H-1B Specifics for Foreign Medical Graduates

For Foreign Medical Graduates (FMGs) looking to enter the U.S. workforce, H-1B status is often the best option. H-1B status, “the working visa,” allows foreign professionals to work legally in the United States in specialty occupations, which includes medicine. In order to obtain this status, a FMG must possess a medical degree from an accredited medical school in the U.S. or abroad, and the sponsoring employer must agree to pay the prevailing wage for the offered position.

There are several other detailed requirements that must be fulfilled in order for a FMG to obtain H-1B status. They are:

1. The passage of the United States Medical Licensing Examination (USMLE) 1, 2, and 3 or the equivalent.
– This is a multi-part professional exam sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners. Physicians with a master’s degree are required to pass this exam in order to be able to practice medicine in the United States.
– The USMLE assesses a physician’s ability to apply knowledge, concepts and principles, and to demonstrate fundamental patient-centered skills. Each of the three steps of this exam complements the other; no step stands alone in the assessment of readiness for medical licensure.

2. Must obtain an Educational Commission for Foreign Medical Graduates (ECFMG) Certification.
– This certification program assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited.
– The ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/graduates.
– It conducts three examinations: Step 1, Step 2CK and Step 2CS. The certificate is issued if the physician passes all three steps within a seven-year time frame.

3. Must obtain licensure in the state of intended employment.
– The requirements for licensure vary state by state. This can sometimes be the most difficult step in working towards H-1B status.
– As obtaining state licensure can often take many months, it is important to start this process early on.

One complex aspect of the H-1B process is what is called the “H-1B cap.” Each year, U.S. Citizenship and Immigration Services allots 65,000 regular H-1B cap numbers, plus an additional 20,000 advanced-degree cap exemptions for those with a master’s degree earned at a U.S. college or university. If there are enough cases to meet or exceed the cap, the filing period ends after five days and the lottery process begins. The lottery simply means the applications are chosen at random via a computer selection process.

For FMGs applying for H-1B status through the cap, this means there is no guarantee in obtaining status. However, if the FMG works for a non-for-profit hospital or a hospital associated with a U.S. college or university, they may be exempt from the cap selection.

H1-B visas are granted initially for up to three years, and are renewable for another three years. With some exceptions, H-1B visas are limited to six years in duration. As H-1B status is considered dual-intent, once the six years have been exhausted a FMG may want to consider obtaining a green card. We will look at green card options more closely in the following article.

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