In this post we will explore the other visa option commonly pursued by non-US citizens for residency--the H1B visa. The H visa is a true work visa. It allows a non-US citizen to hold a professional position that requires significant training. H visas are commonly used by physicians and by IT professionals. Because of the "Home Country" issue with the J visa (see part 1), they are often preferred by non-US citizens training in the US, though they do have their limitations as well.
Securing an H1B visa can be difficult in the limited timeframe available between match day and starting residency, as we will explore below. For U.S. medical school graduates who are on F-1 visas in medical school, a common strategy is to complete the first year of residency on an F-1 OPT (optional practical training), then use this time to apply for the H1B. We will explore the OPT visa in another post.
Heads up:
Currently, most H1B applications are suspended for the remained of 2020, however, exceptions are made for physicians who are involved in the care of COVID-19 positive patients. It is unclear how future H1B applications will be processed, and any applications should involve discussion with your hospital employer and a legal representative if possible.
Basic facts:
A foreign physician may obtain H-1B visa status for the following purposes:
To teach or conduct research at a public or nonprofit private educational or research institution or agency; or,
To work for a U.S. employer as a physician.
Requirements
Foreign physicians who did not graduate from a medical school accredited by the U.S. Department of Education must prove competence in oral and written English by passing the English proficiency test given by the Educational Commission for Foreign Medical Graduates (ECFMG).
A medical license from the state where the physician will practice.
Complete and pass all USMLE Steps 1, 2, and 3. These exams may also be required to obtain a medical license.
Physicians educated, trained, and licensed in Canada may not have to pass the USMLE (or an equivalent) to obtain a state license.
The H-1B application process requires the following
The employer to determine the prevailing wage for physicians in the same geographic area
The employer to file a Labor Condition Application (“LCA”) with the U.S. Department of Labor (“DOL”), where the employer attests that the physicians working conditions will not adversely affect similar U.S. physicians
The employer to file an H1B petition with the USCIS (U.S. Citizenship and Immigration Services.) and demonstrate its ability to pay the appropriate wage to the sponsored physician.
Advantages
The biggest advantage of being on an H1B visa is being able to apply for permanent residency (ie. green card) sponsorship after completing residency. Unlike the J1, the H1B does not have a 2 year home residency requirement (see part 1), therefore one can start working in the US right after completing residency.
Once hired in the US into a permanent job (ie. After residency) on an H visa, your employer can sponsor you for permanent residency. This is one of the easiest paths to citizenship.
One can moonlight on an H1-b visa if you can obtain a full license (which depends by state).
The H Visa can be transferred from institution to institution anytime, although it usually takes 2-3 months to do so and there are some limitations (discussed below)
Disadvantages
· There is an annual limit to the number of H visas available in the US-known as the cap limit. In the past years, this limit is around 65,000/year. In addition, given the large number of applicants per year, applicants now must enter a lottery. Only if chosen from the lottery, can applicants begin an application subject to the cap limit.
Most hospitals affiliated with academic institutions or non-profits are not subject to the cap limit. Therefore, it is less difficult for physician residents to secure an H1B visa. However, keep in mind that if an H1B visa obtained outside of the cap can only be transferred to another institution that is not subject to the cap. If one ends up working in an institution that is subject to the cap, then a new H1B application will have to be submitted
The application is much more expensive and needs to be paid and completed by your employer on your behalf, hence many residency programs refuse to sponsor H visas because of all of the work involved. Sometimes people will hire a lawyer to help with the application but this is paid out of pocket.
The timing of applying for H1B and having a visa before starting residency is quite difficult. After finding out the match results in Mid March, one has only about 3 months to: take and pass step 3, obtain a medical license, complete the application, and have it processed before the start of residency. This is a very tight timeline and usually impossible to achieve. In order for the H1B to be possibly processed on time, the only option is to select the premium processing option, which allows the application to be processed in weeks rather than months. This costs ~$1000 extra. As such many people who get the H1B visa usually use OPT on the first year of residency, in order to have more time to gather the required documents.
The H visa is valid for 3 years and renewable for another 3 years for 6 years tota). This can be a big problem if you decide to do a long residency or a fellowship after residency.
Dependents (Spouse/children) obtain H-4 visas. They cannot work in the US on these visas.
In order to get an H, you will need to pass all THREE steps of the USMLE (unlike the J, where you only need Step 1 and 2).
