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    Visa and Immigration Basics for IMGs

    Non-U.S. IMGs (or anyone who is not a U.S. citizen/green card holder) need a visa to start a residency. The two common types of visas that allow IMGS to start a residency are J-1 and H-1B. Among the various visa types, the J-1 visa is the most common. It is sponsored by ECFMG (and not the residency program itself).

    Types of visa and the Employment Authorization Document (EAD)

    J-1 Visa (ECFMG sponsored)

    • Both the applicant and the program must coordinate with ECFMG to process this visa.
    • The J-1 visa is offered for one year and is renewed every year.
    • Renewal can be completed online while the individual remains in the United States (no need to return to the home country or repeat the visa interview).
    • Every program has a designated training program liaison (TPL) in its GME office, who works with the trainee to secure all requirements and coordinate with the ECFMG.
    • There is a two-year home country physical presence requirement after residency completion, but many physicians can obtain a waiver of this requirement and continue to work in the United States.
    • Moonlighting is not allowed under the J-1 visa.
    • If a J-1 physician brings a dependent, the dependent will be sponsored on a J-2 visa.

    H-1B Visa

    • The H-1B visa is sponsored by the employer (e.g., residency training program, hospital, university).
    • This visa requires the applicant to pass the USMLE Step 3 exam prior to visa sponsorship.
    • It has no two-year home country physical presence requirement.
    • Moonlighting is allowed with an H-1B visa.
    • The proportion of residency programs sponsoring H-1B visas for training has gradually decreased, especially in recent years. The immigration requirements are multistep, costly (for the employer) and often complicated with bureaucratic immigration nuances.
    • If an H-1B physician brings a dependent, the dependent will be sponsored on an “H-4” dependent visa.

    Employment Authorization Document

    • An EAD is not a visa.
    • EAD holders can convert to a J-1 or H-1B visas (if the program sponsors them) and hence become primary visa holders, not dependents.
    • An EAD card is issued to J-2 and H-4 dependent visa holders, who are then authorized to work in the United States.
    • An EAD is not automatically issued to dependents. One usually applies for it through United States Citizenship and Immigration Services (USCIS), which (in some cases) can take more than six months.
    • Upon obtaining the card, EAD holders do not require visa sponsorship to work.
    • Moonlighting is allowed with an EAD.
    • The ability to work is dependent on the spouse’s visa. If the spouse’s visa gets terminated, so does the dependent.
    • EAD holders can convert to a J-1 or H-1B visa (if the program sponsors them) and hence become primary visa holders, not dependents.
    • The following sections discuss the J-1 and H-1B visa applications and other requirements and provide additional tips.

    J-1 Visa Process

    To apply for a J-1 visa, an IMG must meet the following criteria:

    Tips for Applying for a J-1 Visa

    • Make sure your passport is valid for the duration of your requested visa. If it won’t be or you don’t have a passport, renew your passport or apply for one ASAP. Refer to the U.S. Department of State's Bureua of Consular Affairs Exchange Visitor Visa information for more country-specific details.
    • Make it a priority to complete your visa sponsorship paperwork and other requirements sent by the program. Every day counts!
    • Use the priority/express mail option wherever possible.
    • Do not assume anything while filling out forms and documents — when in doubt, ask senior staff, coordinators, your TPL and ECFMG support for help or clarification.
    • Obtaining a Statement of Need (SON document from the Ministry of Health (MOH is the most time-consuming step in the process. Start that process ASAP by downloading the application form from your home country’s MOH website and familiarize yourself with the instructions for applying. (Be sure you’re using the most updated application form; double-check by calling or emailing the MOH.)
    • You can submit the application for a SON as soon as you have your offer letter or contract. (SON guides from some countries such as India may mention a DS-2019 form as a required document for application; this applies only for those who already have a J-1 visa and not for first-time J-1 applicants.)
    • After you complete all documentation and the MOH submits your SON to ECFMG-will ECFMG will start reviewing your application and issue your DS-2019 form.
    • ECFMG mails the DS-2019 form to your program’s TPL, who will mail it to your home address abroad.
    • The DS-2019 form, along with your passport and other supporting documents, is required before you can apply for a visa interview.
    • Remember that you will not be able to enter the United States more than 30 days before the program start date noted on your DS-2019 form (usually the first day of orientation). Book your flights accordingly.
    • Ensure that you pay all fees, including Student and Exchange Visitor Information System (SEVIS) fees, before the visa interview.
    • As soon as you enter the United States, make sure you contact/meet with your TPL to activate your SEVIS record. This is a VERY important step to avoid delays in obtaining your Social Security number (SSN). (See the “Validation of Initial Arrival” and “Obtaining a Social Security Number” sections in this guide for more specific details about the SSN.)

    J-1 Visa Waivers and Pathways to Permanent Residency

    View more on how to obtain J-1 Visa Waivers and pathways to permanent residency here.

    Dependents

    ECFMG is authorized to sponsor spouses and/or unmarried minor children under the age of 21 for J-2 status. The visa application procedure for J-2 dependents at U.S. consulates is the same as for J-1 visa applicants. Once sponsorship is approved by ECFMG, the spouse and/or children are each issued their own Form DS-2019.

    J-2 dependents must:

    • Maintain a valid passport.
    • Secure and maintain required health and accident insurance.
    • Notify ECFMG of plans to permanently depart the United States prior to the J-1 spouse/parent (or of plans to change U.S. visa status).
    • Live with the J-1 physician (at the same U.S. residential address).
    • Adhere to all U.S. laws.

    J-2 Work Authorization

    J-2 dependent spouses and, in some cases, minor children under age 21 are eligible to apply for employment authorization from USCIS (U.S. Citizenship and Immigration Services). However, the income derived from the spouse’s employment cannot be used to support the J-1 physician and/or the family. Your spouse will be required to submit an estimate of the family’s monthly budget and proof of adequate financial resources with the application for employment authorization.

    Visa Interview Tips

    • The J-1 visa is an exchange visitor visa. Be prepared to provide USCIS with the following information if requested: 
    • Proof of a permanent residence abroad (i.e., in your home country) that you have no intention of abandoning.
    • Proof of sStrong economic, social and family ties to your home country.
    • The usefulness of your experience in the United States to your home country.

    Applying for a Change in Visa Classification from Within the United States

    If you are in the United States under a visa status other than J-1, you may be eligible to process Form DS-2019 by filing an Application to Extend/Change Nonimmigrant Status (Form I-539, file online with USCIS here) with a USCIS regional service center (find a USCIS office here).

    It is important to verify USCIS’s current filing requirements and processing times, which may be several weeks to months. During this time, you must maintain your current visa status. Physicians are not permitted to train until USCIS has approved the change of status. Approved applications result in the Department of Homeland Security (DHS)/USCIS issuing a Notice of Action (Form I-797), which will include a new Form I-94 granting status change to J-1 Duration of Status (D/S). Change-of-status applicants are strongly advised not to depart the United States while awaiting a decision on a change-of-status application, to avoid potential problems with their SEVIS records. Once USCIS approves a change-of-status application and confers J-1 status, travel outside the United States is not required. However, any subsequent travel outside the United States will require you to secure a J-1 stamp on your passport.

    To make a change in J-1 visa category, use Educational Commission for Foreign Medical Graduates's Request for a Change of J-1 Visa Category Memo (.pdf).

    Arrival in the United States

    Form I-94

    Unless you are a citizen of Canada, you cannot enter the United States as an exchange visitor unless you have a J-1 visa stamp on your passport. You can enter the United States no more than 30 days before the beginning of your program, as shown by the date on your Form DS-2019. You cannot participate in a training program during the 30-day “grace period” before your program commences.

    Upon arrival in the United States, present your passport, visa and Form DS-2019 to a U.S. Customs and Border Protection (CBP) immigration officer, who will inspect your documents. Present your passport, visa, and Form DS-2019 to the immigration officer. If all your documentation is found to be in order, you will be admitted to the United States on J-1 status. You will be issued Form I-94, Arrival/Departure Record. Form I-94 documents the date/place of admission to the United States and your status. Because you are entering as a J-1 physician, your Form I-94 should be notated with your J-1-Duration of Status (D/S). If you are issued Form I-94 indicating a status other than J-1 D/S or notating a specific end date, it is important that you contact ECFMG immediately.

    You may not always receive a physical I-94 form, and may have to download it post-arrival at the U.S. Customs and Border Protection's 1-94 Website.

    Validation of Initial Arrival

    Upon arrival to the United States, you must report to your training program as soon as possible and present the ECFMG-recognized training program liaison with evidence of your J-1 visa status, as follows:

    • Copy of the passport page with the J-1 visa stamp issued by a U.S. consulate (Canadian citizens are not required to have a visa stamp)
    • Copy of Form I-94 (or Form I-797) reflecting your J-1 D/S status

    If you are an ECFMG-sponsored J-1 physician, your TPL must complete a Validation of Initial Arrival in J-1 Status form for SEVIS reporting and upload it with the required supporting documentation to your ECFMG sponsorship application record. Upon receiving the documentation, ECFMG will validate your arrival to the United States in SEVIS. Once validation is completed in SEVIS, your program start date cannot be amended.

    SEVIS validation is required to apply for a U.S. Social Security number; J-1 physicians must wait 11 business days after being validated in SEVIS before applying for an SSN. Validation status can be confirmed in OASIS - Online Applicant Status and Information System (OASIS), ECFMG's web-based information service for ECFMG applicants. See “Obtaining a Social Security Number” below.

    H-1B Visa Process

    Process for Applicants

    • Applicants must have a job offer. (In GME, the NRMP match suffices.)
    • The application is filed via an immigration attorney through USCIS.
    • A Labor Condition Application (Form ETA-9035) is filed with the U.S. Department of Labor.
    • The employer must be able to show that the non-immigrant/applicant is fully qualified to fulfill their job duties through their education and previous work experience.
    • Once approved, applicants can file for an H-4 visa for their spouse or children. The institution can require the employee to assume filing fees for dependents.

    Institution Responsibilities

    • The sponsoring institution must pay the cost of processing the H-1B visa application.
    • The basic USCIS filing fee is approximately $460 (basic fee for a company with 25 or fewer employees), approximately $500 (including fraud detection) or approximately $1,500 for companies with more than 25 employees. If a company has more than 50 employees and over half are sponsored on an H-1B visa, there is an additional fee of approximately $4,000 (Public Law § 114-113).
    • Premium processing of Form I-907 comes with an additional fee, approximately $2,500), it is a service that offers 15 calendar day processing time. File Form 1-907 online here.
    • The employer must identify the position, job duties, educational background and level of skill required for the position and require the submission of a CV without date gaps.
    • The company must create a job posting to notify all affected workers of its intent to petition for an H-1B worker (to prove a lack of qualified U.S. applicants for the job).

    H-1B Visa Resources and Information

    References

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