VISA options/Path to Green Card During Residency for Int'l (F-1) student U.S. medical graduate

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Feb 19, 2012
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Hi Everyone,

I am a fourth year (International) medical student in NY on a F-1 visa, about to graduate and start residency in the U.S. I am originally from West Africa and did my undergraduate in the U.S as well. I worked for a few years on OPT and a H-1B visa between undergrad and medical school.

I am starting this thread for current and future medical students on a F-1 visa. The information below details the visa options and current pathways (as of 2017) to the green card after graduating medical school in the United States. Some of it may be useful to foreign medical graduates as well.

Disclaimer: I gathered this information from consulting with an immigration lawyer specifically for physicians. However, this information is for general guidance only. The application and impact of laws can vary widely based on the specific facts involved. As such, it should not be used as a substitute for legal advice from a professional. Before making any decision or taking any action, you should consult with a lawyer.

There are 2 types of VISA for residency (J-1 or H-1B) and therefore 2 general pathways.

J-1 pathway

OPT (1 year) + J-1 (up to 7 years) -->
  • 2- year leave out of U.S. or
  • Waiver for working in underserved areas for 3 years or at VA for 2 years (for both a position must be open and they decide where you go).
  • Hardship waiver that exempts you of the 2-year leave (this one is interesting; you have to prove that you leaving will negatively impact a U.S. citizen that can be a spouse (i.e.: you are the breadwinner) or a dependent (children)).
  • Persecution waiver (self-explanatory).
After the waiver you can apply for a H-1B and follow that pathway to the green card. You can't marry out of the J-1, meaning you would still be subjected to the leave or waivers.

OPT (1 year) + H-1B ( up to 6 years) +/- (1-year extension) to
--> O-1 VISA (extraordinary abilities) or
--> E-B1 VISA (self-sponsored ) or E-B2 (Sponsored) green card.

Must have a Sponsor AND satisfy 3 of the following 8 criteria:
  1. Publications (posters, ppts, pubs etc...)/ presentations
  2. Leader in the field
  3. Judge of work of others (like reviewer for a journal)
  4. Significant contributions to the field
  5. Materials about the alien (meaning lots of good stuff comes up when they google you)
  6. High salary compared to peers in same specialty
  7. Memberships
  8. Awards (like Olympic medal or Pulitzer Prize).
Takes about ONE YEAR to get it.
Can apply up to 1 year before starting new job after residency or fellowship.

Must satisfy 3 of the same 8 criteria as O-1 .
Takes about ONE YEAR to get it.
Can apply anytime during residency if you feel like your application is strong enough.
People typically wait until they have one year of fellowship left.

"National interest waiver"

Must have a Sponsor only that can vouch for your extraordinary abilities.
Takes ONE to TWO years to get it.
Typically people apply for it as soon as they get a job, which often is at the end of residency or half way through fellowship.

There are many ways to satisfy these criteria and the decision is completely subjective. Someone with 20 publications could be denied vs. someone with 3 publications could be granted the visas; it is up to the USCIS officer to determine the "strength" of your documentation in satisfying the aforementioned criteria.

Per the lawyer, one item that dramatically enhances your application is support letters from your colleagues or peers.
  • The institution to which they are affiliated is more important than their rank or title.
  • They must be doctors, but not necessarily in your specialty.
  • "Independent references" have more weight than familiar ones; meaning people who don't personally know you but know of your contribution to your field.
What you can--but really should-- do now in preparation; in () are the things that have major impact on your application:
  • Keep track of every presentation whether it be a ppt, lectures, posters, or publications.
  • Join and take leadership roles in professional societies (major).
  • Become a reviewer for a national or international publication (major).
  • Keep every correspondence in which you were asked for your expertise/opinion about anything (Don't worry about HIPAA; they fix it later).
  • Network like your life depends on it because those of the people who will write your support letters.
  • Publish or blog about your work online-- officers will google you. The more good stuff they find, the better.
Please reach out by inbox or reply to this message if you have further questions or comments.

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Jun 1, 2018
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Hi, thanks so much for starting this thread and all the information you have given. I have quite some questions concerning this path. I am on OPT now, after my undergraduate in the U.S. I anticipate medical school in the near future by the grace of God. Now, I know, as a medical student, I will be on an F-1 student visa, is this the same status I will have for medical residency as well as internship? OR is an H1-B sponsor required from whatever hospital that I will be attending as a resident and doing my internship in?

Thank you