Foreign Medical Graduates

Residency/Fellowship Requirement

Foreign medical graduates who seek to practice clinical medicine in the United States generally must complete residency training at a U.S. residency program in order to obtain a state medical license. An exception is made for those doctors who have completed an accredited residency training program in Canada. These doctors may obtain a state license without repeating residency training in the U.S.

The Educational Commission for Foreign Medical Graduates ("ECFMG") sets forth the requirements for a foreign medical graduate to obtain a U.S. residency program placement. These requirements include: successfully passing an English test and a basic science test, and receiving certification through ECFMG. Either the ECFMG or the residency program itself can act as a visa sponsor enabling the foreign medical graduate to obtain a J-1 visa and enroll in the residency program.

In order to be J-1 or H-1 eligible, it is necessary to maintain work-eligible status in a residency program; residents receive compensation for their work and are considered "employees" for that purpose.

Medical License

States generally issue medical licenses to both foreign and U.S. medical graduates upon a showing of substantial completion of the requisite number of residency training years, satisfactory results on the USMLE, and certification of foreign medical education, among other things.

J-1 Waiver

Once a foreign medical graduate has decided to remain in the United States upon completion of his/her residency/fellowship program, he/she must begin the process of attaining a J-1 Waiver. The J-1 Waiver waives the two-year home residency requirement the J-1 holder is subject to upon completion of the residency/fellowship program.

A J-1 Waiver can be obtained through one of the following options:
1. - A "No Objection" Letter process
This waiver option is generally not available to medical residents who received their medical training in the U.S.
1. 1. - An Interested Government Agency ("IGA") waiver
2. The most common way for a foreign medical graduate to obtain a J-1 waiver. For clinical care physicians working in federally designated areas having shortages of primary care physicians, these waiver recommendations are available through several federal agencies including: Appalachian Regional Commission, Delta Regional Authority, the Department of Health and Human Services, and the Veterans Administration.
4. 2. - A waiver application based on hardship or persecution; or
5. If an alien can establish that he/she will suffer persecution upon return to the home country, the foreign residency requirement will be waived. The threat of persecution must be based on one of the following three grounds: (1) race; (2) religion; or (3) political opinion.
  2. - A Health Agency Request.
    
    State health departments can also sponsor J-1 waivers through the Conrad State 30 Program for foreign medical graduates who have an employment offer that will fill a medical necessity. Usually the doctor is working in a primary care position in a medically underserved area in the state. This program is limited to 30 foreign medical graduate waivers per state per year.
6. In order to qualify under the state program, medical doctors must be offered a full-time job with a health care facility serving an area with a shortage of medical professionals. In addition, the doctor must agree in writing to work at the medical facility for forty (40) hours per week, for a minimum of three (3) years, and must begin work at the health care facility within ninety (90) days from the approval of the waiver.
Work Eligible Visa Options

Once a J-1 waiver and state medical license are obtained, a foreign medical graduate may obtain a new work authorized status for U.S. employment, generally obtained through an H-1B visa (professional temporary worker) or a green card (immigrant visa). H1-B visas must be filed with the U.S. Department of Labor and with the U.S. Citizenship and Immigration Services. Generally, federal law requires most foreign physicians who have received a J-1 waiver to stay in H-1B status for three years before petitioning for a green card.