Physician Contracts: Negotiating your first contract – part I

As residents, we enjoy a rather sheltered life. We work hard, read digest and debate cutting edge medical research and studies, and try to do a darn good job taking care of patients. The one thing we don’t do? Learn the business of medicine. While some residents will go on to continue in academia, the majority will emerge to engage in one or the other form of private practice. All these endeavors involve a crucial legal document – the contract, made between the employer and the prospective employee i.e. You! The employer can be a hospital, a private group or even a solo practitioner trying to hire a partner. In this post, we share our thoughts about negotiating your first physician contract.

While this post will ramble on, perhaps in multiple parts, there are two extremely important observations that need to be put out right now to emphasize their importance: (more…)

Visa for residency : J1

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.

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How a handshake can make your doctor nervous

While roaming the hallways of the hospital recently, I came across one of my favorite patients. Mr. Patient is tall, somewhat stooped over, and a very pleasant man in his early 80s. On hospital visits, he is always accompanied by his wife of several decades and today was no exception. At the time I saw them, they were deeply engaged in the great intellectual exercise of locating a hospital department, an elderly couple standing befuddled in front of a gaggle of signs pointing every which way. And as always, they were deeply engrossed in a dialogue. There was a lot of head-shaking and a few words floated to my ears as I approached them “…no, no, that way is the Xray…”. As he turned around, incomprehension, followed a moment or two later by a big smile of recognition, made an appearance and his hand extended for a handshake.

As we shook hands however, I rapidly became deaf to their words. I could not hear much of anything they were saying, and only mechanically uttered some social niceties. It was the handshake! Or, the lack thereof.

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The J1 research visa

This post is for those foreign / international medical graduates who are considering applying for a J1 ‘research’ visa, or came to the United States as research scholars on J1 visa and now want to switch to a residency program on the same visa.

Let’s get one major issue out of the way at the very outset – there is no J1 research visa. There’s just the J1 visa. Period. (waiting for the howls of protest to die down!)

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Moonlighting for residents and IMGs on H1B or J1 visa

Here is a succinct definition of moonlighting:

to work at an additional job after one’s regular, full-time employment, as at night.

Many institutions in a typical city need round-the-clock physician coverage but don’t have residency programs and find it too expensive to hire full-time physicians to provide such coverage. Such institutions would typically include hospitals, nursing homes etc. These places often find it financially more viable to hire residents or fellows to cover shifts during nights or weekends. These residents are “moonlighting”. It is a well established and acceptable practice, provided some rules and regulations are adhered to.

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Visa for residency : H1B, employment and the ‘green card’

The most critical difference between H1B and J1 visas remains the issue of jobs and applying for green card. On a J1 visa, at the end of your residency / fellowship training, you must either, return to the country of last legal permanent residence for 2 years, or do a “waiver” job typically in a medically underserved area. You must do one of these things before you can apply for a green card, and that too via an H1B visa! (This aspect of J1 will be explored in a seperate post – coming soon).

On the H1B visa however, you are free to apply for green card at the end of your residency. You are also free to seek jobs at “regular” places.

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Visa for residency : H1B and fellowships

It is debatable whether getting a fellowship on H1B visa is any more difficult than on J1. While it is widely acknowledged that people on J1 visa experience little or no difficulty moving on to fellowship training after residency, some folks on H1 can find the going a bit tougher.

Most big, university programs have no issues when it comes to sponsoring visas. Programs at large universities are looking for excellent candidates and they don’t care about visa issues in general – they have the resources, both human and financial. If they find a great candidate on J1, they’d take him. Ditto for H1B.

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Visa for residency : H1B

The H1B visa is issued to “temporary workers” and falls under the nonimmigrant visa category. A lot of information technology folks come to the US on H1B visa and so do a lot of foreign / international medical graduates. Let’s look at how an H1B visa applies to an IMG seeking residency in the United States.

According the Department of State:

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