To practice medicine in the United States, a physician must graduate from medical school, complete a U.S. residency program and pass licensing examinations.  Foreign nationals may enter the U.S. to attend medical school under a student (or F-1) visa.  This visa allows a foreign national to stay in the U.S. so long as she is enrolled full-time in school and for up to a year after graduation to complete additional practical training. Most foreign medical graduate (FMG) physicians graduate from medical schools outside the U.S.  Regardless of whether the foreign national physician attends medical school in the U.S. or abroad, he must obtain a visa to complete a medical residency program.

J-1 Visas for Medical Training

One visa option is the J-1 exchange visitor (or J-1) visa, which is sponsored through the Educational Commission for Foreign Medical Graduates (ECFMG).

The ECFMG has stringent requirements for sponsorship in a clinical training program.  Details of the process, including application forms, can be found at www.ecfmg.org.  At a minimum, an applicant for J-1 sponsorship must:

• Be an international medical graduate (IMG), i.e., a graduate of a medical school outside of the United States and Canada.  The medical school and graduation year of the IMG must be listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER).
• Pass Steps 1 and 2 of the United States Medical Licensing Examination (USMLE) (or an acceptable combination of components of the former Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), the National Board of Medical Examiners (NBME) Part sequence, or the Visa Qualifying Examination (VQE));
• Be certified by the ECFMG (hold a Standard ECFMG Certificate).  Certification requires passage of Steps 1 and 2 of the USMLE,  the Test of English as a Foreign Language (TOEFL) , and the ECFMG Clinical Skills Assessment (CSA) examination;
• Hold a contract or an official letter of offer for a position in a program of graduate medical education or training that is affiliated with a medical school.  The program must be accredited by the Accreditation Council for Graduate Medical Education (ACGME); and
• Provide a written Statement of Need from the Ministry of Health of the physician's country of last legal permanent residence (regardless of country of citizenship). This statement should attest that the country needs physicians trained in the proposed specialty and/or subspecialty.

One major requirement of this visa is that the foreign national must return to his homeland for two years after completing the residency program (the two-year foreign residency requirement). Consequently, a “J-1 Physician” cannot remain to work in the U.S. immediately after completion of his medical residency program. Needless to say, this presents a formidable obstacle for many foreign born physicians.  Fortunately, there are a number of methods to obtain a waiver of the two-year foreign residency requirement (“J-1 Waiver”) and then work with the H-1B professional worker (H-1B) visa.

H-1B Visas for Medical Training

In addition, some foreign nationals avoid this hurdle altogether by completing their medical residency programs with an H-1B visa (as opposed to the exchange visa). To qualify, these physicians must have passed all three steps of the USMLE and be sponsored by the residency program, rather than the ECFMG.  Many training programs will not sponsor H-1B visas but it appears many will.  The program must pay the prevailing wage for resident physicians and follow certain other requirements.

To address your unique immigration situation, you are invited to contact our firm at [email protected], 214-672-2000.

The information provided in this article is intended to help you understand basic issues involved in the immigration process for foreign physicians, and are offered only for general informational and educational purposes. This information is not offered as, nor does it constitute legal advice or legal opinions. You should not act or rely upon the information in this article without first seeking the advice of an immigration attorney.