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Are Visa Issues Causing Delays for IMGs?

In the Jan. 2004 issue of the GME E-letter, we reported that the AMA will work to minimize the time it takes for international medical graduates (IMGs) to obtain visas to participate in GME or practice medicine in the US.

Visa delays have caused some programs to scramble while waiting for IMGs to arrive, reported delegates at the AMA Interim Meeting in Hawaii. Some observers worry that continued delays will make IMGs less attractive candidates for residency slots.

A recent letter from the Educational Commission for Foreign Medical Graduates (ECFMG®) indicates that 924 (82 percent) of the 1,133 J-1 physicians in their first year of sponsorship, with a scheduled start date between June 1 and July 31, 2003, arrived on time or within 31 days of their program start date.

We asked directors whether this had become an issue for their programs and received the following responses:

We have numerous examples where residents' visa problems delayed their beginning on-time. This has occurred for both H-1 and J-1 visas. The State Medical Board has also been instrumental in several delays in the licensing process. It has caused a strain on the other residents to cover necessary hospital services and on-call. Ironically this has worsened the problems with work-hour restrictions too.

Visa problems have been a major difficulty for our residency program. Three of our five residents (we are a small rural training track) are on J-1 visas. The third is still waiting for hers to arrive, and has been unable to start residency as planned. We are hoping to have her start next month but have no assurance of that.

The majority of trainees in our pulmomary disease/critical care medicine fellowship are IMGs, and there have been repeated problems due to (1) visa delays and (2) early departures to waiver posts at end of fellowship.

Last July one first-year fellow, who was chief medical resident at our medical center in 2002-03, visited his home in Lebanon for 2 weeks in June and was not allowed to reenter the US without a lengthy verification process. Result: He missed 3 months of fellowship. Another fellow departed 6 months before finishing his critical care year for a waiver position that he felt obliged to take. The repercussions for our program, and the effects on other trainees, are considerable.

Should we thank Mr. Ashcroft for more misdirected "security" measures?

The delay in processing J-1 visas has a major adverse impact on our community and internal medicine program. Traditionally, we have had applicants with outstanding USMLE scores and communication skills from whom we were able to selectively choose candidates for our program. Presently, we are not considering any J-1 visas because of our previous experience from the year before whereby they could not begin residency on July 1.

We all want the best candidates for our programs and community, and this has been a detriment to the selection process. We also feel that home security is an important issue, but it should not impact medical education and community service adversely.

We recommend a special department as part of the Homeland Security to expedite the application of resident physicians and other technical professionals that are important to maintain high standards in the nation.

We experienced a great deal of problems with beginning residents obtaining their J-1 visas. One couldn't start until August 1, another not until the third week of September, and a third could never obtain his visa, although we waited until October before looking for a replacement (who was able to start January 1).

I believe that this will influence most program directors as far as selecting candidates for interviews, with US citizenship or permanent visas carrying more weight than in the past among the variables considered.