J-1 Visas for Foreign Doctors

• Applying for the J-1 Visa
• Nonimmigrant Intent
• Employment
• Two-Year Foreign Residency Requirement for J-1 Physicians
• Waivers of the Two-Year Foreign Residency Requirement for Physicians
• Immigration Options for J-1 Physicians After Completing Foreign Residency or Obtaining Waiver

Many of the foreign doctors coming to train in U.S. residency programs enter through the J-1 exchange visitor program.  J-1 exchange visitors coming to the United States for graduate medical education or training must be certified and sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG).  ECFMG assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States. 

J-1 visitors who come for medical education or training are automatically subject to the two year foreign residence requirement.  J-1 physicians are also subject to time limits on the duration of their program. Doctors coming to the United States on exchange visitor programs for the purpose of observation, consultation, teaching, or research in which there is little or no patient care are not automatically subject to the home residency requirement.

Applying for the J-1 Visa

J-1 visa status requires sponsorship by an organization designated by the U.S. Department of State to provide exchange visitor programs.  ECFMG is designated by the State Department to sponsor J-1 clinical training programs or advanced research for foreign physicians.  Foreign physicians must be certified by the ECFMG, requiring passage of the United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 Clinical Knowledge (CK), the Test of English as a Foreign Language (TOEFL), and the ECFMG Clinical Skills Assessment (CSA).  Foreign physicians must also meet other criteria for J-1 sponsorship, including an offer letter from a U.S. training program and a Statement of Need from the Health Department of the home country.  Specific details of the requirements for J-1 sponsorship is available on the ECFMG website. Once these requirements are verified, the ECFMG will issue the physician a Form DS-2019 which can be presented at a U.S. consulate abroad, together with supporting documentation, to receive a J-1 visa. 

Nonimmigrant Intent

J-1 visa applicants must demonstrate to the consular officer that they have binding ties to a residence in a foreign country that they have no intention of abandoning.  Applicants must show that they are coming to the United States for a temporary period.  Since circumstances vary greatly, it is difficult to state the specific evidence that may be needed, but it may include documents showing the ownership of property, family ties, membership in social organizations and other reasons for returning to the home country.

Employment

Employment while in J-1 exchange visitor status depends upon the terms of the program. Participants in programs providing on-the-job training, teaching, research, or other activities that involve paid employment may accept such employment. Participants in programs that do not involve work may not accept outside employment.

Two-Year Foreign Residency Requirement for J-1 Physicians

Physicians who come to the United States in J-1 exchange visitor status for the purpose of receiving graduate medical education or training after January 10, 1977, are automatically subject to a two-year foreign residency requirement.  This residency requirement must be fulfilled or waived before a J-1 physician can apply for permanent resident status (a “green card”), or an H or L nonimmigrant visa.  To fulfill the foreign residency requirement, J-1 physicians must reside and be physically present in the country of their nationality or last legal permanent residence for an aggregate of at least two years following their departure from the United States.  It is possible to obtain a waiver of this foreign residency requirement.  More information on J-1 waivers for physicians is provided below.

Foreign physicians in J-1 status who come to the United States to observe, consult, teach, or research are not automatically subject to the two-year home-country physical presence requirement.  However, this requirement may be imposed if the U.S. or foreign government financed the physician’s visit, or if the physician’s field of study is listed on the home country’s Exchange Visitor Skills List.  J-1 physicians who did not enter for graduate medical training may be eligible for a waiver of the two-year foreign residency requirement by obtaining a “No Objection” statement from their country of citizenship, as well as other types of J-1 waivers.  Physicians subject to the J-1 foreign residency requirement because of graduate medical training in the United States are not eligible for waivers based on “No Objection” letters.

Waivers of the Two-Year Foreign Residency Requirement for Physicians

Foreign physicians who held J-1 status for graduate medical education or training are subject to a two-year foreign residency requirement before they are eligible for an immigrant visa, for permanent resident status, or for a nonimmigrant visa as a specialty worker (H) or intracompany transferee (L).  This requirement may be waived in certain circumstances.  J-1 waivers for physicians are available on the following grounds:

• Exceptional hardship would be suffered by the physician’s U.S. citizen or lawful permanent resident spouse or child;
• The physician would be subject to persecution on account of race, religion, or political opinion if returned to the home country;
• A U.S. government agency requests a waiver of the requirement where the physician is actively and substantially involved in a program or activity sponsored by or of interest to such agency; or,
• A State Department of Public Health, or its equivalent, requests a waiver of the requirement on the physician’s behalf  (limited to 30 per state each fiscal year).

If a physician obtains a J-1 waiver based on the request of a U.S. government agency or state health department, the physician must be employed full-time as a specialty worker (in H-1B visa status) for three years in a geographical area designated by the Department of Health and Human Services as having a shortage of health care professionals or in a VA facility.  This employment must begin within 90 days of receiving the waiver.  Failure to comply with the requirements for the waiver may result in the physician again being subject to the two-year rule.

Immigration Options for J-1 Physicians After Completing Foreign Residency or Obtaining Waiver

Once the home residence requirement has been either satisfied or waived, the J-1 foreign physician may apply for H-1B nonimmigrant status or permanent residency (also known as a “green card”).  A physician may apply for permanent residency in the United States through the  labor certification process, national interest waiver, or as Aliens of Extraordinary Ability.  For more information, see Permanent Residence Options for Physicians.