International Medical Graduates who seek entry into U.S. programs of Graduate Medical Education (GME) must obtain a visa that permits clinical training to provide medical services.
Obtaining a J-1 Visa
The most common visa international medical graduates use to participate in U.S. GME programs is the J-1 visa.
The Educational Commission on Foreign Medical Graduates (ECFMG) is authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 visa.
Information on eligibility and deadlines is available from ECFMG's Exchange Visitor Sponsorship Program.
To apply for a J-1 visa, an IMG must meet the following criteria:
- Passed USMLE® step 1 and step 2 CK (or equivalent).
- Have a valid ECFMG Certificate.
- Have a contract or official letter of offer for a position in a program of Graduate Medical Education or training with a medical school.
- Provide a statement of need from the Ministry of Health of the country of last legal permanent residence (LPR) regardless of country of citizenship.
Two-year Home Country Physical Presence Requirement
Upon completion of training in the U.S., J-1 visa holders must return to their home country for a period of 2 years to transmit the knowledge they gained in the U.S.
An individual must fulfill this obligation before being eligible for a change or adjustment of visa status to certain types of U.S. visas. These visa types include:
- H–Temporary worker
- L–Intra-company transferee
- U.S.–Permanent resident
J-1 Visa Waivers
The only exception to the 2-year home residence requirement of the J-1 visa program is to receive a waiver.
Under the law, the following 3 circumstances can provide a waiver of the 2-year residency requirement:
- The waiver applicant can demonstrate that he or she will suffer from persecution in his or her home country or country of last legal permanent residence.
- Fulfillment of the residency requirement would bring proven exceptional hardship to the applicant's spouse and/or children who are U.S. citizens or permanent residents.
- The applicant is sponsored by an Interested Governmental Agency (IGA) that is interested in the physician’s continued employment in the United States.
The following governmental agencies have sponsored waivers for international medical graduates:
- The Department of Health and Human Services
- The Department of Veterans Affairs
- The Appalachian Regional Commission
- The Department of Agriculture
- The Department of Housing and Urban Development
- State departments of public health may sponsor up to 30 J-1 physicians per year for waivers to provide care in underserved communities.
Once an international medical graduate receives a J-1 waiver and a state medical license, he or she may obtain a new work authorized status for U.S. employment, which in most cases will be an H-1B visa or an immigrant visa.
Other Visa Types
The H-1B visa is for temporary workers in specialty occupations who hold professional-level degrees. It has no 2-year home residence requirement. The H-1B visa allows a foreign national to enter the U.S. for professional level employment for up to 6 years.
The H-1B visa is available to graduates of foreign medical schools who have passed the necessary examinations, have a license or other authorization required by the state of practice, and have an unrestricted license to practice medicine or have graduated from a foreign or U.S. medical school.
An immigrant visa (also known as a green card or permanent resident status) permits a foreign citizen to permanently remain in the U.S.
A lawful permanent resident (LPR) has the right to become a naturalized U.S. citizen after living in the United States for 3 to 5 years.
To obtain immigrant status, one must qualify as a specified immediate relative of a U.S. citizen or another LPR, as an employee of a sponsoring employer or prospective employer or as a "diversity immigrant" under a visa lottery program.
The applicant must not fall into any of the categories of aliens deemed inadmissible by law:
- Mental defect
- Communist party affiliation
- Drug trafficking