The USA can be compared to Disney World, especially for International Medical Graduates (IMGs), because “here, dreams come true.” It is not astonishing that US medical hospitals and residency programs are often the first choice for smart physicians across the world, mainly because:
- US physicians and surgeons are paid almost twice as much, when compared to doctors in other developed parts of the world (such as Australia, England, Germany etc.). In most developing countries like Nepal, India and Pakistan, doctors make under $20,000 per year (1)
- The opportunities for research and technological development are immense in the United States. In fact, the US government spends 17.9% of the annual GDP (gross domestic product) on the provision of healthcare facilities to its citizens (2).
- Most doctors in developing countries face discrimination, racial profiling, corruption and violence; hence, opting for a healthcare career in United States is an excellent opportunity for personal and professional growth.
But before you can accomplish this all, the first and foremost step is getting a US visa that would allow you to pursue your dreams.
Pre-Requisites for Foreign Physicians to be considered for a Visa in United States:
Although there are plenty of immigration consultants who can help foreign doctors in getting a US visa (either in general or in specialist category), you can save a lot of money by doing a little research on your part. Nonetheless, if you don’t know anything about the US immigration process, hiring an attorney is definitely an expensive yet practical option.
Available visa options are:
- Visitor visa or temporary work visa (which are classified under non-immigration visas)
- Special Visas (TN visas or Visas for Extraordinary physicians)
- Immigrant visa (green card or permanent residence)
You can get help from your consultant regarding job prospects, getting waivers, and getting a permanent residence status in the US. Before entering and practicing medicine within the US, the foreign medical graduates are bound to fulfill medical licensure and US federal immigration regulations, which include (but are not limited to):
- ECFMG Certification:
ECFMG (abbreviation of Educational Commission for Foreign Medical Graduates) provides certification and registration to foreign medical graduates who have successfully completed their residency requirements. You can obtain this certification after thorough scrutiny of your basic medical education via a multi-stepped testing system that includes basic medical knowledge (USMLE Step 1), and clinical skillfulness as well as command of the English language (USMLE Step 2 CK and Step 2 CS).
ECFMG certification is a compulsory requirement for individuals who are seeking opportunities as a resident or as a fellow in US hospitals and is accredited/ recognized by the Accreditation Council for Graduate Medical Education. This certification is also applicable to foreign qualified individuals looking for unrestricted medical license.
To learn more about it, please visit – http://www.ecfmg.org/certification/requirements-for-certification.html
- Compliance with the Laws of US Immigration:
As a foreign physician, you are eligible for a Temporary worker visa (H-1B), Exchange visitor visa (J-1), and other legal means of entering and working in United States. Before applying for residency in the United States, you must obtain a visa that would allow you to work in the region (which definitely excludes Student Visas). Down the road, you can become eligible to pursue legitimate, permanent residence in the United States, after completion of a two-year residency requirement in an accredited residency or fellowship program.
What should you know about the Temporary (Non-immigrant Visas)?
Both a temporary worker visa (H-1B) or an exchange visitor visa (J-1) belong to the category of non-immigrant visas, available for foreign doctors planning to practice and live in the United States.
Exchange visitor visa (J-1): ECFMG sponsors J-1 visas for international medical graduates. The J-1 visa is valid until completion of your residency and can be renewed during your residency or fellowship (as and when needed).
Note: After finishing your residency, J-1 visa holders are not allowed to stay in the United States and are bound to return to their homeland, where they are required to spend 2 years before they may come back to the United States to practice medicine.
A J-Waiver is made available for physicians willing to bypass this two-year compulsion in several ways:
- Obtain a No-Objections Letter/ Statement: Request a ‘No-Objections’ letter from the government of your country of origin.
- Conrad Waiver: Every state’s health department has the autonomy to give out 30 J-waivers per annum under the Conrad waiver program. You can also apply for a J-Waiver via this program.
- Persecution Waiver or Hardship Waiver: if your spouse or children are permanent residents (green card holder) or citizens of the United States and you are able to validate that going back to your homeland will bring them destitution and unwanted harassment, then you can get a Hardship Waiver.
- IGA Waiver (also referred to as Interested Government Agency Waiver): You can also request employment or placement in a medically underserved category (also termed as HSPA or Health Professional Shortage Area).
Temporary work visas (H-1B) can be obtained once J-1 holders have a J-waiver.
Additional information regarding the processing requirements, timeline, procedure and fee structure can be obtained from – http://www.ecfmg.org/evsp/
H-1B Temporary Worker Visa:
Foreign graduates can also obtain an H-1B visa in order to start their healthcare career within United States. You need a US firm, possibly your healthcare organization, to sponsor your H-1B visa. Additionally:
- After completion of residency, the employees have to get their H-1B visas sponsored by their new employer in a fresh appeal.
- Physicians holding non-immigrant (H-1B) visas have very limited precincts in employment prospects because they have very limited chances of getting in a Medically Underserved Area (MUA) or a Health Professional Shortage Area (HPSA).
An H-1B visa is better than a J-1 visa because the holder doesn’t have to return to his country of origin after finishing the residency. Additionally, H-1B is a dual-purpose visa, which suggests that paperwork towards obtaining a green card or permanent residence can also be initiated under National Interest Waiver program or PERM.
It is extremely important to understand that a limited number of temporary work visas (H-1B visas) are issued annually, forcing international physicians to pursue J-1 exchange visas.
Additional information regarding the processing requirements, timeline, procedure and fee structure can be obtained from http://www.internationalcenter.umich.edu/immig/h1bvisa/
Other Visa categories are:
H-3 Visa: A variant of the H-1 Visa that is issued to foreign doctors who intend to acquire clinical training in the United States only. After the completion of training, these doctors are required to use their skillset in any country other than the United States.
You can get more information about the H3 Visa requirements, limitations and procedures from this link:
O -1 Visa: Doctors or physicians who have rendered exceptional medical or research-based services in their hometown can apply for this visa. There are a few conditions or requirements that should be met before applying for this visa; such as:
- You must possess extra-ordinary skillset
- You must produce a letter (also referred to as Consultation letter) by physicians of the respective field as a testament to your extraordinary skillset in that field
For more information regarding the application procedure, requirements and timeline, visit this link
TN Visas: If you are a resident and practicing doctor from Mexico or Canada, you can apply for a TN visa that is an implementation of the North American Free Trade Agreement. There are a few constraints if you opt for TN visas, such as:
- You can only apply for physician research and teaching positions in United States
- You have to renew the visa at intervals
For more information regarding this visa category, please visit http://www.internationalcenter.umich.edu/immig/tnvisa/
Immigrant Visas
Permanent residence allows individuals to remain in the United States forever, and if all rules and laws are followed, these individuals can become US citizens after a time period of three to five years of stay in the United States. A foreigner can get an immigrant status:
- If he or she is immediately related to a US citizen (spouse or child of a US citizen)
- If he/she is sponsored by a US employer
- If he/she gets a lottery visa under the diversity visa program
An applicant is considered unaccepted if found in criminal offence, mental flaw, Marxist party association, drug trading, or extremism.
For foreign doctors, immigration to the US can be acquired through a National Interest Waiver, certification from the Department of Labor and lastly, through the category made for aliens of special ability or for the intelligentsia, including professors and researchers.
For more information regarding this visa category, please visit http://www.uscis.gov/green-card/other-ways-get-green-card/green-card-through-physician-national-interest-waiver-niw
Nowadays, the most common route to acquire immigration among international medical graduates is by getting a certificate from the Department of Labor. Conventionally, it has been a very sluggish process, with complicated paper work. Recently, however, the DOL has made alterations to streamline the process and make it fast and less complex. But in terms of processing times, getting immigration under the National Interest Waiver is the fastest, with a processing time of sixty to ninety days. The NIW program has added strings to it however, so profound exploration is highly recommended before applying for the NIW.
References:
- Indicators, O. E. C. D. (2011). Health at a Glance 2011. http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013-Chart-set.pdf
- http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
