Residency Visa Options Part 1: J1

Introduction

As an international student (ie. Non-US citizen/non-green card holder), applying for and obtaining a residency training position in the US requires securing a visa for the next few years of your training.

In general, there are two types of visas available to complete post-graduate training in the US: the J1 and the H1B (and for some, F1-OPT). Over the next few posts, we will go over these two visas, starting with the J1 visa in this post. Each visa option has its pros and cons, and your decision would depend on a variety of factors, including which visa is offered by your preferred residency program, your length of training, and where you intend to practice medicine after residency.

The J1 Visa

The Exchange-Visitor Visa, or J-1 visa, is a non-immigrant visa issued by the U.S. Department of State that provides internationals to teach, study, conduct research, or receive job training in the U.S.

There are 15 categories of J-1 visas, some of them include intern, teacher, trainee, and alien physician. For residency, you will be applying under the alien physician category, sponsored by the ECFMG (Education Commission for Foreign Medical Graduates).

Please note that the proclamation issued by President Trump on June 22, 2020 (Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak) does not apply to physicians pursuing residency training. The J1 alien physician category is exempt from the provisions of the Proclamation. See https://www.ecfmg.org/annc/presidential-proclamation/ for more details.

How does it work

The J-1 visa can be issued to (non-US citizen) International Medical Graduates (IMGS) or US MDs who:

1) Obtain ECFMG certification (received diploma, passed Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination)

• For US MDs, obtaining ECFMG certification is not required, however, you will still need to have your diploma and pass Step 1 and Step 2 CK.

2) Provide a Statement of Need from the Ministry of Health of the country of most recent legal permanent residence (or referred to as "home country"), regardless of country of citizenship, stating that the country is in need of physicians in the particular field that the applicant wants to pursue.

• The procedure for obtaining the Statement of Need varies depending on the home country.

3) A signed copy of the contract with the hospital, obtained from your residency program after the match.

The process for applying for the J1-visa can be started after finding out which program you have matched into. In general, applications are handled by the graduate medical education office, who will work with you and your program to make sure that a complete application is submitted through the ECFMG. The ECFMG will then sponsor you for the visa to be issued by the US Department of State. The process for a new J-1 visa application can take about 3 months, give or take.

Advantages

• The J-1 visa can be valid for up to 7 years, which is longer than the amount of time allowed for an H1B visa (maximum 6 years), making it more suitable for graduates pursuing longer residencies or an additional fellowship

• The paperwork requirements are much less and there is a smaller fee compared to the H1B visa. The fee is paid by the resident, however.

• More residency programs offer the J1 visa than the H1B visa. There are many well known and strong programs that only offer the J1 visa.

Disadvantages

• The J1 visa is not a true work visa, you cannot moonlight on it

• After completion of the training, the applicant has to return to his/her home country for two years before re-entering the U.S. on another visa (ie. H1B). This two-year requirement can be circumvented through “J-1 Waiver” jobs, such as working in a federally or state-designated underserved area for 3 years or a government institution, however, these jobs are limited.

• You cannot switch from a J1 visa to an H1B visa or green-card without completing the home residency requirement or obtaining a waiver. Marrying a US citizen while on a J1 visa does not waive this requirement.

Few Final Notes

The J1 visa is a very common visa used by international medical graduates to pursue a residency in the US. It has some advantages as well as disadvantages that must be carefully considered based on one's choice of residency specialty, length of training, location preferences, choice of program, and desire to return to his/her home country.

The J1 visa may be more suitable for you if:

• you are thinking of returning to work or pursuing a fellowship in your home country after completing residency

• you are thinking of completing a residency with/without a fellowship that may last longer

• you would like to have more program choices when applying (especially for competitive specialties)

One thing to note is that the J-1 is not as bad as everyone makes it out to be. Yes, the two-year residency requirement is a drawback. If you plan to remain in the US for the long term after residency (and are thinking of transitioning to a green card), then the two year home country requirement may mean delaying future plans and require more flexibility on your part. However, in some cases, being willing to be on a J-1 visa could be the dealbreaker of getting a residency position in the US.