General Eligibility for IMGs
IMGs who seek entry into U.S. programs of Graduate Medical Education (GME), must obtain a visa that permits clinical training to provide medical services.
Obtaining a Visa
J-1 Exchange Visitor Program and ECFMG Sponsorship
The most common visa to participate in U.S. graduate medical education programs is the J-1 visa. The Educational Commission on Foreign Medical Graduates (ECFMG) is authorized by the U.S. Department of State to sponsor IMGs for the J-1 visa. Information on eligibility and deadlines is available from ECFMG's Exchange Visitor Sponsorship Program.
To apply for a J-1 visa, an IMG must have passed the USMLE Step 1 and Step 2 CK, have a valid Standard ECFMG Certificate at the time of commencement of training, hold a contract or an official letter of offer for a position in an accredited program of graduate medical education or training that is affiliated with a medical school, and provide a statement of need from the Ministry of Health of the country of last legal permanent residence (LPR) regardless of country of citizenship.
Two-Year Home Country Physical Presence Requirement
Upon completion of training, they must return to their home country for a period of two years to transmit the knowledge they gained in the U.S. An individual must fulfill (or obtain a waiver of) this obligation before being eligible for a change or adjustment of visa status to certain types of US visas. These visa types include H, temporary worker; L, intra-company transferee; and US permanent resident.
J-1 Visa Waivers
The only exception to the two-year home residence requirement of the J-1 visa program is receipt of a waiver. Under the law, the following three circumstances are the only ones that provide for waiver of the two-year residency requirement:
1. If the waiver applicant can demonstrate that he or she will suffer from persecution in his or her home country or country of last permanent residence;
2. If fulfillment of the residency requirement would bring proven exceptional hardship to the applicant's spouse and/or children who are U.S. citizens or permanent residents;
3. If the applicant is sponsored by an interested governmental agency (IGA) which is interested in the physicianÆs continued employment in the U.S.
Since waivers based on expected persecution or hardship are very rare, most IMGs receive waivers by finding an IGA to sponsor them. Traditionally, the Department of Health and Human Services (DHHS), the Department of Veterans Affairs (VA) and the Appalachian Regional Commission (ARC) were the agencies that sponsored IMGs for J-1 waivers. Recently, the Department of Agriculture (USDA) and the Department of Housing and Urban Development (HUD) began to sponsor IMGs for waivers. In addition, through the Conrad-30 program sponsored by Senator Kent Conrad of North Dakota, state departments of public health may sponsor up to 30 J-1 physicians per year for waivers to provide care in underserved communities.
On December 3, 2004, President Bush signed into law an AHA-backed bill (S. 2302) that extends the State 30/J-1 Visa Waiver Program for two years. The program, which expired in June, allows state health agencies to annual hire up to 30 J-1 foreign physicians to practice in rural and inner-city communities with physician shortages. It waives the requirement that foreign physicians who have completed their residencies in this country return home for two years before they can apply for an immigrant visa. Physicians selected for the waivers can apply for an immigrant visa. Physicians selected for the waivers can practice in primary care or specialty medicine, if a local shortage in the requested specialty can be demonstrated, and are exempt from caps on H1-B visas. Up to five doctors selected in each state can work in regions not specifically designated as underserved by the Department of Health and Human Services.
To enter and remain in the U.S. as a non-immigrant or immigrant requires several steps. First, a foreign citizen or his or her employer or relative must file an application with the Department of Homeland Security (DHS) to be classified in one of the non-immigrant or immigrant visa categories. If the DHS approves the application, the foreign applicant may need to go to a U.S. embassy or consulate overseas to have a visa stamped in his or her passport. This stamp indicates the visa category and the dates of issuance and expiration. At the U.S. border, an immigration inspector will review the visa stamp and issue an admission card. The inspector can authorize admission for any length of time up to the expiration date on the visa stamp. The INS also issues permanent resident alien cards to immigrants in the U.S.
Most of the approximately 50% of IMGs who are not U.S. citizens or permanent residents enter the U.S. on a J-1 Exchange Visitor visa or an H-1B visa.
Temporary Worker H-1B
The H-1B visa is for temporary workers in speciality occupations who hold professional-level degrees. The Immigration Act of 1990, and subsequent technical amendments, made the H-1B available to graduates of foreign medical shools who have passed FLEX or the equivalent, have passed an English language exam, and hold a license appropriate to the activity. The advantage of the H-1B visa is that it has no two-year home residence requirement, as does the J-1. The H-1B allows a foreign national to enter the U.S. for professional level employment for up to six years.
H-1B employment authorization is employer specific. The GME program must file an H-1B petition on behalf of the IMG; the law does not permit prospective trainees to file for themselves. To qualify for an H-1B, an IMG must be in possession of a full, unrestricted state medical license or the appropriate authorization for the position, an MD or full unrestricted foreign medical license, English language competence as established by passage of the ECFMG English language examination and passage of the USMLE Steps 1, 2 and 3.
F-1 Student Optional Practical Training
The INS grants H-1B visas to temporary professional workers who are required to have a prearranged job, either temporary or permanent, in a professional field before they receive a visa. There is an initial admissions period of three years, with the possibility of extending oneÆs stay for a second three-year period. After staying in the U.S. for the maximum six-year period, a foreign citizen is required to live abroad for one year before re-entering the U.S. in an H or L visa category.
An H-3 visa is granted to a trainee who is a foreign citizen coming to the U.S. temporarily to receive training not obtainable in his or her home country. After receiving this training in the U.S., those on an H-3 visa must use the skills gained in the U.S. in a foreign country.
