IMP has been the industry leader for over 20 years in the recruitment and consultation of physicians from around the world who wish to practice medicine in the U.S. We have conducted numerous physician seminars and conferences throughout the Europe and North America to educate attendees on how to build a successful strategy for a career in medicine in the U.S. Our consultant staff will advise you on the following:
- Visa options
- State Licensing requirements
- Specialty Board issues
- Overall marketability and timeline
For more information on your specific situation Contact us
Employment of International Medical Graduates Who Trained in J-1 Visa Status
The majority of international medical graduates who come to the United States for residency or fellowship training do so on a J-1 visa. A J-1 visa is issued for the duration of the physician’s training in the U.S. for a maximum of 7 years. A J-1 visa allows the physician to work only for the facility where he or she is serving as a resident or fellow. At the conclusion of residency or specialty training, the J-1 physician is required to return to his or her home country for two years before the physician can return to the U.S. This obligation is often referred to as the J-1 foreign residence requirement.
Obtaining a Waiver of the J-1 Foreign Residence Requirement
Under certain, limited circumstances, a physician who is here in the U.S. in J-1 visa status can obtain a waiver of the J-1 foreign residence requirement to enable him or her to stay in the U.S. after completing post graduate medical training. Currently, one of the available routes for a waiver is to obtain the support of a state department of health or federal government agency by agreeing to provide health care at a Veterans Administration Hospital, or to patients in a Health Professional Shortage Area or Medically Underserved Area in the United States. The State Departments of Health also have the authority to place up to ten physicians in areas that are not medically underserved.
The federal government agencies that have J-1 waiver programs for physicians who will engage in patient care are the Department of Veteran Affairs, the Department of Health and Human Services, the Delta Regional Authority and the Appalachian Regional Commission. In addition to the federal agencies, each state Department of Public Health is also authorized to sponsor 30 J-1 waivers per fiscal year. Each of these agencies has its own J-1 waiver requirements. However, all agencies require at a minimum that the physician have a three-year employment contract with a qualified employer.
The employer on behalf of the physician submits the waiver request to the state health department or federal government agency. The physician cannot file on his or her own behalf. Processing time varies considerably, anywhere from one to three months or more, depending on the government agency involved. If the state health department or government agency agrees to recommend a waiver, it will forward its recommendation to the U.S. Department of State’s J-1 Waiver Review Office.
Within approximately one to two months of receiving the interested government agency recommendation, the Department of State will send its recommendation to the U.S. Citizenship and Immigration Services (USCIS). The USCIS has the final authority to grant the waiver of the J-1 foreign residence requirement. In almost all cases USCIS will follow the recommendation of the Department of State.
Obtaining the H-1B Visa to Allow the Physician to be Employed in the U.S.
A waiver of the J-1 home residence requirement does not allow the physician to work in the U.S. In order to obtain work authorization, the physician’s employer must file an H-1B visa petition and obtain an approval of the visa petition.
The H-1B visa is designed for employers who wish to employ temporarily foreign nationals in “specialty occupations.” H-1B visas are available for physicians who come to the United States to perform direct patient care, provided that the physician possesses a valid medical license from the state of intended employment and has successfully completed all parts of the Federation Licensing Examination (FLEX) or the United States Medical Licensing Examination (USMLE). The H-1B visa is issued for an initial three-year period with a maximum allowable stay of six years. The H-1B visa limits the physician to working only for the employer who obtained the visa for him or her.
The H-1B visa requirements impose a number of responsibilities on the employer, which include meeting the prevailing wage rate for similarly employed physicians in the employer’s geographical area. In the event the employer terminates the H-1B employment, the employer is liable for return transportation to the employee’s home, if the employee chooses to leave the U.S., although in most cases the discharged employee will locate new employment in the U.S.
The H-1B visa category is the only visa category available for a physician who has obtained a J-1 waiver based on service to the medically underserved or VA medical center. Physicians must work for three-years in H-1B visa status to comply with the terms of the J-1 waiver. Failure to complete three years of employment in H-1B status will result in the physician once again becoming subject to the two-year foreign residence requirement.
Because there are several government agencies involved in the J-1 waiver and H-1B visa process, it is important to plan ahead and begin the process at least six months before the date the physician intends to begin employment.
Summary of the Immigration Process
I. Obtaining a Waiver of the J-1 Foreign Residence Requirement
A. Prospective employer submits a waiver request to an appropriate federal government agency or State Health Department.
B. The waiver request is reviewed to determine if it meets the waiver program requirements. Processing time at this stage can take up several months, depending on the J-1 waiver program. If the request is approved, the government agency or Health Department forwards its favorable recommendation to the U.S. Department of State Waiver Review Office.
C. The Department of State (“DOS”) reviews the waiver request. In most cases, the DOS will follow the recommendation of the State Health Department or interested government agency.
D. The DOS sends its favorable recommendation to the U.S. Citizenship and Immigration Services (“USCIS”). USCIS issues the final decision on the waiver request in the form of an I-797 Notice of Action.
II. Obtaining the H-1B Visa for the Physician
A. Physician must 1) have a medical license for the state where he or she will work; 2) be certified by the Educational Commission on Foreign Medical Graduates; 3) have passed Parts and II of the Federation Licensing Examination or Parts I, II, and III of the United States Medical Licensing Examination.
B. Employer files a Labor Condition Application with Department of Labor, demonstrating that it has complied with Department of Labor salary, record keeping and notice requirements.
C. Employer files an H-1B visa petition with the U.S. Citizenship and Immigration Services.
This information provides a very basic outline of the process involved. It is meant to be only a general description of the process and does not constitute legal advice. It is advisable to seek assistance from a qualified immigration attorney before beginning the J-1 waiver process.
Used with permission from The Law Offices of Dayna Kelly, P.C.