Hey guys. I wanted to get some opinions about matching as a US med school grad, but not a US citizen. I have been hearing that the more competitive residency programs will not sponsor visas as much as they used to, because they have enough competitive US citizens to fill their positions, without going through this hassle of sponsoring.
That is correct but it depends on what kind of visa you need. Sponsoring a visa is a hassle for some programs, one they'd rather not deal with. You have to be special for some programs to consider it.
The J Visa
The J visa is an "exchange visitors" visa. The idea is that you get to come to the US for training, and then take that training back to your home country to improve the health care / teaching in your home country. I believe J visas are only available for clinical medicine and medical research. The basic facts are as follows:
It is easy to get. There is no limit to the number of J visas issued. The ECFMG is the sole source of these visa in the US. They have a very helpful website here.
In order to get this visa, you need:
To obtain an ECFMG certification (which proves you attended a qualified medical school outside the US/Canada)
Pass Step I and Step II CS/CK of the USMLE
Obtain a contract for a PGY position in the US
Provide a Statement of Need from the Ministry of Health of the country of most recent legal permanent residence, regardless of country of citizenship. This statement provides written assurance that the country needs physicians trained in the proposed specialty and/or subspecialty. It also serves to confirm the applicant physician's commitment to return to that country upon completion of training in the United States.
The statement of need can usually be obtained in your home country, or sometimes requested in a consulate. It can be easy or hard to get this letter, depending on your country of origin.
The fees for these visas are inexpensive, and no lawyer is required.
Spouses / children obtain a J-2 visa, which allows them to work/study in any capacity (i.e. they are a full work visa)
The visa holder is required to return to their home country for a minimum of 2 years after the visa expires.
The only exception to this rule is the J Visa Waiver program -- if a J Visa physician obtains a job which qualifies for a waiver, and they work in that position for a certain period of time (I believe it's 3 years), they become exempted from the "return home" requirement. These positions are rare, often poorly compensated, and potentially less than ideal. They only exist because US physicians will not fill them.
You cannot moonlight on a J visa.
A J visa is only good for 7 years. This covers most residencies and fellowships.
You can only change specialties once on a J visa, before the end of the PGY-2 year.
The H Visa
An H visa is a true work visa. It allows a non-US citizen to hold a professional position which requires significant training. H visas are commonly used by physicians and by IT professionals. Because of the "Home Country" issue with the J visa, they are often preferred by non-US citizens training in the US. However, they have some other issues. Basic facts:
They are much more difficult to get. There is an annual limit to the number of H visa's available in the US. It's extremely complex, but last year all of the visas were given away many months before they would be valid. Current practice suggests that it may take 6-9 months to get an H visa, if one is obtainable at all.
They are much more expensive and complicated. Usually you need to hire a lawyer to make it all happen, which costs $$$. There is a $1000 premium processing fee, which really isn't optional if you want to start your training anywhere near July 1st. This site has a list of all the documents / paperwork you will need to generate.
Some residency programs refuse to sponsor H visas because of all of the work involved.
Non profits and Universities are immune to the cap, and hence can always get an H visa. However, an H obtained outside the cap is only transferrable to another institution immune to the cap.
In order to get an H, you will need to pass all THREE steps of the USMLE (unlike the J, where you only need Step 1 and 2). Realistically, you should have passed all three before even applying for a residency position if you wish to try to get an H visa.
You can transfer your H Visa anytime you want, although it usually takes 2-3 months to do so.
If you get hired in the US into a permanent job (i.e. NOT residency) on an H visa, your employer can sponsor you for permanent residency. This is one of the easiest paths to citizenship. Note I said "easiest", not "easy". This is the major advantage of the H visa. Note that if your H is obtained outside of the cap, this will only work for an employer who is University / Non profit.
Your H visa is only good for 6 years (actually it's good for 3 years, and renewable once). This can be a big problem if you decide to do a complex fellowship (like interventional cards, which is 3+3+2 = 8 years in most institutions now).
Dependents (Spouse / children) obtain H-4 visas. They cannot work in the US on these visas at all.
You can moonlight on an H1-b visa if you can obtain a full license (which depends by state).
So if you get a J visa programs are more likely to be interested than someone wanting an H1-b visa.
Also, it might look bad that the program took a non US citizen, and may prevent others from applying to their program because of this.
Not if you're a grad of a US medical school. Its the foreign grads, even US citizens trained abroad, that tend to "ruin" the rep of residency programs (in the eyes of some smug AMGs). If you go to a US medical school, this is not a problem.
Basically what im asking is, does a person in this position have a chance at matching at US competitive programs and residency? I would think they have some type of advantage, being graduates from a US med school, but thats not what i have been hearing.
As an AMG you would have an advantage over the typical non-US citizen applying, but as mentioned above, programs have to be willing to sponsor you for a visa.
