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Careers in Medicine

International Students

General Information

Is it an issue?

For some programs, being a non-US citizen/permanent resident is an issue. Some programs will not consider international students for interviews, simply because of citizenship (or rather, non-citizenship). For other programs, it has no effect at all on whether you get offered an interview or not. Previous students have encountered a broad spectrum of program directors and administrative assistants whose knowledge varied from zero to more than I needed. Many program directors or chairmen addressed the issue of immigration status in the interview, others did not, and it was up to students to initiate the conversation and find the information.

Visas 

Current Student Visa: F-1 visa is good for the duration of your time in medical school and through your Optional Practical Training period. After medical school ends, you are then eligible to work for 12 months under the Optional Practical Training (OPT) program. You should use your OPT time to do your internship year. See OPT application section. During your internship, you (or your program) will apply for a new visa status – usually either a H-1B or J-1. This is how it works for most international medical students.

 

H-1B

J-1

Visa Type

Temporary Employment

Exchange Visitor (Physician Training)

Length of Visa Status

Up to 3 years can be requested with each petition.

1 year

Renewal

Renewable in up to 3 year increments until a total of 6 years has been used.  (Note: If you used H-1B within the prior 6 years, that period of time counts towards the 6 years). 

Renewable annually for up to 7 years.  An additional 2 years can be requested in extraordinary circumstances for a total of 9 years.

End of visa status

A US employer can sponsor you for permanent residence.  You can change to another work visa status if you qualify (e.g. O-1).  You can return to your home country for one year (365) and then return to the USA in H-1B visa to begin another 6 year cycle. 

All J-1 Physicians are subject to a two-year home residency requirement.  This means the physician has to return to his/her home country for at least two years (or 730 days) before being able to return to the USA in H-1B status or as permanent resident.  J-1 can obtain waiver of the two-year home requirement by agreeing to work for 3 years in an underserved community (see exception list below). J-1 who agrees to work in an underserved area will be able to obtain an H-1B for the 3 years of service. 

Becoming a Permanent Resident (“Green Card”)

If you marry a US citizen or green card holder, can switch status to permanent residency.  It will take a few months to become a permanent resident if you are married to a US citizen.  It will take a few years to become a permanent resident if you are married to a permanent resident.  You will need to maintain a legal visastatus while you are waiting for permanent residence.

You can also get permanent residence based on sponsorship from a US employer or even self-sponsorship.

J-1 physicians must satisfy the two-year home residency requirement or obtain a waiver (see, Exception list below) in order to qualify for permanent residency.   

Moonlighting

Can moonlight internally but not externally without getting a second H-1B visa.

 

Not permitted internally or externally.  The J-1 is considered a training visa status rather than an employment visa status.

Traveling abroad and returning to US after international travel

No travel signature need from US employer but will need to have an H-1B visa (consular issued) and certain immigration and business documents in order to return to the USA. 

Signature from ECFMG, the organization that sponsors all J-1 Physicians is needed. Will need to have a J-1 visa (consular issued) and certain immigration and business documents in order to return to the USA.

 

J-1 Physician Home Return Exemptions

  • Exceptional Hardship: If a J-1 holder can demonstrate that his departure would cause exceptional hardship to his U.S. citizen or legal permanent resident dependents.
  • Persecution: If a J-1 holder can demonstrate that he can be persecuted in his home country.
  • Interested Government Agency: A waiver issued for a J-1 Physician by a U.S. Federal Government agency that has determined that such person is working on a project for or of its interest and the person's departure will be detrimental to its interest.
  • Conrad Program: A waiver issued for a foreign medical graduate who has an offer of full-time employment at a health care facility in a designated health care professional shortage area or at a health care facility which serves patients from such a designated area. (Note: This definition includes major medical institutions like Vanderbilt)

The H-1B visa is generally the more desirable of the two visas, and fewer programs offer it. Some GME programs will offer it; sometimes the individual residency program will sponsor it.  So, when looking for H-1B information online, you may see that some sites will say that the GME Office does not sponsor H-1Bs.  However, those sites don’t provide information on whether individual residency programs at the medical facility will sponsor H-1B.  (That’s how it is at Vanderbilt; the GME Office doesn’t sponsor H-1Bs but individual residency programs do).   The only way to know for certain is to politely ask the Program Director of the particular residency program you’re interested in. 

H-1B regulations require the institution to cover the USCIS filing fees.  Those costs cannot be passed on to the resident.  The J-1 is slightly less expensive but that cost is almost always covered by the resident rather than the GME Office.  The Educational Commission for Foreign Medical Graduates (ECFMG) sponsors all J-1 physicians and the GME Office works with ECFMG to obtain the necessary immigration paperwork. 

Some programs may offer to do the paperwork for an H-1B if you agree to pay the costs. NOTE: This is illegal. Do not accept if a program offers this option to you.

There is a lot of variation at multiple intuitions and across different programs. For instance, Columbia and Cornell (NY Presbyterian) exclusively offer J-1. No exceptions! Vanderbilt’s GME Office only offers J-1 visa sponsorship, but individual GME programs can sponsor an H-1B if they wish. 

If you look online, you’ll see some things about applying for visas that do not apply to you, having graduated from an American medical school.  You DO NOT need to have completed USMLE Step 3 to obtain an H-1B visa and you DO NOT need an ECFMG certificate. 

Where to find the information

There are a few ways to find out about which visas a program offers.

  1. Program Websites They may or may not state whether or not they offer visas. Usually, programs have information for graduates of foreign medical school. This information does not always apply to us (“foreign students who will graduate from a US medical school”). For example, Johns Hopkins’ Neurology program website: What kind of visa do you offer foreign nationals? The Johns Hopkins University School of Medicine supports the use of the ECFMG sponsored J-1 for clinical trainees. We do not offer H-1B visas except to foreign nationals who are graduates of U.S. medical schools.
  1. GME Offices This is usually your best bet if you want to know if the GME office, itself, sponsors H-1B or if any individual residency programs directly sponsor H-1B. Find the GME office website at the program you’re interested in and email one of the people there. They are the folks who usually handle this information. 
  1. Residency Program Assistants  Sometimes they will know the answers, sometimes they won’t. But often they will know who to get in touch with (usually the GME office).
  1. International Office If the residency program is connected with a university or college, there’s normally an international or immigration office that takes care of H-1B filings. That office will know whether H-1Bs are filed for medical residents.