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International Student Guide:
First of all, I would like to congratulate you on getting into medical school! As an international student at an American medical school, you compose a very select few. That said, the road you will have to fare is slightly different than many of your classmates’. I will try in this guide to give a step by step of how I navigated the process of matching into residency.
Year 1:
There really aren’t too many things about first year that have to do with being an international student on an F1 visa. Your only concerns will be to keep your I-20 alive with Cathy Donahue and making sure to get the necessary paperwork before leaving the country.
The end of Year 1, however, does bring thoughts and questions about research opportunities. As an F1 student, you will be posed with 1 unique challenge and 1 unique opportunity for the summer that I would have liked to know about at the time.
● The challenge in securing research for the summer is that F1 students are not eligible for federal money. This means NIH grants and TL1 will be off-limits to you. Always check with the PI you are interested in working with before signing on for the summer, as there is a good chance that they are being funded with federal money. Obviously, it is your prerogative to work for free
● The opportunity here is that never again will you have enough free time during medical school to secure on campus work. The terms of your visa stipulate that you can work less than 20 hours on a campus job, so whether it is at a lab or at the cafeteria, try to find a job. The reason is somewhat odd but extremely important: you will be able to obtain an EAD - an employment authorization to work in the U.S.A. AND a social security number
○ The social security number is a very, very big deal. With the SSN, your options in terms of banking will open up in the United States
○ The SSN also gives you the ability to apply for certain scholarships
○ Virtually every financial form, leasing contract as you look forward to residency for a new apartment, every scholarship, and eventually your residency contract and VA contracts will require an SSN
○ You CAN wait until you have already matched as a fourth year, as you will be assigned one right before residency begins. However, I cannot tell you the number of opportunities I lost simply because I didn’t have an SSN over my 4 years in medical school. So get a job, even if it’s just for a few months.
○ Looking for apartments, houses, and cars without credit (traditionally tracked by the credit bureaus via SSN) can be stressful if you plan to stay here doing residency
Year 2:
Your second year will be stressful if you do it right. Study, and study hard.As an international student, you need to be rigorously jealous of your exam scores. Step 1 in many ways is a much higher stakes exam for you, and despite your AMG status, you are not judged in the same way by residency programs. You will realize when you are applying for residency that the very first page of the form asks whether or not you will need a work visa. Many programs will auto-screen you out if you ask for certain visas if your step score is not above a certain threshold. This threshold is not uniform for you and other AMG’s.
Your second year is typically also a year where you will be heavily involved in research if you are trying to do something competitive.
-Try to figure out what you want to do early. I know this is a very tall order, as you have not had any true clinical experience yet. But enrich yourself and your knowledge of the specialties, shadow in your very small amount of spare time. Second year is the last time where you will have absolute control over your time.
The reason I bring this up is because once you have a goal of matching into a certain specialty, you will need to speak to your country about something called “statement of need” if you are going to apply for a J1 visa in the future. This is country dependent, i.e. Canada can be very temperamental about how many XYZ surgeons they need that year and may pull support of this visa when you are about to apply. I don’t mean to dash your hopes of following your dreams, but as AMG F1’s, there are certain aspects of the game you will need to be aware of if you want to match.
Year 3:
Honor your clerkships, work hard, learn a lot. Take step 2 CK on time. Don’t take Step 2 CS lightly. Not really much in the way of real international student issues.
Year 4:
Here is where things start to get more tricky.
I will go over visas with you and what I briefly know about South Korean (which we tend to have many of) and Canadian F1 match process. I have heard that the process is very similar for Chinese and Singaporean students.
There are two visas that you will essentially be bargaining for as you go through the interview trail.
J1 Visa: This is an exchange visa that is sponsored by your country of origin. These are essentially free for your residency programs because, as I just noted, they are sponsored by your home country. As you look through the list of programs you would like to apply to, you will notice that many more programs sponsor J1’s over H1’s. This will expand your pool of available programs, but do not be deceived. The J1 visa is a very raw deal for an AMG.
The stipulations are heavy. You will require:
● Statement of need for physicians of your specialty from your home country (as mentioned before, countries can be temperamental even varying by year on how many of a certain doctor they want trained)
● Promise of returning to your home country after training for at least 2 years
○ OR a National Interest Waiver (NIW), which will allow you to serve as an attending in the United States after residency in an underserved area.
The problems are:
● You can’t marry out of it to get a greencard. Once you start the J1 visa, you will be going home for two years or staying on with an NIW
● There are a limited number of J1 spots per state (30 I believe), and the majority of these are reserved for the larger specialties.
● I.e. if you plan on doing GI fellowship after residency, there will be NO J1 spots in California for this training.
● Your country can pull this visa at any time
● Your program can pull this visa at any time
● There are no salary requirements for the program to meet to keep you on this visa.
● If you are a South Korean or Singaporean citizen with stringent military requirements, returning to your home country for 2 years will mean serving in the military before you are an attending.
H1 Visa: This is a work training visa sponsored by the United States. These tend to run the program 2000-3000 USD and a dedicated day of paperwork and legal fees. Legally, you cannot sponsor yourself, and any attempts made by a program to coerce you to do so is a federal offense. That said, only the more competitive academic, privademic programs extend this visa to F1 AMG’s. There are essentially no drawbacks to this visa, as you will be treated as if you were a contracted worker being groomed to become a full time employee and U.S. permanent resident.
The perks include:
● You can marry out of this visa at any time
● You do not have to go back to your home country at any time
● The program must pay you a small percentage above what other residents are generally paid for the work that you do (this is usually enforced more heavily in other lines of work to ensure that H1 visas are not being handed to foreigners for cheaper labor over skilled American employees).
● You can go straight to permanent residency processing after you finish residency.
● There is no H1 cap for physicians like that of J1’s per state
Applying with ERAS:
This will be tedious, but if you do your due diligence you will be handsomely rewarded. The temptation will be to look through some resource like FREIDA Online and check whether a program sponsors an H1 or a J1. This is a dangerous tactic.
Call and directly email the programs you are interested in. This advice may seem innocuous but it means that you will be calling close to 200 programs and emailing them about their visa offer status. The reason to do this directly is that the FREIDA Online information is often out of date. Doing your due diligence at this point will save you hundreds of dollars later on so that you don’t go on an errant flight for an interview for a J1 visa that you don’t want because you made an assumption after perusing a website. Get started early with those calls and emails, they take a long time.
As a general rule, California programs with affiliations to county hospitals no longer sponsor H1’s as of 2016.
Interview Trail:
Always be upfront about your needs concerning a visa. Be very clear with the program director at some point of the day about what type of visa you prefer and whether the program offers it. There are many programs that sponsor either an H1 or a J1 rather than having a hard line about a specific one. So as aggressive as it might seem, you do want them to commit to an H1 if this is the case before you leave the program. Do not be demanding, but explain to them that a your specific set of circumstances. You are an AMG, take pride in this bargaining chip.
Post-match:
Around January of your 4th year you must submit paperwork to Ms. Donahue (the international student advisor) for an extension of your F1 visa to exercise an option called Optional Practical Training. This will be used for your intern year, and is a distinct advantage that you have over IMG’s. This affords you the flexibility of not having to take Step 3 before starting residency. It is also free and buys you time on a J1 to get married if you think that this is where your relationship is headed.
The F1 OPT paperwork and clearance take 3 months to process almost precisely. Do not be lazy about getting this paperwork in as soon as possible. Especially if you did not heed my Year 1 warning to get a social security number. You need your F1 OPT cleared so that you will have an EAD (employment authorization) and an SSN if you want to fill out your residency contract, VA access, and your NPI number before starting residency. Not having this SSN in time will hinder your start time for residency.
Good luck,
Always rooting for you.
Dr Leavey Library, MD
℅ 2016.
First of all, I would like to congratulate you on getting into medical school! As an international student at an American medical school, you compose a very select few. That said, the road you will have to fare is slightly different than many of your classmates’. I will try in this guide to give a step by step of how I navigated the process of matching into residency.
Year 1:
There really aren’t too many things about first year that have to do with being an international student on an F1 visa. Your only concerns will be to keep your I-20 alive with Cathy Donahue and making sure to get the necessary paperwork before leaving the country.
The end of Year 1, however, does bring thoughts and questions about research opportunities. As an F1 student, you will be posed with 1 unique challenge and 1 unique opportunity for the summer that I would have liked to know about at the time.
● The challenge in securing research for the summer is that F1 students are not eligible for federal money. This means NIH grants and TL1 will be off-limits to you. Always check with the PI you are interested in working with before signing on for the summer, as there is a good chance that they are being funded with federal money. Obviously, it is your prerogative to work for free
● The opportunity here is that never again will you have enough free time during medical school to secure on campus work. The terms of your visa stipulate that you can work less than 20 hours on a campus job, so whether it is at a lab or at the cafeteria, try to find a job. The reason is somewhat odd but extremely important: you will be able to obtain an EAD - an employment authorization to work in the U.S.A. AND a social security number
○ The social security number is a very, very big deal. With the SSN, your options in terms of banking will open up in the United States
○ The SSN also gives you the ability to apply for certain scholarships
○ Virtually every financial form, leasing contract as you look forward to residency for a new apartment, every scholarship, and eventually your residency contract and VA contracts will require an SSN
○ You CAN wait until you have already matched as a fourth year, as you will be assigned one right before residency begins. However, I cannot tell you the number of opportunities I lost simply because I didn’t have an SSN over my 4 years in medical school. So get a job, even if it’s just for a few months.
○ Looking for apartments, houses, and cars without credit (traditionally tracked by the credit bureaus via SSN) can be stressful if you plan to stay here doing residency
Year 2:
Your second year will be stressful if you do it right. Study, and study hard.As an international student, you need to be rigorously jealous of your exam scores. Step 1 in many ways is a much higher stakes exam for you, and despite your AMG status, you are not judged in the same way by residency programs. You will realize when you are applying for residency that the very first page of the form asks whether or not you will need a work visa. Many programs will auto-screen you out if you ask for certain visas if your step score is not above a certain threshold. This threshold is not uniform for you and other AMG’s.
Your second year is typically also a year where you will be heavily involved in research if you are trying to do something competitive.
-Try to figure out what you want to do early. I know this is a very tall order, as you have not had any true clinical experience yet. But enrich yourself and your knowledge of the specialties, shadow in your very small amount of spare time. Second year is the last time where you will have absolute control over your time.
The reason I bring this up is because once you have a goal of matching into a certain specialty, you will need to speak to your country about something called “statement of need” if you are going to apply for a J1 visa in the future. This is country dependent, i.e. Canada can be very temperamental about how many XYZ surgeons they need that year and may pull support of this visa when you are about to apply. I don’t mean to dash your hopes of following your dreams, but as AMG F1’s, there are certain aspects of the game you will need to be aware of if you want to match.
Year 3:
Honor your clerkships, work hard, learn a lot. Take step 2 CK on time. Don’t take Step 2 CS lightly. Not really much in the way of real international student issues.
Year 4:
Here is where things start to get more tricky.
I will go over visas with you and what I briefly know about South Korean (which we tend to have many of) and Canadian F1 match process. I have heard that the process is very similar for Chinese and Singaporean students.
There are two visas that you will essentially be bargaining for as you go through the interview trail.
J1 Visa: This is an exchange visa that is sponsored by your country of origin. These are essentially free for your residency programs because, as I just noted, they are sponsored by your home country. As you look through the list of programs you would like to apply to, you will notice that many more programs sponsor J1’s over H1’s. This will expand your pool of available programs, but do not be deceived. The J1 visa is a very raw deal for an AMG.
The stipulations are heavy. You will require:
● Statement of need for physicians of your specialty from your home country (as mentioned before, countries can be temperamental even varying by year on how many of a certain doctor they want trained)
● Promise of returning to your home country after training for at least 2 years
○ OR a National Interest Waiver (NIW), which will allow you to serve as an attending in the United States after residency in an underserved area.
The problems are:
● You can’t marry out of it to get a greencard. Once you start the J1 visa, you will be going home for two years or staying on with an NIW
● There are a limited number of J1 spots per state (30 I believe), and the majority of these are reserved for the larger specialties.
● I.e. if you plan on doing GI fellowship after residency, there will be NO J1 spots in California for this training.
● Your country can pull this visa at any time
● Your program can pull this visa at any time
● There are no salary requirements for the program to meet to keep you on this visa.
● If you are a South Korean or Singaporean citizen with stringent military requirements, returning to your home country for 2 years will mean serving in the military before you are an attending.
H1 Visa: This is a work training visa sponsored by the United States. These tend to run the program 2000-3000 USD and a dedicated day of paperwork and legal fees. Legally, you cannot sponsor yourself, and any attempts made by a program to coerce you to do so is a federal offense. That said, only the more competitive academic, privademic programs extend this visa to F1 AMG’s. There are essentially no drawbacks to this visa, as you will be treated as if you were a contracted worker being groomed to become a full time employee and U.S. permanent resident.
The perks include:
● You can marry out of this visa at any time
● You do not have to go back to your home country at any time
● The program must pay you a small percentage above what other residents are generally paid for the work that you do (this is usually enforced more heavily in other lines of work to ensure that H1 visas are not being handed to foreigners for cheaper labor over skilled American employees).
● You can go straight to permanent residency processing after you finish residency.
● There is no H1 cap for physicians like that of J1’s per state
Applying with ERAS:
This will be tedious, but if you do your due diligence you will be handsomely rewarded. The temptation will be to look through some resource like FREIDA Online and check whether a program sponsors an H1 or a J1. This is a dangerous tactic.
Call and directly email the programs you are interested in. This advice may seem innocuous but it means that you will be calling close to 200 programs and emailing them about their visa offer status. The reason to do this directly is that the FREIDA Online information is often out of date. Doing your due diligence at this point will save you hundreds of dollars later on so that you don’t go on an errant flight for an interview for a J1 visa that you don’t want because you made an assumption after perusing a website. Get started early with those calls and emails, they take a long time.
As a general rule, California programs with affiliations to county hospitals no longer sponsor H1’s as of 2016.
Interview Trail:
Always be upfront about your needs concerning a visa. Be very clear with the program director at some point of the day about what type of visa you prefer and whether the program offers it. There are many programs that sponsor either an H1 or a J1 rather than having a hard line about a specific one. So as aggressive as it might seem, you do want them to commit to an H1 if this is the case before you leave the program. Do not be demanding, but explain to them that a your specific set of circumstances. You are an AMG, take pride in this bargaining chip.
Post-match:
Around January of your 4th year you must submit paperwork to Ms. Donahue (the international student advisor) for an extension of your F1 visa to exercise an option called Optional Practical Training. This will be used for your intern year, and is a distinct advantage that you have over IMG’s. This affords you the flexibility of not having to take Step 3 before starting residency. It is also free and buys you time on a J1 to get married if you think that this is where your relationship is headed.
The F1 OPT paperwork and clearance take 3 months to process almost precisely. Do not be lazy about getting this paperwork in as soon as possible. Especially if you did not heed my Year 1 warning to get a social security number. You need your F1 OPT cleared so that you will have an EAD (employment authorization) and an SSN if you want to fill out your residency contract, VA access, and your NPI number before starting residency. Not having this SSN in time will hinder your start time for residency.
Good luck,
Always rooting for you.
Dr Leavey Library, MD
℅ 2016.
