USMLE Visas

VISA
Doctors who have graduated from foreign medical schools seeking U.S. residency training (who do not qualify for permanent resident status in the U.S.) usually seek either of two visas from the Immigration and Naturalization Service (INS), the J-1 or the H-1B visas. Several recent events affect the use of those two visas by international medical graduates.
7A. The J-visa
The J-1 non-immigrant visa permits completion of an accredited residency or fellowship program of up to seven years duration which leads to board certification. Following this, the resident *must* return to his/her native country or country of last residence for a period of at least two years. ECFMG issues a form called a DS2019 which tells the consulate that you are eligible to enter the US. The American consulate in your own country will decide whether to issue the visa.
Your governmental health office must sign a document indicating the need in your home country for physicians trained in your prospective speciality. Occasionally (this is often an issue for Canadians)the country does not recognize a need for residents in a particular area and refuses to issue the form, but for most it is a simple formality. J-1 visa applications are usually processed quickly, though some countries have a longer processing time due in part to the events of Sept 11, 2001.
It is important to note that coming to the US on a J-1 visa absolutely limits you to staying here only until the completion of any training (be that six months or five years) up to a MAXIMUM of seven years. This is a training visa, so you cannot use to practice independently as an attending. If you think there is a chance that you would like the opportunity to stay in the USA after your training, you should take the USMLE 3 and come on a H1B visa.
There are four ways to stay in the US on a ‘waiver’ of this two year home residency requirement. For most, the only practical way to avoid having to return to your home country is to agree to practice in an underserved area for three years after you have completed your training. These positions are competitive and the competition for them is expensive. For specific information on J-1 visa waivers, Again, please consider coming on a H1B visa to avoid these problems.
7B. The H-1B Visa
The H-1B visa allows the prospective trainee to avoid the J-1 visa requirement to leave the U.S. for two years by petitioning for permanent resident status in the U.S. while in residency training. An applicant for an H-1B visa must be
(1) ECFMG certified (ie have passed USMLE 1, 2ck and 2cs);
(2) must have ALSO passed USMLE step 3 AND
(3) must hold a license to practice in a U.S. state before application (it takes about three weeks to get a training license after your match).
Residency programs decide individually which type of visa they will support for their candidates for residency training. Previously most did NOT support H-1b applications, although the new visa laws passed in October 2000 mean that now many that previously did not offer them should do so. You should ask your programs directly which they will consider for you. Remember that many have the default position of refusing such visas (and even note such decisions on residency and hospital websites), but if you learn about them, and talk to the international officers at these institutions, many will reverse their decision and apply for this visa on your behalf.
Fortunately, many of you reading this will avoid the problems that I had to go through in securing my H1B visa, as now all academic institutions have unrestricted access to H1B visas, without a cap. This means that your H1B visa is likely to be easily available, and processed quickly (though some can still take up to six months). A standard H1b application can still takes about 2-3 months for processing, so to be ready for a July 1st start, you have to be quick about your license and your visa application right after you match, unless your employer will use expedited processing for you. Expedited visa application can be achieved by paying an extra $1000 (your employer must pay this), and the visa will be approved within approx 14 days.
I would urge you to seek the most accurate and timely information available. This analysis my own present understanding of the status of the J-1 and H-1B visas. Foreign medical graduates should verify this information themselves and make every effort to stay up to date on changes in these regulations which may affect your ability to be employed. You should liase closely with your employing hospital in this regard and may wish to retain an immigration attorney to handle the process if your hospital does not have an international office.
You will have to think carefully about which visa is right for you. Note that the Match takes place in mid-March, and for a July start you would likely have only a short time to secure a state medical license and submit your H-1B visa application.