Non-Immigrant Visa Options for Physicians

There are two types of non-immigrant visas available to foreign medical school graduates and physicians: the J-1 visa and the H-1B visa. The J-1 visa is limited to seven years and the H-1B is limited to six years. J-1 visa holders are subject to the 2 year home country residence requirement, but H-1B visa holders are not.

Foreign medical graduates seeking to practice clinical medicine in the U.S. usually must complete (or in some cases repeat) residency training at a U.S. Program in order to obtain a state medical license. The Educational Commission for Foreign Medical Graduates can acts as a visa sponsor enabling the foreign medical graduate to obtain a J-1 visa and enroll in the residency program. Alternatively, the residency program itself may sponsor the foreign medical graduate for an H-1B visa. See section entitled Applying for Medical Residencies in the U.S. for more information.

I. J-1 Foreign Medical Graduates

In order for a foreign medical graduate to receive a J-1 visa in order to pursue medical residencies and other clinical training in the U.S., the individual must enter the United States under the sponsorship of the Educational Commission for Foreign Medical Graduates (ECFMG). An individual who participates in this type of exchange visitor program is subject to the two-year home country residence requirement of INA § 212(e), which is rarely waived. The stay in such J-1 category is limited to seven years, except for exceptional needs. Please see section entitled J-1 Exchange Visitor Visas for detailed information on applying for this type of visa.

To obtain ECFMG sponsorship to engage in clinical training, a foreign medical graduate must have passed either Part I and II of the National Board of Medical Examiners Examination (NBME), the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), or the United States Medical Licensing Examination (USMLE) Steps I and II. However, the following individuals are exempt from these requirements:

  (1) Those who have graduated from a U.S. or Canadian medical school accredited by the Liaison Committee on Medical Education, or

  (2) Those who, on January 9, 1977, were fully and permanently licensed to practice medicine in a state and who were practicing medicine in a state, or

  (3) Those who are nationally or internationally recognized in the field of medicine.

Also, the foreign medical graduate must also provide documentation showing the following:

  (1) The individual’s home country requires physicians to have the type of training the foreign medical graduate will acquire;

  (2) The foreign medical graduate intends to return to his or her home country after completion of the training; and

  (3) The training will not take longer than seven years to complete, or the normal length of time required for the training in the particular area, whichever is shorter.

Please see the section entitled Credentialing & Licensing in the U.S. for extensive information regarding requirements imposed by USCIS specifically for doctors.

A.Two-Year Home Country Residence Requirement

An individual admitted in J-1 status may be subject to a two-year foreign (home country) residence requirement. Without a waiver of this requirement, the individual is not eligible to apply for permanent residence or apply for any change of non-immigrant status (i.e., H or L status) in the U.S.   This two-year period must be spent in the individual’s home country, or the country in which they last permanently resided before coming to the U.S.   An individual is subject to the 2 year home residence requirement if:

  • The individual’s participation in an exchange visitor program was financed by the government of the country of his or her last residence;
  • At the time of admission, the individual was a national or resident of a country which the Department of State had designated as clearly requiring the services of individuals with the alien’s special skills or knowledge; or

  • The alien came to the United States to receive graduate medical education or training.

B.Waiver of the Home Country Residence Requirement

Those who think they may be subject to the requirement and who do not wish to go home may consider applying to the Department of State for a waiver of the requirement. The basis for a waiver are as follows:

  • Possible persecution:If the J-visa holder can demonstrate that he or she would be subject to persecution at home on account of race, religion or political opinion, the home residency requirement may be waived. The standard is similar to that of asylum.
  • Exceptional Hardship to United States Citizen:

    If the J-visa holder can demonstrate that his or her compliance with the home residency requirement would impose exceptional hardship on a U.S. citizen or permanent resident spouse or child, the home residency requirement may be waived. The hardship must amount to more than that normally associated with separation. In other words, forced separation from family always imposes hardship, but for a waiver to be granted the exchange visitor must show some exceptional hardship or combination of hardships, often of a medical, financial, or psychological nature. The likelihood of the hardships must be well documented.

  • “No Objection” Waiver:

    If the J-visa holder’s home country does not object to the person’s decision not to return home, the home residency requirement may be waived. A “no objection” statement is a diplomatic communication between the home country’s government and the Department of State. Please keep in mind that a “no objection” statement does not compel the Department of State and the USCIS to waive the requirement, and the waiver may still be denied. Also, this form of waiver is generally not granted to those whose exchange visit was funded, directly or indirectly, by the U.S. government, and cannot be granted at all to those whose J program consisted of graduate medical education or training.

  • Request by an Interested Government Agency:

    A federal government agency (or, in the case of physicians, a state health department) may also request that a waiver be granted. Such an “interested government agency” must show both (i) that granting a waiver is in the public interest, and (ii) that compliance with home residency requirement would be “clearly detrimental” to a program or activity of official interest to the agency. The government agency need not employ or intend to employ the exchange visitor. Requests for waivers should be made as early in the exchange program as possible: the application process is lengthy, and most applicants will want to apply concurrently for an H-1B visa, which is much harder to get at some points in the year than at others. Some of the agencies that most commonly request waivers are the U.S. Department of Health and Human Services, the Department of Education, and, for physicians willing to practice in medically underserved areas, the Appalachian Regional Commission, the U.S. Departments of Agriculture, Veterans Affairs, and Housing and Urban Development, and state health departments. Any federal agency can request a waiver, but some other agencies that somewhat commonly do so are the National Science Foundation, the Departments of Energy and Defense, and the National Aeronautics and Space Administration.

II. H-1B Visa

Certain foreign physicians may also obtain an H-1B visa, for which there is no two-year home country residence requirement. A foreign national who is a graduate of a U.S. or foreign medical school (or, who is licensed to practice medicine in a foreign jurisdiction) may engage in full-time professional, clinical employment on an H-1B visa.

To qualify, the foreign physician must meet the following requirements:

  • The individual has passed the FLEX or an equivalent (e.g., USMLE Steps I, II and III), or is a graduate of a U.S. medical school;
  • The individual has obtained ECFMG English language certification (or is a graduate of a U.S. medical school); and
  • The individual has licensure as required for the type of employment by the state of intended employment.

Please see the section entitled Credentialing & Licensing in the U.S. for extensive information regarding requirements imposed by USCIS specifically for doctors. See also, section entitled H-1B Visa for detailed information on applying for this type of visa.