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There are two types of
non-immigrant visas available to foreign medical school graduates and
physicians: the J-1 visa and the H-1B visa. The J-1 visa is limited to seven
years and the H-1B is limited to six years. J-1 visa holders are subject to the
2 year home country residence requirement, but H-1B visa holders are not.
Foreign medical graduates
seeking to practice clinical medicine in the U.S. usually must complete (or in
some cases repeat) residency training at a U.S. Program in order to obtain a
state medical license. The Educational Commission for Foreign Medical Graduates
can acts as a visa sponsor enabling the foreign medical graduate to obtain a
J-1 visa and enroll in the residency program. Alternatively, the residency
program itself may sponsor the foreign medical graduate for an H-1B visa. See
section entitled Applying for
Medical Residencies in the U.S. for more information.
I. J-1
Foreign Medical Graduates
In order for a foreign medical
graduate to receive a J-1 visa in order to pursue medical residencies and other clinical training in
the U.S., the individual must enter the United States under the sponsorship of
the Educational Commission for Foreign Medical Graduates (ECFMG). An individual
who participates in this type of exchange visitor program is subject to the
two-year home country residence requirement of INA § 212(e), which is rarely
waived. The stay in such J-1 category is limited to seven years, except for
exceptional needs. Please see section entitled J-1 Exchange Visitor Visas for detailed information
on applying for this type of visa.
To obtain ECFMG
sponsorship to engage in clinical training, a foreign medical graduate must
have passed either Part I and II of the National Board of Medical Examiners
Examination (NBME), the Foreign Medical Graduate Examination in the Medical
Sciences (FMGEMS), or the United States Medical Licensing Examination (USMLE)
Steps I and II. However, the following individuals are exempt from these
requirements:
(1) Those
who have graduated from a U.S. or Canadian medical school accredited by the
Liaison Committee on Medical Education, or
(2) Those
who, on January 9, 1977, were fully and permanently licensed to practice
medicine in a state and who were practicing medicine in a state, or
(3) Those
who are nationally or internationally recognized in the field of medicine.
Also, the foreign medical
graduate must also provide documentation showing the following:
(1) The
individual’s home country requires physicians to have the type of training the foreign
medical graduate will acquire;
(2) The
foreign medical graduate intends to return to his or her home country after
completion of the training; and
(3) The
training will not take longer than seven years to complete, or the normal
length of time required for the training in the particular area, whichever is
shorter.
Please see the section
entitled Credentialing &
Licensing in the U.S. for extensive information regarding requirements
imposed by USCIS specifically for doctors.
A.Two-Year
Home Country Residence Requirement
An individual admitted in J-1
status may be subject to a two-year foreign (home country) residence
requirement. Without a waiver of
this requirement, the individual is not eligible to apply for permanent
residence or apply for any change of non-immigrant status (i.e., H or L status)
in the U.S. This two-year period
must be spent in the individual’s home country, or the country in which they
last permanently resided before coming to the U.S. An individual is subject to the 2 year home residence
requirement if:
- The
individual's participation in an exchange visitor program was financed by
the government of the country of his or her last residence;
- At
the time of admission, the individual was a national or resident of a
country which the Department of State had designated as clearly requiring
the services of individuals with the alien's special skills or knowledge;
or
- The
alien came to the United States to receive graduate medical education or
training.
B.Waiver
of the Home Country Residence Requirement
Those who think they may be subject to the requirement and
who do not wish to go home may consider applying to the Department of State for
a waiver of the requirement. The basis for a waiver are as follows:
- Possible persecution:If the J-visa holder can demonstrate that he
or she would be subject to persecution at home on account of race,
religion or political opinion, the home residency requirement may be
waived. The standard is similar to that of asylum.
- Exceptional Hardship to
United States Citizen: If the J-visa
holder can demonstrate that his or her compliance with the home residency
requirement would impose exceptional hardship on a U.S. citizen or
permanent resident spouse or child, the home residency requirement may be
waived. The hardship must amount to more than that normally associated
with separation. In other words, forced separation from family always
imposes hardship, but for a waiver to be granted the exchange visitor must
show some exceptional hardship or combination of hardships, often of a
medical, financial, or psychological nature. The likelihood of the
hardships must be well documented.
- "No Objection"
Waiver: If the J-visa holder’s home
country does not object to the person’s decision not to return home, the
home residency requirement may be waived. A "no objection"
statement is a diplomatic communication between the home country’s
government and the Department of State. Please keep in mind that a
"no objection" statement does not compel the Department of State
and the USCIS to waive the requirement, and the waiver may still be
denied. Also, this form of waiver is generally not granted to those whose
exchange visit was funded, directly or indirectly, by the U.S. government,
and cannot be granted at all to those whose J program consisted of
graduate medical education or training.
- Request by an Interested
Government Agency: A federal
government agency (or, in the case of physicians, a state health
department) may also request that a waiver be granted. Such an
"interested government agency" must show both (i) that granting
a waiver is in the public interest, and (ii) that compliance with home
residency requirement would be "clearly detrimental" to a
program or activity of official interest to the agency. The government
agency need not employ or intend to employ the exchange visitor. Requests
for waivers should be made as early in the exchange program as possible:
the application process is lengthy, and most applicants will want to apply
concurrently for an H-1B visa, which is much harder to get at some points
in the year than at others. Some of the agencies that most commonly
request waivers are the U.S. Department of Health and Human Services, the
Department of Education, and, for physicians willing to practice in
medically underserved areas, the Appalachian Regional Commission, the U.S.
Departments of Agriculture, Veterans Affairs, and Housing and Urban
Development, and state health departments. Any federal agency can request
a waiver, but some other agencies that somewhat commonly do so are the
National Science Foundation, the Departments of Energy and Defense, and
the National Aeronautics and Space Administration.
II.H-1B
Visa
Certain foreign
physicians may also obtain an H-1B visa, for which there is no two-year home country residence requirement. A foreign
national who is a graduate of a U.S. or foreign medical school (or, who is
licensed to practice medicine in a foreign jurisdiction) may engage in
full-time professional, clinical employment on an H-1B visa.
To qualify, the foreign
physician must meet the following requirements:
(1) The
individual has passed the FLEX or an equivalent (e.g., USMLE Steps I, II and III),
or is a graduate of a U.S. medical school;
(2) The
individual has obtained ECFMG English language certification (or is a graduate
of a U.S. medical school); and
(3) The
individual has licensure as required for the type of employment by the state of
intended employment.
Please see the section
entitled Credentialing &
Licensing in the U.S. for extensive information regarding requirements
imposed by USCIS specifically for doctors. See also, section entitled H-1B Visa for detailed information
on applying for this type of visa.
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