Possibility of completing J-1 home requirement before end of residency (aProgDirector )?

[confusedgsresident]

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Hi there,

I am a categorical general surgery PGY-1 at an academic program that is receptive and supportive of IMGs (both as residents and faculty). As a foreign national on a J-1 visa I'm cognizant of my 2-year home requirement (i.e. I will need to reside in my home country, the United Kingdom, for at least two years upon completion of my training before being eligible to return to the US on an immigrant visa, namely an H1b).

This may be a question best directed towards aProgDirector (or even an immigration lawyer), however I am exploring the possibility of taking time out of my program after my PGY-2 year to pursue 3 years of research back home in the UK (with the aim of completing a PhD during this time). When I return to the US and re-enter my PGY-3 class, would I be eligible to apply for an H1b visa? Technically I would have fulfilled my 2-year home requirement, albeit prior to the end of my program. My program does sponsor H1b visas for IMGs, who meet certain criteria (e.g. extensive publications and extra qualifications) which I would hope to accrue during my research years. The international office at my institution has speculated that this might be possible, however, nobody I have spoken to has had to deal with this situation in the past. Because the J-1 visa is renewed on a yearly basis, I was wondering whether my program could stop sponsoring me for the three years that I am back home on research, and when I return, file an application for an H1b instead (as I will have resided in my country of origin for over 2 years prior to this). It would be a shame to have to return on a J-1 and be subject to the 2-year requirement all over again at the end of my residency/fellowship. Sorry if this is quite confusing to follow, but I hope you understand the gist of what I'm saying!

I realize that my situation is somewhat unusual in that many IMGs go to great lengths to avoid returning home for their mandatory 2-year requirement. However, in my case I actually want to return to the UK in the middle of my residency and undertake research in an area I am interested in, with a group that has a good track record of publishing. I would like to avoid leaving the US for 2 years after the completion of my training (i.e. residency + fellowship) as I might encounter issues finding a job after having spent two years out of the country post fellowship.

aProgDirector: Have you ever encountered any residents that have done something similar?

I would be grateful if anyone could share their experiences/thoughts.

 

[NotAProgDirector]

From a visa standpoint, I think your logic is completely sound. You could complete your PGY-2, leave the US, end your visa, complete a PhD, and then when you return you'll need a new visa which could be an H or another J.

That said, this is a pretty crazy plan. There is no guarantee that a PGY-3 will be waiting for you upon your return. Programs are very limited in the number of spots they can have, so having a PGY-3 open for you when you return requires converting a categorical to prelim PGY-1 two years earlier, and then not filling the PGY-2 (or filling a PGY-2 prelim), or requires that some other resident be forced / volunteer to go into a research year or be fired, etc. Plus even if a program does promise you this, if the PD changes in the interim you may find that promise worthless.

And last, exactly how good will your surgical / clinical skills be after 3 years of research? Do not expect the program to cut you much slack.

So I would tread carefully here. The safer plan would be to complete your training, then go for the research time.

 

[confusedgsresident]

Thank you very much for your response! I agree, this is quite a risky plan, as it relies on a lot of different things falling into place (i.e. a PGY-2 spot being available, and me 'making the cut' for an H1b upon return) in order for it to work. I think I would only embark on this if I was provided some long-term certainty by my program.

With regards to maintaining my clinical/technical skills, it would be fairly straightforward to arrange locum tenens work as a surgical resident in the UK during my time in research (I have fulfilled and maintained all my UK-specific license requirements that would enable me to do this). This is something I wouldn't be able to do in the US, due to the restrictions imposed by my J-1 visa.

From what I've gathered, my alternative options are as follows:

1. Complete my residency and fellowship on a J-1 (I agree that this is the safer option, as you mentioned). I could then return home for 2-3 years of research and then apply for an attending/faculty job as someone who is H1b eligible and fulfilled their 2-year home requirement. In your experience, have IMG residents who have done this faced issues with applying for faculty positions after spending time out of the US? Alternatively, I could forego the research idea altogether and apply for a J-1 waiver after my fellowship and work in an "under-served" region and transition to an H1b that way (not an easy feat either). The downside with this option is that contrary to what I initially thought, I've been informed by a few surgical specialty fellowship program directors that being on a J-1 creates issues for funding during fellowship (as fellows are employed as 'assistant faculty'). I don't know the exact details here, but the general message I received was that being on a J-1 was seen as a red flag.

2. Complete my residency and return home for research after my PGY-5 year, complete 2-3 years of research and then apply for a fellowship that would be willing to sponsor an H1b visa. The downside here is that I'm weary that a lot of fellowship programs will see my 2-3 years out of the US on research as an even bigger red flag. Again, have you encountered residents who have found it difficult to match into a fellowship due to a 2-3 year gap following graduation from residency?

Thanks again for taking the time to answer these questions. Obviously, this is a decision that I won't rush into making, without seeking advice from multiple people.

 

[NotAProgDirector]

I think I would only embark on this if I was provided some long-term certainty by my program.

There is no such thing. As I mentioned before, your PD could leave in the interim and any new PD might not honor any prior commitments. And if they don't have an opening, you're stuck.

The downside with this option is that contrary to what I initially thought, I've been informed by a few surgical specialty fellowship program directors that being on a J-1 creates issues for funding during fellowship (as fellows are employed as 'assistant faculty'). I don't know the exact details here, but the general message I received was that being on a J-1 was seen as a red flag.

Being on a J visa for a standard fellowship is no big deal. But, if this fellowship is not GME funded, then what they will do is hire you as faculty to help pay your salary while you continue training. This is very common for non-ACGME accredited fellowships. For example, we have a 2 year IV Cardiology fellowship. Only the first year is ACGME accredited (because current ABIM rules are that IV Cards is a 1 year fellowship, but our program thinks it takes two years). In that second year, you get hired as faculty and bill to pay for your salary. If that's the case at your institution, you cannot be on a J -- you cannot be hired into a faculty position.

 

[confusedgsresident]

Thank you both for your invaluable advice!