[This month’s ABCs of Immigration issue is adapted from Greg Siskind’s new book, The Physician Immigration Handbook.]
ABCs of Immigration: J-1 Visas for Graduate Medical Training
More than 80 percent of the physicians who entered the United States in 2014 on visas with the purpose of participating in graduate medical programs utilized the J-1 visa. J-1 visas are intended for participants in the U.S. Department of State’s Exchange Visitor Program, which is available to individuals entering for a litany of reasons: camp counselors, au pairs, high school exchange programs, international scholars, foreign dignitaries, and, as previously mentioned, physicians participating in residency and fellowship programs. There is one sole J-1 program sponsor, despite the wide array of available programs, the Educational Commission on Foreign Medical Graduates (ECFMG).
What qualifications does a physician need to possess in order to pursue graduate medical training using J-1 sponsorship through ECFMG?
- The pursuant physician must pass the U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge. ECFMG will also accept the former Visa Qualifying Examination, the National Board of Medical Examiners Examination Part I and Part II, the Foreign Medical Graduate Examination in Medical Sciences, or an acceptable combination thereof. Older exams such as the ECFMG Examination or the Federation Licensing Examination do not meet the J-1 requirements (though they may still suffice for licensing, as well as H-1B visa petitions.)
- The physician must have an ECFMGH certificate without expired examination dates. Exceptions for graduates of Liaison Committee on Medical Education (LCME)- accredited U.S. and Canadian medical schools are made.
- There must be an official letter of offer for a position in an approved graduate medical education or training program or contract.
- The physician must provide a Statement of Need from the Ministry of Health of the nationality or country of last permanent residence.
What is a Statement of Need?
A Statement of Need is a written assurance from the home country or country of last residence of a need for physicians in the specialty in which the physician is training, and an assurance that the physician will return to that country upon completion of the program. ECFMG expects this Statement of Need to come from the country of permanent residence if the physician is living permanently in a country other than the country of nationality. Statements of Need must meet the following requirements:
- Specify the exact specialty and/or subspecialty which the doctor will pursue and the existence of a need for qualified physicians having that specialty.
- Be issued by the central office of the appropriate Ministry of Health; and
- Have a certified translation if the original is not in English.
If the physician wishes to change specialty, the letter on file with ECFMG is expiring, or the physician is seeking to change host institutions, a new Statement of Need is required.
How does a physician apply for ECFMG J-1 sponsorship?
Upon the acceptance of a physician into a host institution’s graduate medical training program, the physician will coordinate alongside the institution’s training program liaison (TPL) to submit the J-1 application with ECFMG. ECFMG will then communicate with the TPL in regard to the status of the application.
The initial online application for the J-1 is submitted by the TPL through ECFMG’s Exchange Visitor Network. The TPL provides details on the appointment of the physician; the J-1 applicant is then sent information by ECFMG confirming the institution’s initiation of the J-1 application on behalf of the physician. The physician will then complete the “J-1 Visa Sponsorship” section of ECFMG’s Online Applicant Status and Information System (OASIS). Once the TPL and physician have completed the forms and submitted all the required supporting documentation, ECFMG will proceed with reviewing the application.
ECFMG will then create an electronic record for the J-1 and each J-2 dependent in the Student and Exchange Visitor Information System (SEVIS), a database jointly administered by the United States Departments of State and Homeland Security. Form FDS-2019, Certificate of Eligibility for Exchange Visitor (J-1) Status, is generated through SEVIS in order to confirm the J-1 sponsorship approval. ECFMG must use the SEVIS system throughout the duration of the J-1 and J-2’s stay in the United States to document the maintenance of their status during their stay.
Upon ECFMG’s approval of sponsorship for a J-1, it will mail the original Form DS-2019 to the TPL via regular first-class mail (unless the TPL requests courier service and provides ECFMG with a pre-paid/pre-addressed airbill along with the supporting documents required for the J-1 application.
What documentation does ECFMG expect from a physician applying from J-1 sponsorship?
ECFMG lists the following items to be uploaded in OASIS by the physician.
Required documents:
- Contract or letter of offer;
- Statement of Need;
- Training Program Description, visit http://bit.ly/1NC8NC0 (if entering subspecialty training);
- Current curriculum vitae (CV); and
- Copy of passport name page(s)
Additional documents if applicable:
- Copies of prior Form(s) IAP-66 and/or DS-2019 if physician previously held J-1 status;
- Proof of country of most recent legal permanent residence if different from country of citizenship;
- Copy of I-94 card if applicant is in the United States at the time of application to ECFMG;
- Official documentation of funding source if funds are coming from any place other than, or in addition to, the teaching hospital;
- Return airbill for expedited delivery to the TPL;
- For graduates with LCME-accredited U.S. or Canadian medical schools, a copy of the diploma (with a certified English translation, if applicable)) and a full-face passport-sized photograph; and
- For change of category and program transfer requests, follow the instructions in the ECFMG memo, “Request for a Change of J-1 Visa Category” (Dec. 2014), found at http://bit.ly/1TwMopK. Detailed information about the change of category request process can also be found in this document.
How does a physician include a spouse and minor children?
A request to sponsor J-2 visas for a spouse and any minor children can be made when the J-1 submits his or her initial information through OASIS. Any children under the age of 21 fall under the minor children category. Parents, siblings, other family members, or domestic employees are prohibited from seeking J-2 visas, though in some cases, they can seek a visitor visa to accompany the J-1. If the request for a J-2 is not made at this time, ECFMG requires the submission of a paper application. If approved, separate DS-2019 forms for each J-2 family member will be issued by ECFMG, which is required in order to apply for consular processing of the J-1 visa or a change in nonimmigrant status in the United States.
What is a DS-2019?
Form DS-2019, Certificate of Eligibility of Exchange Visitor (J-1) Status, is an imperative document used to administer the J-1 exchange visitor visa program.
The DS-2019 contains important information, including:
- The exchange visitor’s name;
- The designated sponsor (ECFMG);
- A brief description of the exchange visitor’s program, including the start and end date, category of exchange (graduate medical training), and an estimated cost of the exchange program as well as from where financial support is coming; and
- Whether the J-1 is subject to a home residency requirement.
ECFMG will issue the DS-2019 to the physician seeking J-1 status once the physician has demonstrated that he or she has fulfilled all the requirements for the ECFMG J-1 visa program.
What does the physician need to do with the DS-2019 form after it is issued?
The physician should, first and foremost, thoroughly review the form, ensuring its accuracy. For example, the country listed on the form should be the country where the physician needs to satisfy the home residency requirement. Therefore, if the physician does not truly have the right to return to that country upon completion of the J-1 training, the physician’s country of nationality should be listed on the form.
The DS-2019 will be an important document for the doctor for many years, and it is critical that the doctor retain access to at least a copy of the document. To that effect, it is highly recommended to retain multiple copies of that document, with at least one copy retained in a cloud-based storage device, such as Dropbox or Google Drive.
How long might a physician pursuing graduate medical training stay in J-1 status?
ECFMG sponsorship is restricted to the time typically required to complete specialty/subspecialty training as determined by the American Board of Medical Specialties (ABMS), but shall not exceed seven years.
Can spouses and children enter with the J-1 exchange visitor?
Yes. Spouses and unmarried children who are under the age of 21 are eligible to accompany a J-1 applicant to the United States. They are entitled to a dependent visa called a J-2.
Do J-1 and J-2 applicants need to show they intend to return home in order to get a J-1 or J-2 visa?
Yes. J-1 and J-2 applicants are subject to §214(b) of the Immigration and Nationality Act, which has a requirement for an applicant to prove its strong ties to the home country and a clear intent to return home upon completion of the physician’s J-1 program or early withdrawal from training.
Can a physician coming into the United States for a research position obtain a J-1?
Yes. To participate in programs of observation, consultation, teaching or research, physicians are permitted to come to the United States as J-1 “research scholars”. ECFMG has a separate J-1 program for such types of positions. Additionally, many academic medical centers can sponsor physicians for research positions under their own J-1 programs. These types of programs for sponsoring J-1 physicians have far fewer ECFMG requirements. A physician must only show that he or she is a graduate of a U.S., Canadian, or foreign medical school, have a contract or offer letter for a position, and provide a certification statement from the employer that the physician will have no contact with patients, (even incidental patient contact).
How long can a J-1 researcher physician remain in J-1 status?
Five years is the maximum duration for research scholars.
Can a physician in a J-1 research scholar position change to a graduate medical training J-1?
Yes. Approval from the Department of State, however, is first required for interested physicians, and this permission request must be initiated by ECFMG. ECFMG advises applicants pursuing this type of change to allow at least 60 days for the Department of State to make a decision (in addition to ECFMG’s own processing time).
Can a physician in a J-1 graduate program change to a research scholar J-1?
No; the Department of State bars such changes. According to Department of State regulations, professors and researchers are not allowed to have participated in a J-1 visa program for all or part of the 12-month period immediately preceding the start date of a professor or research scholar J-1 program.
Can a physician change specialties after arriving as a J-1?
Yes. Physicians are permitted to change their designated program of medical training one time and no later than two years after the date of arrival as a J-1 in the United States. Note that this is different from physicians advancing through progressive levels of training that are required by a physician’s chosen specialty/subspecialty Boards.
Can a physician repeat graduate medical training?
Yes, but it is strongly discouraged by ECFMG, and it will only be considered based on the strong recommendation of the J-1’s graduate medical education program director.
What insurance requirements are imposed on J-1 physicians?
J-1s and J-2s are required to have health, accident, medical, and evacuation and repatriation of remains insurance during their J-1 and J-2 stays in the United States. The specific requirements as of 2016 are the following:
- Medical benefits of at least $100,000 per accident or illness;
- Reparation of remains in the amount of $25,000;
- Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000; and
- A deductible not to exceed $500 per accident or illness.
ECFMG provides evacuation and reparation of remains insurance and will match the coverage amounts with federal regulations and ensure that the coverage is effective on the state date of the J-1 program. The majority of physicians are able to obtain the other required insurance coverage as a benefit offered by the training program at the teaching hospital where the physician will be receiving graduate medical education.
Is “moonlighting” permitted for J-1 physicians?
No. Physicians engaging in employment outside their graduate medical training, a practice known as moonlighting, is not permitted for J-1 visa holders and employment outside of approved residency or fellowship training is thusly barred.
How does a physician obtain J-1 status?
Physicians in a nonimmigrant status in the United States (excluding physicians in visitor status under the Visa Waiver Program) can, by applying with U.S. Citizenship and Immigration Services, attempt to adjust their status to J-1 for graduate medical training. Most physicians, however, avoids this option due to the unpredictability of the timing for such applications.
The most common option pursued is the filing of an application for a J-1 visa at a U.S. consulate in the home country or country of residence. To apply for J-1 status, J-1s and J—2s should initially file a nonimmigrant visa application. The following documents should be presented by the physician at the consulate:
- Documents required by the specific consulate, which may include:
- Appointment confirmation page from online scheduling center;
- DS-160 confirmation page with the barcode;
- Passport photo;
- Fee payment receipt; and
- Current passport valid for at least six months.
- Documentation of nonimmigrant intent, including:
- Evidence of a residence abroad;
- Evidence of ties to the home country, including, but not limited to, evidence of:
- Having a job abroad;
- Owning property;
- Enrollment in school outside the United States;
- Close relatives residing in the home country (such as a spouse and/or children who are not travelling with the applicant); and
- Other social and cultural ties to the home country.
- A return airline ticket that is consistent with the length of time necessary to take United States Medical Licensure Exam (USMLE), interview with programs, or participate in an observership.
- Evidence of the physician’s medical credentials, (diplomas, licenses, etc.).
- Documents relating to the reason for the visit to the United States, such as:
- USMLE test registration documentation (if applicable);
- Interview confirmation letters (if applicable);
- Observership or clerkship pre-approval letter; and
- A letter from ECFMG confirming USMLE registration and the necessity to travel to the United States for this purpose before a specific date/ ECFMG will issue this letter upon request after the applicant registers for USMLE Step 2. The letter can be requested at http://www.ecfmg.org/.
- Documents relating to the itinerary of the physician including hotel stays, car rentals, etc.
- Documentation that the physician (or someone else helping the physician) can pay for the trip, including demonstrating that the physician has the funds to cover expenses during the trip to the United States.
- Documentation of the physician’s medical credentials, including diplomas, test results, etc.
In addition to these documents, J-1 and J-2 applicants should bring the following to their consular interview:
- The DS-2019 form (one for the J-1 and separate ones for the J-2 applicants);
- Documentation of nonimmigrant intent (see above);
- The contract or offer form the graduate medical training program;
- While not technically required, it is highly recommended to have available documentation previously submitted to ECFMG to obtain the DS-2019, including the ECFMG certificate, USMLE test results, transcripts, etc.; and
- For J-2s, evidence of a relationship, including a copy of the marriage certificate and/or birth certificate (including a certified translation).
Once the U.S. consulate is satisfied that the applicant has fulfilled the requirements for a J-1 visa, the applicant’s passport and his or her dependents’ passports will be stamped with machine readable visas.
What do J-1s and J-2s need for travel in and out of the United States?
Any J-1 or J-2 travelling outside of the country should prepare the following to present to a CBP officer upon re-entry into the country:
- A passport that is valid for at least six months beyond the date the individual will be returning to the United States;
- Except for Canadian citizens, a valid, unexpired J-1 visa; and
- The original Form DS-2019 containing a travel signature in the box on the lower right side of the form stating, “Travel Validation by Responsible Officer.”
The J-1 will be required to reapply for a new J-1 visa before entering the United States, if their J-1 visa stamp is expired, and should be prepared to follow the same protocol as with the initial J-1 or J-2 application, with the exception of having prepared additional documentation showing the physician has worked in the approved graduate medical education program to present to the consular officer.
In order to obtain the travel-validation signature from ECFMG, applicants need to request it by mailing the original DS-2019 to ECFMG and allowing at least 7 to 10 business days (possibly more if it is a busy time such as the end of the calendar year). The DS-2019 will be returned by regular mail, but the applicant can instruct it to be expedited by providing a prepaid airbill and uploading it to ECFMG’s OASIS online system.
There is a one year period of validity for the regional advisor’s signature for travel and can be used for multiple trips within that year. The DS-2019 form has two spaces provided for signatures in the travel signature box, but ECFMG will provide only which is all that is required.
It is noteworthy that a special rule referred to as a “visa revalidation” exists for trips to Canada, Mexico, and islands adjacent to the United States (excluding Cuba). For trips scheduled to last less than 30 days, and where there are no other trips during that time to any other countries not adjacent or contiguous to the United States, travel on an expired J-1 or J-2 visa is permitted contingent upon the individual’s maintenance of status. Individuals wishing to take advantage of automatic visa revalidation should be sure to have the following in their possession:
- A travel-validated Form DS-2019;
- A previously issued J visa (if the individual changed status in the United States, then a visa in another category is acceptable); and
- A Form I-94 reflecting J-1 visa status (if taking advantage of the visa revalidation, do not relinquish the form I-94).
Nationals of Cuba, Iran, Sudan, and Syria are excluded from the possibility of visa revalidation. Additionally, if applying for a visa at a consulate during the 30 day, the individual may not re-enter with visa revalidation while the application is pending nor if it is denied. Once the application is denied, the applicant will generally be required to travel back to the home country in order to re-apply for a visa to re-enter the United States.
The adjacent islands to which one may travel in order to maintain eligibility for visa revalidation include:
- Saint Pierre
- Miquelon
- Cuba
- The Dominican Republic
- Haiti
- Bermuda
- The Bahamas
- Barbados
- Jamaica
- The Windward and Leeward Islands
- Trinidad
- Martinique
- Other British, French, and Netherlands territory or possessions in or bordering on the Caribbean Sea
How does the I-94 work for J-1 and J-2 visa holders?
J-1s and J-2s are required to possess a Form I-94, Arrival/Departure Record, issued by U.S. Customs and Border Protection (CPB). The form includes the date of entry to the United States, the visa status granted, and the authorized length of stay. In place of an expiration date, J-1 physicians entering the country for the purpose of graduate medical training should have the letters “D/S”. This indicates that the controlling date for the individual’s authorized stay in the United States is the end date on the Form DS-2019, with the addition of the 30-day grace period.
What must a J-1 or J-2 possess in order to be considered having maintained his or her status in the United States?
- An unexpired Form DS-2019;
- A Form I-94 with a “D/S” (duration of stay) expiration date;
- Training in the approved graduate medical education program and no engagement in unauthorized training or employment; and
- Required insurance coverage.
What is the “grace period” at the end of the J-1 or J-2’s stay?
The Department of Homeland Security grants a 30-day additional period of lawful status from the expiration date on the DS-2019. This additional period is given with the purpose of allowing the J-1 or J-2 to make plans for his or her final departure from the United States. During this period, employment is disallowed. Early termination of the J-1s program (such as if the J-1 resigns or is terminated) disqualifies the individual from grace period availability.
Can a J-1 physician in training seek an extension to sit for a specialty board examination?
Yes. However, since the physician will no longer be training under an appointment from a teaching hospital during this period, the institution’s TPL does not initiate the application. Rather, the physician would initiate it through ECFMG’s OASIS online system. The physician would click “Board” on the website and is required to upload supporting documentation regarding the board examination. Note that If a J-1 waiver has been granted to a seeking physician, that physician is not allowed to seek an extension.
Disclaimer: This newsletter is provided as a public service and not intended to establish an attorney client relationship. Any reliance on information contained herein is taken at your own risk.