rdk322

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Aug 10, 2013
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Hi,

I know this may be TOO FAR down the road and I don't want to bother busy residents/med students but this has been bugging me for a while!
I started my first year at a US DO school a few months ago (I'm a Canadian citizen. Not dual) and based on the changes in the Canadian residency system, it it seems highly likely that I'd be down in the US to do residency. I've been reading up on both J1 and H1B issues and with the H1B being hard to come by, I figured I may have to have a back up plan on a J1 while aiming for an H1B.

That being said, I heard about the waiver/return of service with J1. I just wanted to talk to someone who went through this process to tell me what lies ahead/how the experience was. There are days when I keep questioning whether this journey would be worth it all. I like what I'm learning at school and I'm doing fine, but I just don't want things to stop because of visa problems.

I know that there are many threads on visa issues but I haven't been able to find a satisfying answer for my case - Canadian on J1 (would be more relevant if US DO grad but I assume visa problem affects US MD grads just as much).
It seems like some people resort to involving an immigration lawyer in the end.
Has anyone gone through this to comment on it or know any legal counselling services wiling to speak with students on this matter?
(I obviously cannot afford a lawyer now :( I just want some first hand or expert opinion).

Thanks!
 

ThoracicGuy

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You will need to have a certificate of need for your specialty to get a visa from Canada for residency. DO programs are unlikely to have dealt with many people needing visas as compared to MD programs. You should not need an immigration lawyer.
 
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rdk322

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You will need to have a certificate of need for your specialty to get a visa from Canada for residency. DO programs are unlikely to have dealt with many people needing visas as compared to MD programs. You should not need an immigration lawyer.
Thanks ThoracicGuy! I figured there weren't many of my cases around. How about the Canadian MDs though? Do you know what happens to them after their J1? Are they generally able to get waiver or find a way to practise medicine one way or the other? Thanks!
 

aProgDirector

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Whether you are a DO or an MD shouldn't matter, the process is the same:

1. You complete medical school on an F visa.

2. When you match into a residency, you will need a work visa. You will have 2 3/4 options:
A. An OPT extension of your F visa. This is good for 12 months, so only counts as a half an option, since it won't cover your residency. You should check with your medical school whether they will sponsor this. It must come from your medical school. It's very easy for them to do. Assuming this is an option (which it should be), it's what you should use for your PGY-1. This will then give you an extra 12 months to choose something else.
B. An H1b visa. Some residency programs will offer you an H1b. If so, it's hands down the way to go. Because of your OPT, you'll have the whole 12 months of the PGY-1 to get it settled. You'll need to take Step 3 for an H1b (probably, long story), so plan to do so early in your PGY-1. The hospital where you are working will pay for a lawyer for the visa. It's good for 3 years, renewable once, and if you get a job on an H1b you can get a Green Card and become a US citizen (if you don't return to CA).
C. A J-1 visa. You'll need a Statement of Need from your Province, which (sometimes) can be a PITA. But if you try hard enough, you'll get one. And, if you've followed Step A, you'll have 15 months to get it (you can start right after match).
D. Marry a US citizen. This only counts as 1/4 of a solution. But, if you marry someone in the US while in medical school, you'll become a citizen by marriage and all is good. Don't marry someone just to become a citizen -- if you create a "marriage of convenience" and trigger a review, a world of hurt will fall upon you.

3. When you finish your residency, you can:
A. Stay in the US. If on an H visa, you simply get a job on your H visa. Your options may be somewhat limited but many places will sponsor an H for you. They can then sponsor you for a Green Card, and you'll become a US citizen. If you're on a J visa, then you'll need a J waiver. This will more seriously limit your options (and it will depend upon your specialty), but there's a good chance that you'll get a J waiver job -- it just might not be where you would choose to live, or not at the type of place you might want to work. But there are exceptions.
B. Return to Canada -- US training is considered equivalent. Some Canadian residencies are longer than US -- IM is a prime example. In that case, you might need to either work one extra year in the US as a resident, or figure out a way to get credit for a year in Canada. I have seen both options happen.
 

RuralMedicine

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Marry a US citizen. This only counts as 1/4 of a solution. But, if you marry someone in the US while in medical school, you'll become a citizen by marriage and all is good. Don't marry someone just to become a citizen -- if you create a "marriage of convenience" and trigger a review, a world of hurt will fall upon you.
Marrying a US citizen will not grant someone citizenship. If certain conditions are met the spouse may qualify for permanent residency (i.e. greencard). The spouse can opt to then proceed with applying for citizenship but this is a different process. Also be aware that if one uses marriage to a citizen to apply for permanent residency and applies before they have been married for two or more years any green card which is issued will be conditional and further USCIS interviews will be required before permanent residency is granted. Anecdotally, I have been told that these marriages are much more highly scrutinized as well.
 

aProgDirector

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Yes, I agree. I was a bit too cavalier about the marriage --> citizenship pathway.

If the OP wants a J visa, no lawyer is necessary. This is usually very straightforward.
If the OP wants an H visa, a lawyer is always needed. Usually it will be paid for by the employer.
If the OP wants a GC via marriage or any other pathway, a lawyer who knows what they are doing is critical. Missteps are easy, painful, and irreversible.
 
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rdk322

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Thanks for the input, @aProgDirector and @RuralMedicine!

I read many stories here about visa problems and things getting complicated so I wanted to know what I was getting myself into. Unfortunately, my school doesn't seem to know how to help international students beyond helping them match (mostly J1 and they don't know what happened to them afterwards). From what it sounds like there seems to be a few ways to get around the problems based on what's been mentioned here but

1) do you think international AMGs can realistically expect to practise in the US? (provided that one goes for primary care).

2) How feasible is it to obtain J1 waivers for AMGs? aPD mentioned that it will work likely but I thought there was a cap and I thought it'd be very competitive.

Thank you again!!
 

Raryn

Infernal Internist / Enigmatic Endocrinologist
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Thanks for the input, @aProgDirector and @RuralMedicine!

I read many stories here about visa problems and things getting complicated so I wanted to know what I was getting myself into. Unfortunately, my school doesn't seem to know how to help international students beyond helping them match (mostly J1 and they don't know what happened to them afterwards). From what it sounds like there seems to be a few ways to get around the problems based on what's been mentioned here but

1) do you think international AMGs can realistically expect to practise in the US? (provided that one goes for primary care).

2) How feasible is it to obtain J1 waivers for AMGs? aPD mentioned that it will work likely but I thought there was a cap and I thought it'd be very competitive.

Thank you again!!
The cap is 30/state. Many states don't fill their entire amount of J1 waivers. In addition, positions at VAs frequently (?always?) don't count against the cap. I've known a number of J1s who graduated residency/fellowship and all of them found a waiver job, though some had to move to less desirable locations.
 
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PistolPete

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FYI, Health Canada has been causing problems for DO's wanting J1 statements of need. Another reason why I recommend the H1b (if nothing else, saves you the hassle of dealing with Health Canada, and additionally is a dual-intent visa, allowing a pathway for green card and citizenship down the line, whereas the J1 is an obstacle).

I'm a DO, Canadian citizenship only, that was on a F1 student visa during med school, then OPT for my intern year during which time my program got the services of a lawyer and applied for the H1b on my behalf and paid the costs. Currently on an H1b. Hoping to stay in the US and get the green card eventually. It's been a long and painful process and the visa situation has hindered me in applying to residencies/fellowships, but it's doable.
 
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rdk322

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@PistolPete, thanks for sharing what you went through! I remember talking to you earlier in the summer, but we haven't talked about the statement of need. I understand that H1B is ideal but why would Health Canada cause problems for DOs to obtain the statement of need especially if they're going for the unlimited endorsement fields?
 

PistolPete

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I've just heard that they aren't easy to deal with since they're not as familiar with DO's. I haven't obtained a statement of need or know anyone that has, though, so it could be easier these days… I would email [email protected] to be sure. They don't specifically mention DO's on the website. They do state that your training needs to be ACGME accredited, not AOA, in order to get the statement of need.

"Yes. Postgraduate medical training in the United States that is accredited by the ACGME is recognized by the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, the Collège des médecins du Quebec, and by Canadian provincial and territorial medical regulatory authorities."
 
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