IM H1B VS J1 VISA

[yellowbluegreen]

Hey guys,

I am currently in the process of ranking my IM programs. So far, it appears that my good university programs are mainly J1 wheras my H1B programs are not as stellar as the J-1. It has come to my attention that it is extremely difficult to secure a fellowship on an H1B? Personally, I am interested in Cardiology or Rheumatology. I am not sure if I should rank programs based on reputations or visa.

If anyone can help me sort this dilemma out, I would greatly appreciate it!

Thank you!

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[Animalcules]

It depends what your goals are. If you want to stay in academia, H1B always. If you are fine with a few years in an underserved area after fellowship, J1.

 

[Pier]

Question from a total outsider trying to understand the situation a bit: wouldn't it be better to work for the VA? Or do the VA have a subsection of "underserved areas" within the VA?
These question are based on the assumption that VA can substituite the "working in underserved area" thing.

 

[dbalfour]

Yes it is hard to get H1b for fellowship, although not impossible. I did residency at a community hospital IM program on H1b. Most of the people in my residency who went onto fellowships actually got a green card after residency doing hospitalist or PCP work before going onto fellowship. Some have gone onto fellowships on J1 right after residency. I know of one who did H1b for fellowship. She already had a lot of research under her belt before residency, so she was able to get green card while in fellowship, but for a while it was harrowing for her as well since the 6 year limit of H1b doesn't give you a whole lot of time to get a green card. I would say, unless you are able to get into top notch program on J1, H1b for residency is usually better, especially if your ultimate goal is to get into academics. You are not tied to a J1 waiver, which will require 3 years of service at least, before moving onto get a green card, while if you got a sponsor after residency on H1b you can go straight to a green card within 1-2 years (depending on country of origin, of course). If you go to a prestigious J1 residency, then straight onto a fellowship on a J1, you will still need to do J1 waiver after, which could be done at an academic institution if there is a VA, but usually you will be forced to find an underserved area, which means there will be a big gap after fellowship for academics, if that is where you are headed. Of course, if academics is not your ultimate goal, that doesn't matter, and many people have found their J1 waiver positions nice places to actually settle down.

 

[NotAProgDirector]

The summaries above are spot on. As you've discovered, more competitive programs tend to offer J visas, where less competitive offer H visas -- as an incentive to get more competitive applicants. If you complete a residency on an H, getting a fellowship on an H is much more challenging -- those same places that interviewed you and offered J's won't take you on an H visa for fellowship (most likely). You can put in your application that you're willing to switch to a J for fellowship, but they are unlikely to believe it. Places that are offering you an H for residency, you could get a fellowship on an H -- but there are less of those types of programs. I had a stellar resident recently on an H whom applied to a competitive fellowship, got very few interviews, ultimately matched but it was a nail biter for us all -- but he was looking at top notch univ programs.

No easy answer. Pick your poison.

 

[yellowbluegreen]

Thank you so much for this incredible information as I have been torn between how to choose my residency programs. I was wondering if you guys could comment on the following concern.

I have heard mixed reviews in regard to Cleveland Clinic Florida (H1B) and I was wondering if it holds the same level of reputation as the CCF. I know it does not hold the exact same reputation but in the eyes of fellowship programs, do they consider it a solid program? Contemplating if that's a better choice or a University of Miami with a J-1? Also University of Miami has a VA hospital so theoretically speaking would I be able to do my 3 years of waivership there? How bad is this wavership?

I really appreciate all your advice and help! You guys are amazing!