To pursue Cardiology after residency, which Visa in residency will have more chance? J1 or H1b

[Duy Chung]

I am a NonUS-IMG applying to IM. I plan to follow the Cardiology path after residency. At the moment, I am in the middle of the residency interview. I have difficulty with the order of my top 2 programs, which are very promising for a cardiology career after residency.
- Program 1: small program in an underserved area. Pros: offer H1, plan to have in-house cardiology fellowship (everything seems to be in place but has not opened yet). Cons: not strong in scholarly activities, the teaching is not so excellent, not many graduates went to Cardiology, and APD seems not to know many things about the program.
- Program 2: average program in a large system, offer J1. Pros: provide excellent teaching, multiple scholarly activities, amazing PD-APD-Faculty, one graduate do card/year.

1. I know Cardiology is a competitive sub-specialty, so there will be a high chance of unmatching fellowships. So, in the case of unmatching, which Visa will have better outcomes?

2. I don't know about the number of Cardiology Fellowship Programs that offer H1b. Because if the number is low, it will be like shooting myself in the foot if I choose H1b.

3. Regarding the time limit, H1b is limited to 6 years while J1 is limited to 7 years. So will the time limit be a factor that needs to be considered while choosing the residency program?

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[NotAProgDirector]

In general, there are more fellowships that sponsor J visas rather than H. But just because there are more of one than another shouldn't drive your decision.

If you're on an H visa, you can always switch to a J visa. However, programs that offer J's may decide you'd be unlikely to do so.

If unmatched, you're much, much better off on an H visa. With an H visa you can get (almost) any job in the US (that offers to sponsor visas) and ultimately become a US citizen. With a J visa you will need a waiver which will limit your options. It's very complicated, you should read this thread: Orientation about Visas ??

The time limit is usually not an issue, you can get extensions on both visas.

 

[Duy Chung]

Thank you for your answer. I read the thread you suggested. It was excellent. But at some point, it turned to med school admission issue. So, there are some things I would like to gain more insight into:

1. VISA aside, regarding the training/scholarly activities aspect, which program will offer me a higher chance of Cardiology Fellowship Matching?

2. Please correct me if I'm wrong. I believe most of the H1B Cardiology Fellowship Programs are large/university institutes. My USMLE scores are not strong, so applying to these programs is not a good idea.

3. I read many threads in which you said H1B could be "downgraded" to J1. I'm interested in this option. I would be grateful if you could elaborate on this topic.

4. And, in Cardiology Fellowship Matching, in case of unmatching, will the gap between residency and the applying year be a matter? Like three years in J1 and 1-2 years in H1B.

5. Following up with the previous question, another option is to wait until I have GC (H1B pathway) to apply for Cardiology. I wonder whether this option will improve my chance or sabotage it.

Thank you very much for your help! Wish you all the Joy and Happiness in this season.

 

[mszzeta]

I am a NonUS-IMG applying to IM. I plan to follow the Cardiology path after residency. At the moment, I am in the middle of the residency interview. I have difficulty with the order of my top 2 programs, which are very promising for a cardiology career after residency.
- Program 1: small program in an underserved area. Pros: offer H1, plan to have in-house cardiology fellowship (everything seems to be in place but has not opened yet). Cons: not strong in scholarly activities, the teaching is not so excellent, not many graduates went to Cardiology, and APD seems not to know many things about the program.
- Program 2: average program in a large system, offer J1. Pros: provide excellent teaching, multiple scholarly activities, amazing PD-APD-Faculty, one graduate do card/year.

1. I know Cardiology is a competitive sub-specialty, so there will be a high chance of unmatching fellowships. So, in the case of unmatching, which Visa will have better outcomes?

2. I don't know about the number of Cardiology Fellowship Programs that offer H1b. Because if the number is low, it will be like shooting myself in the foot if I choose H1b.

3. Regarding the time limit, H1b is limited to 6 years while J1 is limited to 7 years. So will the time limit be a factor that needs to be considered while choosing the residency program?

J1 offers better chance of matching into a cards fellowship. However, J1 is VERY hard to find a job, especially in geographically desired regions. There has been people who have to do hospitalist or PCP to waive the J after Cards fellowship

 

[NotAProgDirector]

1. Impossible to tell you which is "better". If you're concerned about your competitiveness for Cardiology, then probably your best chance is at your home program. If you have a smaller community program that's new, they may decide to take mostly/all internal candidates. That might be your better choice. If in Prog 2 only one person per year is doing cards, is that because only one person is interested? Or many more are interested and can't get a spot? If the latter, one has to wonder if you're going to be that one person. But it's possible that Program 1 will never get their Cards fellowship off the ground. Or that they may be interested in taking outside applicants. There's no way to know.

2. I don't know which programs accept H1b visas. There won't be many. Usually, it's less competitive programs that offer H1b's as an incentive to good IMG's needing visas.

3. Nothing stops you from switching an H visa to a J visa. You simply let your H visa expire, and get a J visa. But I expect that many programs will look at your current H and figure that you'll rank any program willing to give you an H visa higher, and hence they may decline to interview you. So although this is certainly possible, it may still impact your application.

4. Yes, it will matter. First, visa or not, if you don't match one year you're going to have increased difficulty trying to match the next year. You'll need to do something to make your application better. Usually, that's either a chief medicine year, a nonaccredited heart failure or cardiac imaging fellowship, a cardiology hospitalist, or dedicated research time. On a J visa you can do a chief year or a non-accredited fellowship although there is extra paperwork the program needs to deal with. You can't do dedicated research. If you start a hospitalist position, that's on a J waiver which is a 3 year commitment. So you have some limited options.

On an H visa, you can technically do anything. But you'd need to get places to sponsor your H visa for these one year positions, which won't be easy given how expensive and complicated the process is. You would also consume one year of H time, and the limit is 6 years (although extensions are possible).

5. Long gaps between residency and fellowship application can be fatal to your application, especially if it isn't strong in the first place. Many places that hire you on an H1b visa after residency may not be wlling to start the GC process until you've been there for some time, And the GC process can be long and protracted. Your best option is to get a spot immediately following residency. The longer you wait, the harder it's going to be.

 

[Duy Chung]

J1 offers better chance of matching into a cards fellowship. However, J1 is VERY hard to find a job, especially in geographically desired regions. There has been people who have to do hospitalist or PCP to waive the J after Cards fellowship

I have heard the same thing before. Could you elaborate on this?

 

[Duy Chung]

1. Impossible to tell you which is "better". If you're concerned about your competitiveness for Cardiology, then probably your best chance is at your home program. If you have a smaller community program that's new, they may decide to take mostly/all internal candidates. That might be your better choice. If in Prog 2 only one person per year is doing cards, is that because only one person is interested? Or many more are interested and can't get a spot? If the latter, one has to wonder if you're going to be that one person. But it's possible that Program 1 will never get their Cards fellowship off the ground. Or that they may be interested in taking outside applicants. There's no way to know.

2. I don't know which programs accept H1b visas. There won't be many. Usually, it's less competitive programs that offer H1b's as an incentive to good IMG's needing visas.

3. Nothing stops you from switching an H visa to a J visa. You simply let your H visa expire, and get a J visa. But I expect that many programs will look at your current H and figure that you'll rank any program willing to give you an H visa higher, and hence they may decline to interview you. So although this is certainly possible, it may still impact your application.

4. Yes, it will matter. First, visa or not, if you don't match one year you're going to have increased difficulty trying to match the next year. You'll need to do something to make your application better. Usually, that's either a chief medicine year, a nonaccredited heart failure or cardiac imaging fellowship, a cardiology hospitalist, or dedicated research time. On a J visa you can do a chief year or a non-accredited fellowship although there is extra paperwork the program needs to deal with. You can't do dedicated research. If you start a hospitalist position, that's on a J waiver which is a 3 year commitment. So you have some limited options.

On an H visa, you can technically do anything. But you'd need to get places to sponsor your H visa for these one year positions, which won't be easy given how expensive and complicated the process is. You would also consume one year of H time, and the limit is 6 years (although extensions are possible).

5. Long gaps between residency and fellowship application can be fatal to your application, especially if it isn't strong in the first place. Many places that hire you on an H1b visa after residency may not be wlling to start the GC process until you've been there for some time, And the GC process can be long and protracted. Your best option is to get a spot immediately following residency. The longer you wait, the harder it's going to be.

1. I agree. Anything can happen.

2. I will search for more information regarding the H1B Cardiology Programs.

3. I understand. So, J1 applicants have a good chance in the J1 program, H1 applicants have a good chance in the H1 program. As for now, there are only around 80 H1 programs and more than 200 J1 programs. In conclusion, J1 applicants can apply more broadly than H1 applicants. Would you please correct me if I'm wrong?

4. I understand.

5. I got it.

 

[ROBINHO]

Regarding your initial comparison between Program 1 and 2 you have to decide what is more important to you---quick path to green card versus wanting to be a cardiologist, If you are passionate about being a cardiologist then program 2 makes sense. Going to a remote residency with no scholarly opportunities, no match success to cardiology, and poor teaching---sounds like good bye to cardiology.

Every IMG invariably has to make this decision. You have to choose a path that makes sense for you and your family. Some people want a quicker path to green card so that they they can guarantee work for their spouses and not have to stress themselves up versus waiting 9 years to green card ( if you do cardiology). If you go down the route of J1, you will get a job, albeit in less desirable place as a waiver)

 

[ROBINHO]

1. I agree. Anything can happen.

2. I will search for more information regarding the H1B Cardiology Programs.

3. I understand. So, J1 applicants have a good chance in the J1 program, H1 applicants have a good chance in the H1 program. As for now, there are only around 80 H1 programs and more than 200 J1 programs. In conclusion, J1 applicants can apply more broadly than H1 applicants. Would you please correct me if I'm wrong?

4. I understand.

5. I got it.

Cardiology is competitive. You need to get into a strong residency to have a chance. It doesnt matter how many H1 programs are available in cardiology. You need to go the best residency that gives you a shot at Cardiology----IF CARDIOLOGY is the most important thing for you. Your description of program suggests that you will not be a strong candidate for H1 programs either

 

[mszzeta]

I have heard the same thing before. Could you elaborate on this?

I am surprised that you have not heard this and this means you need to do more work yourself regarding the US system for IMGs (extremely unfriendly compared to US AMGs.....but compared to other countries, this is the most open one in the world)

J1 is easier to for matching into a cardiology fellowship than H1b and you have got the answer from other people, particularly about number of programs who sponsor H1 and J1 respectively

If you decide to practice in US after fellowship AND you have been on "physician J1 visa" (different from research J1 visa) at any time point, you need to obtain a waive including working in a medically underserved area for at least 3 years. These waive jobs are hard to find, especially for specialist such as cardiologist. And thing would be MUCH difficult to find a job in a desirable geographic location. Many people go to either midwest rural or do hospitalist to meet the waive requirement.

Even marrying a US citizen cannot get ride of the waive requirement

Another route is to go back to your home country for 2 years. This will fulfill the J1 requirement, and then come back to US. I would not be surprised if some people consider their hometown that they grew up better than midwest......

 

[Duy Chung]

Regarding your initial comparison between Program 1 and 2 you have to decide what is more important to you---quick path to green card versus wanting to be a cardiologist, If you are passionate about being a cardiologist then program 2 makes sense. Going to a remote residency with no scholarly opportunities, no match success to cardiology, and poor teaching---sounds like good bye to cardiology.

Every IMG invariably has to make this decision. You have to choose a path that makes sense for you and your family. Some people want a quicker path to green card so that they they can guarantee work for their spouses and not have to stress themselves up versus waiting 9 years to green card ( if you do cardiology). If you go down the route of J1, you will get a job, albeit in less desirable place as a waiver)

Thank you very much for your input. I really appreciate it. Luckily, my partner and I applied to this year's residency as a couples match, and we are passionate about cardiology. As for now, we don't worry about our personal life aspect as we are happy with what we have. So, we focus more on the match and the possibility after residency.

 

[Duy Chung]

Cardiology is competitive. You need to get into a strong residency to have a chance. It doesnt matter how many H1 programs are available in cardiology. You need to go the best residency that gives you a shot at Cardiology----IF CARDIOLOGY is the most important thing for you. Your description of program suggests that you will not be a strong candidate for H1 programs either

I understand.

 

[Duy Chung]

I am surprised that you have not heard this and this means you need to do more work yourself regarding the US system for IMGs (extremely unfriendly compared to US AMGs.....but compared to other countries, this is the most open one in the world)

J1 is easier to for matching into a cardiology fellowship than H1b and you have got the answer from other people, particularly about number of programs who sponsor H1 and J1 respectively

If you decide to practice in US after fellowship AND you have been on "physician J1 visa" (different from research J1 visa) at any time point, you need to obtain a waive including working in a medically underserved area for at least 3 years. These waive jobs are hard to find, especially for specialist such as cardiologist. And thing would be MUCH difficult to find a job in a desirable geographic location. Many people go to either midwest rural or do hospitalist to meet the waive requirement.

Even marrying a US citizen cannot get ride of the waive requirement

Another route is to go back to your home country for 2 years. This will fulfill the J1 requirement, and then come back to US. I would not be surprised if some people consider their hometown that they grew up better than midwest......

I am sorry for the misunderstanding. What I mean is I have heard that J1 VISA offers a better chance of matching into Cardiology Fellowship, but I am not clear about it.

Regarding the job after fellowship, I understand what you said. It is not a problem for me as My partner, and I are willing to move anywhere and take any positions.

 

[mszzeta]

I am sorry for the misunderstanding. What I mean is I have heard that J1 VISA offers a better chance of matching into Cardiology Fellowship, but I am not clear about it.

Regarding the job after fellowship, I understand what you said. It is not a problem for me as My partner, and I are willing to move anywhere and take any positions.

Sorry I probably misunderstood you...