The J-1 non-immigrant visa allows completion of an accredited residency or fellowship program of up to seven years' duration that leads to board certification. Following this, the resident must return to his/her native country or country of last residence for a period of at least two years. The U.S. consulate issues the J-1 visas in the country from which the resident is coming and to which s/he will return after residency. The ECFMG Exchange Visitor Program generally sponsors the J-1 visas. Your governmental health office (ministry of health) must sign a document indicating the need in your home country for physicians trained in your prospective specialty (try to obtain this document ahead of time). However, the U.S. consulate sometimes refuses to issue J-1 visas when they believe the applicant does not intend to return. Since J-1 visa applications are filed after the match, when the resident has already secured a position, inability of the applicant to obtain a visa may pose a problem for residency programs.

Exchange visitors holding J-1 visas are allowed to remain in the U.S. up to seven years. They cannot stay longer to pursue other types of training, or for practice, or for academic activities unless they qualify for a waiver to the foreign residency requirement.

There are now four statutory justifications for such a waiver. Three have been available for several years:

• A finding by the INS of potential exceptional hardship for a spouse or child who is a U.S. permanent resident or citizen if they move to the alien's country of origin

• A finding by the INS that the alien would face persecution on returning to his or her country

• Support of a waiver from a U.S. government agency (most commonly U.S. Veterans Administration and Appalachian Regional Commission) based on the alien's accepting a position that could not be filled by a U.S. citizen

Canada is a special case in regard to a J-1 visa. She refuses to submit the documentation needed by her nationals to obtain a J-1 visa status.

THE H-1B VISA

The H-1B visa allows individuals to avoid the J-1 visa foreign residency requirement (requirement to leave the U.S. for at least two years after training is complete) by petitioning for permanent resident status in the U.S. while in residency training or any other line of work. Applicants for H-1B visas must have:

• ECFMG certification
  
• evidence of having passed the USMLE Steps 1, 2 AND 3
  
• a license to practice in a U.S. state or territory before application

The H-1B visas are available to all professionals (not just medical) and there is a cap of 115,000 of such visas that can be issued in each fiscal year (October to September). The number of applications always greatly exceeds the cap number. The cap is usually reached by April of each year. Thus, applicants whose applications are received after the cap has been met will not be given visas to begin work on July 1st; rather, their visas will be issued from the next year's batch for beginning work on October 1st. It appears that each year the cap for H-1B visas is reached earlier and earlier. However, it is possible that extensions on an H-1B visa for stays in the country longer than six years may occur. Also, the United States INS may issue up to 200,000 H-1B visas in future years.

You will have to think carefully about which visa is right for you, and whether an October start would be possible or permitted by your residency program.

OTHER VISAS WORTH KNOWING ABOUT:

H-4 visa

This is the visa on which all dependents of an H-1B visa holder will be permitted into the country. Holders of this visa cannot obtain work permits under any circumstance. However, they can change the visa type to H-1B if there is an employer willing to sponsor them.

J-2 visa

If you have a spouse working under a J1 Visa, you can obtain a work authorization as long as your spouse's J1 Visa is active. Not all programs are aware of this possibility.

Advantages:

• If your spouse gets a waiver of the "2 year home return" clause, you don't have to find a waiver-acceptable position. Any position will suffice.
• There is no additional processing (work permit is obtained within one day - you have to pay some small fees, however).

• It is tied to the spouse's immigration situation.

This is a visa that is not used during residency programs, but it is good to know about it ahead of time because it may be one solution to staying in the U.S. after residency.

Advantages:

• Some fellowships will allow for this visa - this is, however, a rare occurrence.
• There are no quotas on number of these visas.
• There is no time limit on this visa - You can stay in the U.S. forever on it. It is usually approved for an initial three years and then extended yearly.
• At any time a switch to permanent residency (green card) is possible (if there is sponsor).

• Not everyone is eligible. Those with prior research experience are primary candidates (it helps if during the O1 status you intend to conduct research).
• Processing time may take up to 6 months.
• Spouses will not be allowed to work unless they obtain independent visas that permit working.
• You can change from J1 Visa to O1 Visa, but the 2-year home country return requirement will stick with you (however, this may give you time to find an adequate position which can be used to waive this requirement).