ABCs of Immigration: Seeking a Visitor Visa to Pursue Graduate Medical Training in the United States

Posted on: December 21st, 2017
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[This month’s ABCs of Immigration issue is adapted from Greg Siskind’s new book, co-authored by Elissa Taub, The Physician Immigration Handbook.]

Doctors who would like to pursue graduate medical training in the United States must, first and foremost, make at least one trip to the country in order to take the U.S. Medical Licensing Examination (USMLE) Step 2 Clinical Skills examination and have interviews with residency and fellowship programs. Generally, this will necessitate a B-1 business visitor visa, and if the physician is seeking clinical observership, he or she will additionally need a visitor visa. Once acquired, the visa will then be presented at a port of entry where a U.S. Customs and Border Patrol (CBP) officer will admit the physician, usually for the allotted time span for which it is necessary to compete the purpose of the trip to the United States.

Who needs a visitor visa?

Visitors of most nationalities who seek entry into the United States must seek a visa, with a number of exceptions. Some countries’ nationals do not require actual visa stamping for visitor status entry into the United States. Canadians, Bermudans, and certain nationals of the Caribbean and Pacific Island countries are permitted entry into the United States without a visitor visa and instead must present a passport. Unless they have a Border Crossing Card, Mexican nationals generally require both a passport and visa.

Nationals of 38 countries are also permitted entry without a visitor visa under the Visa Waiver Program (VWP), including the following countries:

-Andorra                 -Hungary                 -Norway

-Australia                -Iceland                   -Portugal

-Austria                   -Ireland                   -San Marino

-Belgium                 -Italy                        -Singapore

-Brunei                    -Japan                     -Slovakia

-Chile                       -Latvia                     -Slovenia

-Czech Republic    -Liechtenstein          -South Korea

-Denmark               -Lithuania                 -Spain

-Estonia                  -Luxembourg           -Sweden

-Finland                  -Malta                      -Switzerland

-France                   -Monaco                   -Taiwan

-Germany               -Netherlands            -United Kingdom

-Greece                  -New Zealand

 

Nationals from these countries have a 90-day period during which they can remain in the country without a visa stamping. This is different from individuals entering the country on B-1 visas who may end up with either shorter or longer periods of permitted entry. Nationals from the above listed countries are permitted entry exclusively for the purpose of business, pleasure, or transit, and must have a return or onward ticket.  They must also be in possession of a machine-readable passport, with some exceptions during a phase-in period, and not have any other reason to prevent admissibility, such as past criminal violations.

Starting in the year 2009, all VWP participants who enter the country by air or sea are required to use the Electronic System for Travel Authorization (ESTA) at https://esta.cbp.dhs.gov/esta/. Before their trips to the U.S., all travelers must input their data in ESTA and receive clearance for travel. Failure to do so can result in denied entry onto the aircraft or vessel bound for the United States. CBP recommends completing the ESTA within 72 hours of scheduled travel, as its processing is not always quick. ESTA contains questions asking for information similar to the Form I-94W, Nonimmigrant Visa Waiver Arrival/Departure Record, completed on the airplane or vessel, including the name of the applicant, the applicant’s date of birth, the duration of the trip taken, the address in the United States, and whether the applicant has been convicted of a crime. The applicant should, however, log in to the website changing destination addresses and itineraries for future trips. There is a small fee for using ESTA, which currently is $4 for processing and an additional $10 if the application is approved.

VWP applicants are not allowed to apply to change status to any other visa category as visitors while in the United States.

What are legitimate reasons for entering the Unites States in visitor status?

A number of different activities are listed in the U.S. Department of State Foreign Affairs Manual (FAM) 9 FAM 41 Notes which are considered to be acceptable for B-1 and B-1 status. The list is not meant to be exhaustive, and performing skilled or unskilled labor is not included and must be approved using one of the work visa programs.

Coming to the United States in order to complete USMLE steps or to interview for residency programs is not explicitly mentioned in the Foreign Affairs Manual, but State Department Practice has always been to consider these as acceptable B-1 business visitor activities. At least one consulate states on its website:

Medical practitioners who have completed their medical degree and are now seeking to enter the United States to complete their United States Medical Licensure Exam (USMLE) Steps II, II C/S, and/or III should apply for a B1 visa. Those who wish to travel to the United States to interview for residency programs should also apply for this visa.

The FAM does explicitly note observerships and “elective clerkships” as acceptable activities:

9 FAM 41.31 N10.4-1 Medical

(CT:Visa-1777; 11-29-2011)

An alien who is studying at a foreign medical school and seeks to enter the United States temporarily in order to take an “elective clerkship” at a U.S. medical school’s hospital without remuneration from the hospital. The medical clerkship is only for medical students pursuing their normal third year internship in a U.S. medical school as part of a foreign medical school degree. (An “elective clerkship” affords practical experience and institutions in the various disciplines of medicine under the supervision and direction of faculty physicians at a U.S. medical school’s hospital as an approved part of the alien’s foreign medical school education. It does not apply to graduate medical training, which is restricted by INA 212(e) and normally requires a J-visa.)

9 FAM 41.31 n11.8 Medical Doctor

(Ct:VISA-701; 02-15-2005)

A medical doctor otherwise classifiable H-1 as a member of a profession whose purpose for coming to the United States is to observe U.S. medical practices and consult with colleagues on latest techniques, provided no remuneration is received from a U.S. source and no patient care is involved. Failure to pass the Foreign Medical Graduate Examination is irrelevant in such a case.

How long does it take to get a visitor visa?

There is a wide range of possible processing times for visitor visas (or B-1s) applications. Some U.S. consulates can process a visitor visa application almost immediately, while others can take weeks or even possibly months. For example, as of the publication of this book, Buenos Aires was taking two days to issue visitor visas, while Mumbai was taking 16 days, and Havana was taking 89. In order to account for these prospective waiting periods, physicians should plan to book an appointment early.

How does a physician apply for a B-1 visa?

The rules governing visitor visa applications vary from U.S. consulate to U.S. consulate, and it is a good practice for applicants to review the information posted on their specific U.S. consulate website. Applicants should generally begin at the website for the U.S. embassy in the home country and carefully review the section on consular services to determine the appropriate consulate to present the visitor visa application. The procedures for applying for a visitor visa are outlined on each U.S. consulate’s website. An alternative starting point is a website called “Apply for a U.S. Visa” at http://www.ustraveldocs.com.

The application process conducted by U.S. consulates around the globe starts with the completion of the Form DS-160m Online Nonimmigrant Visa Application, which can be found by visiting http://ceac.state.gov/genniv. In order to complete the form, applicants must upload a passport-style photograph which can be no more than six months old. The photograph has a number of requirements for consideration. The picture must be in color, must feature the applicant facing the camera with his or her eyes and ears visible, without a hat, headphones, or anything else which would obscure the view of the applicant’s head, the applicant’s head must be between 1 inch and 1 3/8 inches (22mm and 35mm) or 50 percent and 69 percent of the image’s total height from the bottom of the chin to the top of the head, and the background of the photograph must be either white or off-white in color. Sunglasses or tinted glasses of any kind should not be worn in the photo, and photos which contain a glare in the individual’s glasses may be rejected.

Upon completing the DS-160 form, applicants should print their confirmation page on a laser printer.

Procedural variations among consulates amplify upon completion of this step. Local U.S. consulates determine the process for paying the visa application fee. Some use the online payment system created by the U.S. Department of State, while others have relationships with local banks which accept payments on behalf of the U.S. consulate. Still others use online scheduling websites in which applicants select the date of their appointment at a U.S. consulate, and some consulates permit in person pick up of the passport.

What documents should the physician present at a U.S. consulate or port of entry?

Doctors who are seeking entry into the United States in order to prepare for graduate medical training need to present the following:

  1. Documents required by the specific U.S. consulate, which may include:
    -Appointment confirmation page from online scheduling website;
    -DS-160 confirmation page with the barcode;
    -Passport photo;
    -Fee payment receipt; and
    -Current passport valid for at least six months.
  2. Documentation of nonimmigrant intent, including:-Evidence of 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 spouse, and/or children who are not travelling with the applicant); and
    *Other social and cultural ties to the home country.
  3. A return airline ticket that is consistent with the length of time necessary to take USMLE, interview with programs, or participate in an observership.
  4. Evidence of the physician’s medical credentials (diplomas, licenses, etc.).
  5. 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 for Educational Commission on Foreign Medical Graduates (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 ecfmg.org.
  6. Documents relating to the itinerary of the physician including the hotel stays, car rental, etc.
  7. 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.
  8. Documentation of the physician’s medical credentials, including diplomas, test results, certifications, etc.

What should the physician expect at the visitor visa interview?

Consular officers interview all applicants applying for visitor visas, and these interviews are typically quite fast. For reference, it is not unusual for officers at a number of U.S. consulates to conduct upwards of 10 interviews per hour. Unfortunately, this translates to officers forming opinions about applicants very quickly, after only a few questions, and the high probability that applicant’s meticulously prepared documents will not be reviewed very closely. In spite of this, applicants should remain prepared to succinctly explain the purpose of their trip, present the officer with a well-organized set of documents, and answer any questions the officer may have (such as how long the trip is going to be, what the physician will be doing other than the main purpose of the application [which ideally will be no other side plans], whether the physician is currently employed in the home country, etc.).

What happens after the interview?

It is possible the consular officer will approve the application immediately following the interview. If this is the case, the applicant’s passport will be sent for visa printing and the applicant will either receive the passport by mail or retrieve the passport for the U.S. consulate.

There are several reasons, however, which could result in an application’s denial. A consular officer could reject an application if he or she believes it to be incomplete and requiring more documentation. If this is the case, the application will be denied, but the applicant retains the capability of applying again, including the requested documentation. Some consulates permit applicants to quickly return with the requested documentation, while others require a new form for submission.

The denial of some applications is based in the officer’s belief that the application does not adhere to the requirements set forth in §214(b) of the Immigration and Nationality Act (INA). This denial will be very apparent to the applicant, as the officer will supply a written notice stating such. Section 215(b) denials are founded on the consular officer’s belief that the applicant does not have enough strong ties to the home country and will seek to immigrate to the United States upon the program’s completion. Applicants faced with this type of denial must submit a new application with much stronger evidence.

Some U.S. consulates discourage submitting new applications until a substantial period of time has elapsed.

A consular officer has the authority to deny an application is he or she believes the applicant has fraudulent intentions, such as coming to the United States with a purpose in mind other than what was stated in the application.

Other cases can be held up if a consular officer places them in “administrative processing.” Administrative processing can have multiple meanings, and generally the applicant is not informed as to the rationale behind this decision. In some situations, administrative processing means that the applicant will be required to supply additional information, which is then taken into consideration by the U.S. consulate. Other cases could be determined by the consular officer to require further investigation before visa issuance. Some of the larger consulates have staffs whose responsibility it is to make such inquiries to ensure that the applicant is being truthful. In addition to these reasons, administrative processing delays can be prompted by security clearances usually based on checking the applicant’s name against numerous criminal and security databases.

The time frame for most U.S. consulates to complete administrative processing is usually a few days or weeks. Though the U.S. Department of State’s goal is to complete all administrative processing within 60 days, delays can prolong this, especially with applications waiting for security clearance.

What should the physician expect at the port of entry?

Once issued a visitor visa, physicians are permitted travel to the United States. Individuals from visa waiver countries with their ESTA approval can also travel to the United States, but entry is contingent upon an additional interview with a CBP port-of-entry officer. In preparation for this, the applicant should have the same documentation which was presented at the consular interview and be prepared to answer similar questions. If satisfied, the CBP officer will grant entry and place an entry stamp in the passport with a date detailing the amount of time the individual is authorized to stay in the country. The officer will also create an I-94, Arrival Departure Record, in either paper or electronic format. Since paper I-94s are quite rarely issued, most applicants can simply access their I-94 by going online to https://i94.cbp.dhs.gov/. Applicants are permitted to stay in the United States until the expiration date listed on the I-94. If a paper I-94 is issued, it must be presented by the applicant upon exiting the United States. It is a good practice to retain a copy of the departure boarding pass to have evidence of the departure from the United States in the event of an error in CBP’s databases.

Can physicians extend their stays as visitors?

With the exception of VWP entrants, it is possible to seek an extension of one’s authorized stay as a visitor in the United States, though it comes with inherent risks. Included in the process is filing an I-539 application with USCIS. If an applicant has stated a specific purpose for coming to the country only to subsequently request an extension for an unrelated purpose, the application can be denied and future applications at the U.S. consulate, such as for the J-1 work visa, and the port of entry could become more difficult. Before seeking an extension, physicians are cautioned to speak with an immigration attorney.

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