take extra few weeks of time).

I believe that if you are on J1, even if you marry an American, you cannot convert to green card or citizenship. You either go to underserved area in the U.S. for 3 years or be ready to take your American wife with you back to your home country for 2 years afterwards. Don't take the J1 visa lightly.

I will add more if I think of something.

Good post Thewonderer!

Originally Posted by Thewonderer

I believe that if you are on J1, even if you marry an American, you cannot convert to green card or citizenship. You either go to underserved area in the U.S. for 3 years or be ready to take your American wife with you back to your home country for 2 years afterwards. Don't take the J1 visa lightly.

I think you can also go work for the VA, which doesn't necessarily have to be in an undeserved location.

I keep reading about how USMLE Step 1, 2 and 3 are needed in order to get the H1B visa. What about DO students? Is COMLEX 1, 2 and 3 sufficient for an H1B (i.e. could I just take Step 1 in addition to the COMLEX exam)??

sorry, I don't know about D.O. That's a tough question. You can try the following law firm.

http://www.shusterman.com/medguide.html

They are pretty knowledgable but expensive. I was going to ask them a question but their consultation fee was high. That scared me away

Originally Posted by PistolPete

Good post Thewonderer!



I think you can also go work for the VA, which doesn't necessarily have to be in an undeserved location.

I keep reading about how USMLE Step 1, 2 and 3 are needed in order to get the H1B visa. What about DO students? Is COMLEX 1, 2 and 3 sufficient for an H1B (i.e. could I just take Step 1 in addition to the COMLEX exam)??

Most of DO residencies have no experience whatsoever with foreign applicants! I emailed few of them back in the days and they were like what? visa? why would you need one?
A lot of dual accredited residencies would sponsor for H1B though!

Wonderer,

Are you 100% sure that US graduates are exempt of writing step three for H1B?? are we automaticaly licensed physicians in the state we graduate from?

Originally Posted by Thewonderer

Yes, you can moonlight on H1B. But most places you want to moonlight at won't want to bother to get you a concurrent H1B work visa. Realistically, that's just not possible.

For Canadians coming down to the U.S. for medical school, you should consider going back to Canada for residency. Doing residency in the U.S. and go through this work visa hassle is not worth your time.

A few of my attendings did J1 waivers and they made lots of money (but were really bored). I guess they were lucky. It could have been worse for them!

.

Some hospitals seem to turn the blind eye on this as I know of few J-1 residents who moonlighted.
There are a lot of programs willling to sponsor for H1B. I have emailed over 27 Neurosurgery programs and over 10 of them were willing to sponsor for H1B. If you are planning to stay in the USA I say go for H1B, if you want to work in Canada I say do your best to match in Canada but keep your options open because it's very hard, this year only 54% of US grads matched in Canada!!

The problems with J-1 is not only the returning home clause, it's that as a Canadian you are really limited in your choices of residencies! The other problem s that you are at risk of getting abused if you apply for a waiver. I know a Cardiologist who had to work for 90K a year in order to get his waiver. While that might not be a problem for an IMG with no debt. If you are Canadian wih 250k in debt, this simply means that you are filing for bankrupcy!

Originally Posted by M.Furfur

Most of DO residencies have no experience whatsoever with foreign applicants! I emailed few of them back in the days and they were like what? visa? why would you need one?
A lot of dual accredited residencies would sponsor for H1B though!

I know that osteopathic residencies don't (usually) sponsor visas. That was not my question.

My question was, as an osteopathic student that will be applying to ALLOPATHIC residencies that do sponsor H1B visas, can I ONLY take Step 1 (possibly Step 2CK)? I ask because the allopathic residency websites always state that USMLE Steps 1 , 2 and 3 must be complete before H1B sponsorship. One website even stated that USMLE 1, 2 AND 3 must be complete before the rank order list is submitted in February in order to be eligible for H1B, which I don't know how that is possible since I believe you need to have graduated from medical school before you can even sit for Step 3.

So anyway, my question was can I still get an H1B if I do NOT pass USMLE Step 3, but do pass COMLEX III?

I really don't want to have to spend an extra $2000 (or however much it is) as well as time and energey to take 6 board exams as a medical student if I can help it.

I don't know for sure but if COMLEX III is necessary to become a licensed physician in that state, then I would say yes.

"Wonderer,

Are you 100% sure that US graduates are exempt of writing step three for H1B?? are we automaticaly licensed physicians in the state we graduate from?"

These are two separate issues. For the purpose of H1B visa sponsorship, if you have an American M.D., you are eligible to be sponsored. You would still need to take step III in most states to hold a valid medical license in that state.

The reason for the confusion is that almost all the folks who need H1B sponsorship are foreigners who have graduated from foreign medical schools. So the mantra of step III is repeated on these websites over and over again. Foreigners who hold American M.D. degree are very very rare.

Again, some residencies programs might not know the details of American M.D. and H1B sponsorship.l YOu should still check with them individually before you interview or match.

A couple of points:

1. Theoretically, TheWonderer is correct that you should not have to take USMLE III for an H Visa. The rule with an H is that, if a license is required to do the job you are applying for, that you are qualified to get that license. Since all residents start on some sort of training license (or, some states actually have no license at all), and Step 3 is not required to start internship, theoretically no one (US grad or not) should need Step 3.

However, it's up to the USCIS to decide whether you've met the legal requirements, and it appears that they do not differentiate between a resident physician and a physician in general. Since USCIS usually requires Step 3, all non-US citizens applying for an H, regardless of the location of their medical school, should plan on taking Step 3.

2. The COMLEX exams should be equivalent for an H visa, as they equally allow you to get a license. I have no direct experience with this, though.

3. Moonlighting on a J visa is a very bad idea, even if your program is willing to "overlook" it. It is a visa violation. If, 5 years down the line, you are working at your J Waiver position and trying to get a GC and someone notices that you were moonlighting while on your J, your visa can be immediately revoked, all of your work towards citizenship annulled, and you can be deported. Although that's unlikely to happen, IMHO it's not worth the risk.

For your information:

H-1B Visas

The other H-1B option is open to persons seeking to engage in a clinical practice or engage in graduate medical training. Such persons generally must meet a number of requirements including the following:

1. Passage of an appropriate credentialing exam. These would include the Federation Licensing Examination (FLEX)(parts I and II), the National Board of Medical Examiners certifying examinations (NBME)(Parts I, II and III) and the United States Medical Licensing Examination (USMLE)(steps 1, 2 and 3). Note that combinations of parts of different examinations will not suffice;

2. Proficiency in English demonstrated by passing the English test of the Educational Commission for Foreign Medical Graduates (ECFMG);

3. A full and unrestricted license to practice medicine in a foreign country or graduation from a foreign medical school; and

4. A license or other authorization to practice medicine in the state where the doctor will be working.

Note that the first three requirements noted above do not apply to doctors who graduate from medical schools in the United States. Such doctors only need to show they have graduated from a US medical school and that they possess the appropriate state license. Also, the first two requirements above are waived for doctors who are of national or international renown in their area of specialization and who have graduated from a foreign medical school.

For all doctors applying for H-1B visas, the basic requirements for that visa still apply - the position must pay the prevailing wage, the employer must file a Labor Condition Application, the employer must file an I-129 form with the INS, etc.


I sincerely hope that the above is true. According to 8 C.F.R. § 214.2(h)(4)(viii)(B)(2), "(2) The alien has passed the Federation Licensing Examination (or an equivalent examination as determined by the Secretary of Health and Human Services) or is a graduate of a United States medical school; and


(i) Has competency in oral and written English which shall be demonstrated by the passage of the English language proficiency test given by the Educational Commission for Foreign Medical Graduates; or


(ii) Is a graduate of a school of medicine accredited by a body or bodies approved for that purpose by the Secretary of Education.

I'll probably have to check on this with a lawyer, but it seems that foreign nationals who are graduates of US medical schools (I presume this applies to osteopathic medical schools as well) do not have to show proof of passage of all 3 USMLE examinations to USCIS in order to get an H1-B visa, but only that they have a state license (which requires passing either the USMLE exams or COMLEX exams).

In that case, I hope that I can just do COMLEX 1-3 and USMLE 1 and (maybe) IICK, get my temporary state license, and be good to go.

[QUOTE=aProgDirector;6738231]A couple of points:

1. Theoretically, TheWonderer is correct that you should not have to take USMLE III for an H Visa. The rule with an H is that, if a license is required to do the job you are applying for, that you are qualified to get that license. Since all residents start on some sort of training license (or, some states actually have no license at all), and Step 3 is not required to start internship, theoretically no one (US grad or not) should need Step 3.

However, it's up to the USCIS to decide whether you've met the legal requirements, and it appears that they do not differentiate between a resident physician and a physician in general. Since USCIS usually requires Step 3, all non-US citizens applying for an H, regardless of the location of their medical school, should plan on taking Step 3.

[QUOTE]

Sorry, I don't mean to offend you. But there is no such thing as theoretically right or wrong on this subject. If you have an American M.D., you are eligible to apply and receive your H1B the day you get your diploma.

I cannot overemphasize this because timing is so important. Use OPT in your intern year. But by beginning of Dec, start getting your program to fill out H1B paperwork and hire a lawyer so everything is ready to be mailed to US Immigration by some time in Jan; the reason is that the earliest date you can apply for H1B is exactly 6 months before your starting date.

Don't wait. Some states, correct me if I am wrong, won't let you take step III until end of internship year. Some people might wait until Step III scores to come back. Don't wait for any of these if you have an American M.D. degree. You want to save yourself grief and have to scramble and pay $1000 down the road near June for premier processing.

You already paid enough tuition. Save yourself $1000.

Originally Posted by Thewonderer

Sorry, I don't mean to offend you. But there is no such thing as theoretically right or wrong on this subject. If you have an American M.D., you are eligible to apply and receive your H1B the day you get your diploma.

No offense taken, and PistolPete has documented that this is true. I stand corrected, happily.

Originally Posted by Thewonderer

I cannot overemphasize this because timing is so important. Use OPT in your intern year.

A good point. Although you can get an H1b right out of medical school, it's unlikely (but not impossible) that it will all be completed between graduation and the beginning of internship.

Originally Posted by Thewonderer

Some states, correct me if I am wrong, won't let you take step III until end of internship year.

This is confusing. In order to take Step 3, you must be "sponsored" by a medical licensing authority (i.e. a state). Each state sets it's own rules about minimum criteria. Sometimes you need no GME experience, 6 months, 12 months, or 2-3 years. The rules for AMG's and IMG's are often different.

Here's where it gets confusing: You can be sponsored by ANY state -- you don't have to live there, work there, or travel there at all. Once you're sponsored by a state, you can then take the exam in any other state. Some states have no GME training requirements -- hence you can definitely take Step 3 anytime after you 1) pass Step 1 and 2, and 2) graduate from medical school as long as you apply to one of the states that has no GME requirements.

...

Originally Posted by MX health

Hi,

I'm trying to get information regarding the following question and I apologize if this has been covered before.

If Im doing a master's in public health, already ECFMG certified, under an F1 visa, can I use my OPT for internship? If so, do I have to take step 3 before internship to get H1-B in the future?

For the OPT question, theroretically no. The practical training on the OPT/F1 is supposed to be directly related to the F visa studies. Hence, if you wanted to do an "MPH internship" at the CDC, you could use an OPT visa. But you can't use an OPT visa to do a medical internship after an MPH.

That being said, I have seen this done before. It depends on the MPH school (which would need to sponsor the visa), the program, and the USCIS.

As for the H1b question, if you went to a foreign medical school you will need to take Step 3 prior to an H1b visa. Foreign nationals attending US schools may be able to get an H1b without Step 3. Regardless, it's best to have Step 3 done before applying, so it's not an issue.

hi
i have one question that have been bothering me for longtime
is it possible to finish both residency and fellowship in a J 1 visa??
in other word can i do my 3 year residency in internal medicine then follow it up with 4 years cardiology followship...?? thats total of 7 years
plz give me an answer .. i really need it
thanks

You can definitely do this. Cardiology is actually only a 3 year fellowship. Although interventional and EP are both theoretically 1 additional year, many programs have extended them to 2 years. The J is only good for 7 years, so you may not be able to train in IV or EP.

Hi,

I am a Canadian citizen studying in Canada. What would be the best visa for me to come practice in US AFTER finishing all my training in Canada?

Thanks for letting me know

Others might be more knowledgable in answering this question than me, but if you finish all your residency training in Canada, get board certified, and then want to come practice in the US, it would probably be best to just get the hospital or private group to sponsor you for a green card.

Alternatively, you could get the H1-B visa, but that is only good for 6 years, so you'd need a green card later anyway, assuming you want to stay in the US for more than 6 years. J-1 visa would be least useful to you, I think.

I'm considering doing research in the states but I'm confused whether I should look for a paid research(i.e J1) on an unpaid one(i.e B1).

Before I post tons of questions, I'd appreciate it if anyone first can establish whether a research J-1 visa is bound by the 2 year rule or not.

Originally Posted by rox

I'm considering doing research in the states but I'm confused whether I should look for a paid research(i.e J1) on an unpaid one(i.e B1).

Before I post tons of questions, I'd appreciate it if anyone first can establish whether a research J-1 visa is bound by the 2 year rule or not.

It is not, sort of.

The main site of information about J visas from the US gov't is here.

On that page, you'll find:

Two-Year Foreign Residency Requirement

An exchange visitor is subject to INA 212(e) requirement, if the following conditions exist:

• The program in which the exchange visitor was participating was financed in whole or in part directly or indirectly by the United States government or the government of the exchange visitor's nationality or last residence;
• The exchange visitor is a national or resident of a country designated as requiring the services of persons engaged in the field of specialized knowledge or skills in which the exchange visitor was engaged for the duration of their program (Exchange Visitor Skills List 9 FAM 41.62, Exhibit II);
• The exchange visitor entered the United States to receive graduate medical education or training.

So, if you are here as a Research Scholar you are not part of GME and hence the 2 year rule does not attach.

BUT!!!!!

The Research J has it's own rule, that bars you from getting another research J for 2 years after you leave the US. That's described nicely here.

So, from my review of the situation, nothing would stop you from working on a research J and then switching to a clinical J, but you'd probably need to leave the country, give up one visa, and apply for another.

That being said, you should check with a lawyer, rather than someone who simply reads what's on the internet (which would be me).

aProgDirector, thanx a lot for your replies in the thread!

I still have one question though. As most of US residency programs require PGY-1 before applying to them, is it possible for a Canadian med graduate to match in Canada, spend one year in this program (and take Step 3 during it) and apply for US residency with H1 B sponsorship?
This way the grad student can get necessary PGY-1 training and has time to take Step 3 exam (which is required in most cases for H1 B sponsorship). What do you think? Is this pathway feasible?

Originally Posted by legal78

aProgDirector, thanx a lot for your replies in the thread!

I still have one question though. As most of US residency programs require PGY-1 before applying to them, is it possible for a Canadian med graduate to match in Canada, spend one year in this program (and take Step 3 during it) and apply for US residency with H1 B sponsorship?
This way the grad student can get necessary PGY-1 training and has time to take Step 3 exam (which is required in most cases for H1 B sponsorship). What do you think? Is this pathway feasible?

Most US residency programs do not require a PGY-1. Some fields are designed to require a prelim year (like derm and rads).

So, assuming you meant "If I plan to apply for Advanced programs in the match, can I apply for a canadian PGY-1 prelim year, take Step 3, and then get an H1b?". The answer is yes, but remember that if you apply for an advanced spot (i.e. PGY-2) the match is for the following year -- ie. the Rads/Derm matches that just occurred are for spots starting July 2010 (not 2009). So you could:

1. Apply in your 4th year of med school to canadian prelims and US advanced matches. Presumably match into both. Complete the prelim, take STep 3 during prelim, and start PGY-2 on an H1b.

2. Apply in your 4th year to prelims only. Start the prelim, complete Step 3. Apply to PGY-2's in the match while a prelim. Getting enough time to interview can be a big problem. If you match, you have a year off between the end of the prelim and the beginning of the PGY-2.

3. Apply in your 4th year to prelims only. Complete the prelim, complete Step 3. Apply to PGY-2 programs, and match. Now you have 2 years off between your prelim and PGY-2.

Thanks, I've just never heard of Canadian prelim programs (have you?), but I'll try to figure it out.

Originally Posted by aProgDirector

If you get hired in the US into a permanent job (i.e. NOT residency) on an H visa, your employer can sponsor you for permanent residency. This is one of the easiest paths to citizenship. Note I said "easiest", not "easy". This is the major advantage of the H visa. Note that if your H is obtained outside of the cap, this will only work for an employer who is University / Non profit.

How long does the process take to obtain a GC? Is there any sort of transitional visa between H1 and GC(I believe there is such a thing for those who marry american citizens)?

Originally Posted by rox

How long does the process take to obtain a GC? Is there any sort of transitional visa between H1 and GC(I believe there is such a thing for those who marry american citizens)?

Hard to say how long it takes to get a GC, since it depends on how you apply. For example, you can't just marry a US citizen and apply for a GC -- there's all sorts of hoops to jump through and you have to prove it's not a marriage of convenience, etc.

If you are in process of getting a GC, you can usually get an EAD which would allow you to work.

Originally Posted by aProgDirector

You can only change specialties once on a J visa, before the end of the PGY-2 year.

Can one change specialities beyond PGY2 while on H1 visa?

If you're on J1 visa and get a Green Card, can you change specialities beynod PGY2 ?

Thanks.

Originally Posted by rox

Can one change specialities beyond PGY2 while on H1 visa?

If you're on J1 visa and get a Green Card, can you change specialities beyod PGY2 ?

Thanks.

1. I believe you can switch specialties on an H, although remember that H is limited to 6 years.

2. Getting a green card while on a J is not possible, AFAIK. Even if you marry a US citizen, you still must return to your home country for 2 years or pursue a J waiver.

Originally Posted by aProgDirector

1. I believe you can switch specialties on an H, although remember that H is limited to 6 years.

2. Getting a green card while on a J is not possible, AFAIK. Even if you marry a US citizen, you still must return to your home country for 2 years or pursue a J waiver.

Thanks for the reply aPD. I understand these questions might be kind of best answered by a lawyer, but I was hoping someone here might have any input or been through the same situation before.

I can understand why people have to return to their country or do the waiver even if they get a GC while on J visa, but can't they still get the GC when they marry a US citizen anyway?

On a related note, when we say "return to their home country", does that necessarily mean their country of citizenship or basically anywhere outside the US?

Originally Posted by rox

Thanks for the reply aPD. I understand these questions might be kind of best answered by a lawyer, but I was hoping someone here might have any input or been through the same situation before.

I can understand why people have to return to their country or do the waiver even if they get a GC while on J visa, but can't they still get the GC when they marry a US citizen anyway?

On a related note, when we stay "return to their home country", does that necessarily mean their country of citizenship or basically anywhere outside the US?

Not sure if you were looking for another answer from me, or someone else.

"Home country" = whatever country sponsored your J visa. That's where you must go for 2 years, I believe.

Hi,

I'm a British med student and was hoping to avoid visa issues by marrying my (American) boyfriend before applying for residency.

Does anyone have any rough idea (ie months, a year or several years) how far in advance of applying for the match we would need to marry in order for me to be on a green card?? (we'd be living in the UK and I would basically only be entering the US in order to do the residency and then presumably stay afterwards - do you have to have lived in the US for a certain period in order to be green card eligible?).

Also am i correct that if i was able to get the green card this would go some way to reducing the difficulty of matching as a foreign grad (as well as coming from a top UK university)?

Thanks!