If you are an international medical graduate (IMG) resident/fellow who wishes to practice medicine in the United States, there are nine critical immigration rules you must know. In this first of four articles covering these nine rules, we will discuss the first three.

Rule #1 . . . . J-1 Physician Foreign Residency Requirement

After residency or fellowship training is completed, all J-1 physicians must return to their home country for two years or obtain a waiver of this requirement before they can be employed in H-1B status or adjust to permanent residence (“green card”).

Rule # 2 . . . . Interested Government Agency (IGA) Waivers for J-1 Physicians

Waivers of the Two-Year Foreign Residency Requirement (“J-1 Waivers”) are available for immediate employment after training, with certain conditions. Any government agency can sponsor J-1 waivers but the most common interested government agency (IGA) waiver programs are:

• Conrad 30 State Program
• Department of Veterans Affairs (VA)
• United States Department of Health and Human Services (HHS)
• Appalachian Regional Commission (ARC)
• Delta Regional Authority (DRA)

Rule #3 . . . . J-1 Waiver Conditions; Strategic Job Search for J-1 Physicians

There are many conditions attached to the J-1 waiver program for the physician and employing medical facility. Some of them are:

• The physician must work in H-1B status for minimum of three years as an employee, not independent contractor, of employing medical facility
• The physician cannot change employers for three years unless he or she proves hardship (extenuating circumstances beyond his or her control)
• The physician cannot complete permanent residence (green card) process until waiver service is completed
• The physician and employer must report to state or federal agency periodically.
• The physician cannot “moonlight” unless part-time employer files concurrent H-1B petition

Strategic Job Search for J-1 Physicians

• Start job search immediately after 2nd year of residency or one year before completion of fellowship
• Finalize employment by early Fall of 3rd year of residency or final year of fellowship
• Target employers located in HPSA/MUA who agree to a three-year contract and no non-compete clause
• Hire an immigration attorney early in process