Nonimmigrant Options for Foreign Medical Graduates

According to the American Medical Association, Foreign Medical Graduates (FMGs) make up approximately 25 percent of the United States physician population. A foreign medical graduate is a physician who graduated from a medical school outside of the United States.

There are several types of nonimmigrant visas available to FMGs: the J-1 exchange visitor visa, the TN visa for Canadian and Mexican citizens, the H-1B visa for specialty occupations, and the O-1 visa for doctors with extraordinary abilities.

J-1 Visa
The J-1 visa is the most common option for FMGs. It is a temporary nonimmigrant visa reserved for participants in the Exchange Visitor Program by the U.S. Department of State. It was originally established to enhance international exchange and mutual understanding between the United States and other nations.

Each year the J-1 Exchange Visitor Program brings nearly 280,000 visitors from outside of the U.S. One sector of this program is the Alien Physician Program. There are several requirements a FMG must meet in order to qualify for this program:

• Must have the adequate education and training to participate.
• Have competency in written and oral English.
• Have passed either Part I and Part II of the National Board of Medical Examiners Examination, the Foreign Medical Graduate Examination, Step I and Step II, or the Visa Qualifying Examination.
• Be able to adapt to the educational and cultural environment in which they will be receiving their education and training.
• Provide a statement from the government of the country of their nationality stating that there is a need in that country for persons with the skills the alien physician seeks to acquire.
• Obtain an agreement or contract from a U.S. accredited medical school, an affiliated hospital or a scientific institution to provide the accredited graduate medical education (third party sponsorship).

In order to keep with the program’s goals for international education, some J-1 exchange visitor physicians are required to return home for at least two years following their training before they are eligible for certain U.S. visas, unless they apply for a waiver from the Department of State.

TN Status
TN status is available under the NAFTA treaty category to Canadian and Mexican citizen foreign physicians who intend to work in the U.S. as teaching or research physicians.

Providing clinical care in TN status is prohibited. Direct patient care is only acceptable provided it is incidental to the teaching or research activities. USCIS has found that incidental patient care accounts for less than 10 percent of the overall time spent performing teaching or research duties.

There are some benefits to this category for Canadian citizen foreign physicians in particular. They may obtain TN status at a U.S. Port of Entry. They may also renew their TN status indefinitely. It is also unnecessary for Canadian citizen foreign physicians to have taken the Federal Licensure Examination and the United States Medical Licensing Examination. However, state licensure is required.

H-1B Status
An H1-B visa is a temporary work visa allowing those in specialty occupations to work in the United States. H1-B visas are granted initially for up to three years and are renewable for another three years. With some exceptions, H1B visas are limited to six years in duration.

Because medicine is defined as a “specialty occupation,” the H1B visa is a good option for any foreign medical graduate (FMG) seeking residency or fellowship training in the U.S., and planning to remain in the U.S. to practice medicine at the completion of that training. A FMG may also obtain post-graduate training in this category, provided the transfer is from a residency of fellowship to a hospital or private practice employer.

There are several basic requirements for FMGs in H-1B status:
1. Must possess a medical degree from an accredited medical school (in the U.S. or abroad).
2. Must have an offer from a U.S. fellowship or residency program that agrees to H1-B sponsorship. (Note: Many programs prefer J-1 visas because ECFMG handles the processing for them, while H1B processing must be handled by the employer.)
3. Must obtain Educational Commission for Foreign Medical Graduates (ECFMG) certification.
4. Passage of (USMLE) Steps I,II & III or FLEX Parts 1 & 2.
5. Must have state medical license or documentation of the medical residency program being licensed as a whole.

O-1 Status
O-1 status is for physicians who possess an “extraordinary ability.”  They must be able to demonstrate a level of expertise indicating that they are one of the small percentages who have risen to the very top of their field.

More specifically they must be able to demonstrate at least three of the following criteria:
• Receipt of nationally/internationally recognized prizes or awards for excellence in their area of expertise.
• Membership with professional associations requiring outstanding achievements of their members, as judged by national/international experts.
• The physician has been the subject of articles in the major media.
• The physician has participated on a panel as a judge of the work of others relating to their work.
• The physician has made original scientific or scholarly contributions of major significance.
• The physician has written scholarly articles that have been published in professional journals or other major media.
• The physician has worked in a critical capacity for an organization with a distinguished reputation in the field of medicine.
• The physician has commanded a high salary or other compensation.

Obtaining status as a Foreign Medical Graduate can easily become a complicated legal matter. If you would like more information on the categories discussed above, please contact one of our attorneys today.

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