J1 Waiver jobs at academic centers for haem/onc and other competitive specialties

[gangstasanta]

I've been hearing a lot of contradictory information about this. Some are saying it's very tough to find specialty jobs for your j1 visa, and that many people need to work in primary care even after doing their fellowships. Is that true?
Some say as long as you apply early and are willing to move to a different state you can get a waiver job of your specialty easily, even at academic centers. Is that true? Asking because I want to do a competitive specialty like haem/onc, and I want to be able to join academic medicine later, so I really want the waiver job to be at an academic setting...

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[gutonc]

The first part is absolutely true. I've got a J1 waiver job in rural hem/onc that I'm looking to fill. The 2nd part is much less true. Waiver positions are generally not going to be located in academic settings.

 

[gangstasanta]

The first part is absolutely true. I've got a J1 waiver job in rural hem/onc that I'm looking to fill. The 2nd part is much less true. Waiver positions are generally not going to be located in academic settings.

Thank you for your reply! Do you think it'll be possible for me to enter academia (i want to do research)if i spend 3 years of my waiver job in a non academic setting? Considering i have good research experience during my residency and fellowship training beforehand

 

[gangstasanta]

The first part is absolutely true. I've got a J1 waiver job in rural hem/onc that I'm looking to fill. The 2nd part is much less true. Waiver positions are generally not going to be located in academic settings.

Are waiver jobs found in community centres associated with universities?

 

[gutonc]

Are waiver jobs found in community centres associated with universities?

They can be. But the affiliation is often just a plaque on the building.

 

[gangstasanta]

The first part is absolutely true. I've got a J1 waiver job in rural hem/onc that I'm looking to fill. The 2nd part is much less true. Waiver positions are generally not going to be located in academic settings.

Also, I've heard a lot about there being academic institutions willing to hire that are a part of VA, and that they have no cap. So they should be easy to find right?

 

[gutonc]

 

[Medisaint]

There is nothing easy about getting a waiver job, my friend. This is especially true when you tempt fate by adding subspecialty & academic center as requirements.

The major pathway to getting a waiver is Conrad-30. Each state gets up to 30 waiver spots per year and those are split between all medical specialties/subspecialties. There will be many variables outside of your control. Is a center in an underserved area? Will the Heme/Onc dept be able to hire you? Who else is applying to CONRAD-30 your year and in that state? etc.

To make matters worse, you can only apply to one state at a time for a waiver. This means that if your job at Vanderbilt falls through and your back up is Duke, you'll have to apply for a new NC C-30 waiver which will likely push you past your visa expiration date.

Make no mistake, this will require tremendous coordination and a leap of faith. Make sure you read up on how your target state selects CONRAD-30 recipients too. Be careful of this combination: competitive State (i.e. typically >30 applicants per year) + prioritizes primary care spots + adjudicates applications late in the cycle (I'm looking at you Massachusetts). You could have a perfect job lined up only to find out in January that you're out of luck because too many primary care physicians applied that year.

You'll also want to make connections at potential sites...early. It's important to understand that Uncle Sam does not care about your happiness, your work/life balance, or your career goals. Call it myopic, but unless you are already exceptional enough to qualify for an O-visa (i.e. you are a national asset) your potential contributions to medical science are not considered. As such, remember that Conrad-30 spots are CLINICAL positions designed to address regional physician shortages. When you sign a work contract you are committing to a CLINICAL position on paper.

This is where things get gray...
Imagine that you've just beaten the odds and you've been hired by a major academic medical center's Heme/Onc department. You love the intellectually stimulating environment, your brilliant colleagues, and the amazing research infrastructure that will help make your dreams of becoming a physician-scientist come true. Then you get a look at your schedule for the year and your time is split 95% clinical duties / 5% quality improvement/committee/resident education/research. Does that sound like a physician-scientist job?--On behalf of the XYZ University Heme/Onc faculty, we greatly appreciate the hard clinical work you do that that makes our protected research time possible. Without naming names, this happens.

Suggestions:
If you want to hop off the academic rat wheel then this is as good a chance as any. You'll be able to get a very lucrative job in an underserved area and live like a king.

If you want to pursue academics, I suggest you get ready to make concessions in terms of location and prestige. Consider looking at state schools and second-tier academic centers in low-population states. Look for division chiefs that are interesting in growing their department and would invest in your development as a researcher rather than use you as a laborer.

Good Luck!

Tip: Don't take your subspecialty board exams during your training if possible. Research this independently but there is a clause that lest you extend your J-1 in order to take your exams.

 

[Medisaint]

Also, I've heard a lot about there being academic institutions willing to hire that are a part of VA, and that they have no cap. So they should be easy to find right?

The VA is slow and unreliable. Further, it's not easy to get hired to the VA as a non-citizen. And definitely not a sure thing. They need to advertise your job for like 90 days and justify why they can't give it to an American. University-affiliated VA jobs are quite sought after. They are chill, have good benefits, open doors to VA-specific funding grants, and offer good job security. This is the perfect place for a young, American citizen, heme-onc attending to work and pursue grant funding. Are you comfortable taking that risk? Look at usajobs [dot] gov to track what's available now.

If you're serious about getting a waiver you will need to commit 100s of hours to researching the steps/networking/planning etc.
As initial steps I would:
-Speak to your Program director about your intentions.
-leverage connections your chief/faculty have with other institutions
-Identify potential mentors at other institutions
-Try to find other J1 physicians who navigated your situation. Ideally from your institution and specialty.
-Make a list of eligible sites (i.e. waiver-eligible, have sponsored people before, good fit academically, good fit location, etc.)
-Again familiarize yourself with ALL of the steps involved. This might mean hiring a lawyer who specializes in this for advice.
-Double check everything.
-Create a timetable to work from.

 

[gangstasanta]

I'm feeling helpless about this. Do you guys know people who have done the waiver job and then gotten back to research? My country used to submit a No objection letter which made its citizens waiver exempt. But it recently updated its rules and now that's no longer the case. 😔 Don't wanna take my chances on a competitive fellowship on h1b.... And i wanna do research so bad

 

[Medisaint]

I'm feeling helpless about this. Do you guys know people who have done the waiver job and then gotten back to research? My country used to submit a No objection letter which made its citizens waiver exempt. But it recently updated its rules and now that's no longer the case. 😔 Don't wanna take my chances on a competitive fellowship on h1b.... And i wanna do research so bad

I do not know what the policies are in India but a no objection letter will not get you out of the J1 physician waiver in the US. That was put in place in the 1970s to protect American physicians from having to compete with you, not to protect your country from brain drain.

It theoretically possible to do research US med school, Heme/Onc fellowship, and research through H1b or J1 but it's not easy either way.

There are going to be factors entirely within your control, partially within your control, and completely out of your control.

Within/partially within your control:

1) As an IMG who wants to match to a competitive specialty and then do research you need to be exceptional. How experienced of a researcher are you? Is there rest of your CV (letters of rec, publications, scores, etc) stellar? If you're coming from a place like AIMS then that opens a lot of doors due to its reputation and its network of graduates. If you're coming from a smaller program and matching to a US program is not guaranteed then you may want to choose the visa that maximizes matching to Internal medicine.

2) What are your connections like? Who have you published with? Does your research mentor know Heme/onc researchers States? Can they put you in touch with fellows/attendings who have gone through this?

3) Take the time to learn everything you can about the process.

4) Identified the visa sponsorship policies of ALL the US IM programs you plan to apply to (Make an excel spreadsheet)

5) Find a network of people who are more experienced in this than you. There are plenty of resources, blogs, communities online for J1 and H1b physicians.

Out of your control
1) J1 visa waiver spot distribution in 6-7 years
2) Biases toward your application as an IMG