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What are the requirements for a foreign-trained physician who wishes to practice medicine in the United States?
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| Physicians who did not attend medical schools in the U.S. or Canada must first complete a medical residency in the U.S. |
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| 2. |
Must I pass an examination in order to be admitted into a medical residency program?
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Yes. You must pass all or part of the U.S. Medical Licensing Examination (USMLE). The USMLE consists of three steps. In order to obtain J-1 immigration status, you must pass Steps I and II. In order to obtain H-1B immigration status, you must pass all three steps.
STEP 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.
STEP 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.
STEP 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. |
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| 3. |
Is the USMLE offered abroad or only in the U.S.?
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| Step I of USMLE and Step II (Clinical Knowledge) of the USMLE are offered both in the U.S. and abroad. However, Step II (Clinical Skills) and Step III are only offered in the U.S. |
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What type of visa will I need to enter the U.S. in order to take the USMLE?
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| Most physicians come to the U.S. as either visitors or students in order to take the required examinations. |
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| 5. |
If I am accepted at a medical residency program, should I obtain H-1B status?
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| If you have passed all three parts of the USMLE, you are eligible to obtain H-1B status. However, some residency programs do not sponsor physicians for H-1B status. You should check with the residency programs that you are interested in to see if they are willing to sponsor you for H-1B status before you apply. Also, be aware that there some limitations on H-1B status. Generally, H-1Bs are limited to six years of graduate medical education in the U.S. If you plan to take a fellowship after you finish your residency, and the entire program exceeds six years, think twice before you apply for H-1B status. Also, there are a limited number of people who may obtain H-1B status each year. The quota may be reached before you “match” for a residency program. However, if your residency program is university-affiliated or university-related, you may be exempt from the numerical cap. |
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| 6. |
If I am accepted at a medical residency program, should I obtain J-1 status?
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| J-1 status has some significant advantages over H-1B status: (1) Almost all medical residency programs will sponsor you for J-1 status; (2) You do not have to pass Step II (Clinical Skills) or Step III of the USMLE in order to obtain J-1 status; (3) There is no numerical cap for J-1 residents; (4) You can pursue your graduate medical education for 7 years in J-1 status. |
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| 7. |
Are there any disabilities to pursuing my medical residency in J-1 status?
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| Yes. You are obligated to return to the country of your nationality or last residence for two years after you complete your medical residency and/or fellowship in the U.S. |
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| 8. |
Are there any exceptions to this two-year home residency requirement?
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Yes, there are three possible ways to receive a “waiver” of this requirement:
- You do not have to return to your country if you can demonstrate that it is “more likely than not” that you will be persecuted on account of your race, your religious beliefs or your political opinion;
- You do not have to return to your country if this would cause an “exceptional hardship” to your spouse and children if they are either U.S. citizens or lawful permanent residents;
- You do not have to return to your country if you are sponsored by an “interested government agency” (IGA) and this sponsorship is approved by the State Department and the Immigration Service. Most physicians who receive waivers use this method. See http://shusterman.com/fmg.html
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| 9. |
Which government agencies are permitted to sponsor me for an IGA waiver?
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- Any Federal agency may sponsor a physician for a J waiver although most waivers are sponsored by the Veterans’ Administration (VA) for direct employment only: by the HHS for researchers and for a limited number of primary care physicians; by the Appalachian Regional Commission (ARC) for primary care physicians; and by the Delta Regional Authority (DRA).
- Departments of Public Health in any state, in Guam, the District of Columbia, Puerto Rico and the Virgin Islands may sponsor up to 30 physicians for J waivers annually.
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| 10. |
What are the requirements for an IGA waiver?
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| Generally, you must agree to work in H-1B status a medically underserved area for a minimum of three years. |
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| 11. |
Is there a way for me to work in the U.S. permanently?
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Yes. If your employer can demonstrate that there are no qualified U.S. physicians in your area of practice who are qualified and available for your position, you may apply for a “green card”. Also, if you agree to work in the medically underserved area(s) for five years, you can sponsor yourself for a green card through a national interest waiver.
Remember, that you may also be sponsored for permanent residence through a close relative who is a U.S. citizen or a permanent resident; through the green card lottery; or as an investor. |
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| 12. |
How can I learn more about immigration for foreign-born physicians?
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| Carl Shusterman has practiced immigration law for over 30 years. His five-attorney law firm has assisted over 1,500 physicians across the U.S. in obtaining J waivers, temporary working visas and permanent residence. You can schedule a telephonic legal consultation with Mr. Shusterman at http://shusterman.com/intake.html |
