Peculiar Muse

There’s J1 for residency and J1 for research. This post refers to the J1 visa as it applies to an international medical graduate (IMG) seeking a residency program. For residency J1, an IMG needs to meet certain criteria. Details can be found on the ECFMG site. But briefly, an IMG must have:

• passed USMLE steps 1, 2CK and 2CS. (Step 3 is not required for J1 visa.)
• ECFMG certificate.
• a contract or letter of offer from the residency program.
• and, “Statement of Need” from Ministry of Health or equivalent.

The process

An IMG applies and interviews at a program > program likes her and offers her a position i.e. an offer letter > IMG applies for Statement of Need from her home country > IMG sends all required documents to ECFMG > ECFMG issues DS-2019 > IMG gathers all pertinent documents especially DS-2019 and applies for visa at US embassy or consulate.

In case you missed it, notice the role of the residency program in the above process? They basically don’t have to deal with the hassle of paperwork, handing it instead to the ECFMG. Is it any wonder that residency programs like J1 visa?

The above process seems simple enough, right? Well, it is. Quite simple actually for both the IMG and the residency program.

So what’s the catch?

The catch, and the reason many people don’t want to go on a J1 visa is the exit requirements. Once you are on J1, you cannot change to any other visa unless you fulfill some requirements – the exit requirements, I call them. Think of J1 as a long hallway with only two doors as the exit. You can either return to your home country for 2 years – the Home country requirement – or, you can try to get a waiver. Usually, J1 waiver comes in the form of a J1 waiver job. Usually in a medically underserved area. These MUAs are generally perceived as very rural and very poor areas that don’t have much to offer an IMG. That may or may not be true (and there are significant exceptions), but that’s the general perception. IMGs usually do find however, a complete or near-complete lack of their culture in these areas. (More on J1 waiver and medically underserved areas, coming soon!).

The advantages of J1 visa

Both H1B and J1 visas have their own set of advantages – real or perceived. While the H1B visa is discussed elsewhere on this site, let’s take a look at J1, shall we?

Easier to get

J1 visa seems to be the easier of the two visas to get. That’s because residency programs usually have no trouble offering residency position on J1 but wince when it comes to H1B due to the paperwork involved. This aspect can also come into play if your scores aren’t sky-high.

Also, for H1B process, most programs would pay for the attorney fee etc but you might need to pay some portion of the filing fee. Some programs can even ask you to hire your own attorney. Converted from US dollars, these costs can be quite high.

Step 3 not needed

If for whatever reason you are not able to take USMLE Step 3, then you don’t really have a choice but to apply for J1 because Step 3 is required for H1B application.

Fellowships are easier

The general perception remains that getting into a fellowship program is easier if you’re on a J1 rather than H1B. Again, not universally true but generally accepted as a fact. An IMG also finds it a little easier to get the more sought after fellowships on J1 rather than H1.

Fellowship duration

The H1B is valid for 6 years while J1 has a maximum of 7 years. If your plans include specializing to the maximum possible, usually you would need an additional year after your initial fellowship. Most of these initial fellowships are 3 years in duration.

An example: Internal medicine residency 3 yrs, cardiology fellowship 3 yrs, then interventional fellowship 1 additional year. That’s a total of 7 years. This math would be impossible on H1B.