ABCs of Immigration: J-1 Visas for Graduate Medical Training

[This month’s ABCs of Immigration issue is adapted from Greg Siskind’s book, co-authored by Elissa Taub, The Physician Immigration Handbook.]

In 2014, more than 80 percent of physicians using visas to enter the United States in order to participate in graduate medical training programs did so via the J-1 visa. The J-1 visa is utilized by participants in the United States Department of State’s (DOS’) Exchange Visitor Program. The Exchange Visitor Program is available to individuals entering the U.S. for a litany of purposes, ranging from camp counselors to foreign dignitaries, from au pairs to international scholars, and, of course, physicians participating in residency and fellowship programs. While hundreds of J-1 programs exist in the United States, only the Educational Commission on Foreign Medical Graduates (ECFMG) is capable of sponsoring physicians.

What are the required qualifications for a physician in order to pursue graduate medical training on an ECFMG-sponsored J-1 visa?

1. The physician must pass the U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge. Additionally, ECFMG will accept the former Visa Qualifying Examination, the National Board of Medical Examination in Medical Sciences, or an acceptable combination thereof. While older Examinations such as the ECFMG Examination or the Federation Licensing Examination fail to meet the J-1 requirements, they may still suffice for licensing and H-1B petitions.
2. The physician must have an ECFMG certificate without expired examination dates. Exceptions are made for graduates of Liaison Committee on Medical Education (LCME)-accredited U.S. and Canadian medical schools.
3. There must be a contract or official letter of offer for a position in an approved graduate medical education or training program.
4. The physician must provide a Statement of Need from the Ministry of Health of the nationality country or country of last permanent residence.

What is the Statement of Need?

The Statement of Need provides written assurance that the home country or country of last residence has a need for physicians in the specialty in which the physician is going to train, and the physician will return to the home country or country of last residence upon the completion of the program in the United States. ECFMG expects the Statement of Need to originate from the country of permanent residence in the event the physician lives permanently in a country other than the country of nationality. Statements of Need must adhere to the following requirements:

• Specifically designate the exact specialty or subspecialty that the physician will pursue, and a need exists for qualified physicians in that specialty;
• Be issued by the central office of the appropriate Ministry of Health; and
• Have a certified English translation if the original is in a different language.

If the physician seeks to change specialty, the letter on file with the ECFMG is expiring, or the physician seeks a change of host institutions, a new Statement of Need is required.

How does a physician apply for ECFMG J-1 sponsorship?

After a physician is accepted into a host institution’s graduate medical training program, the physician will coordinate with the institution’s training program liaison (TPL) to submit the J-1 application to the ECFMG. Communication regarding the status of the application will take place between the TPL and ECFMG.

The institution’s TPL will submit the initial online application for the J-1 through the ECFMG’s Exchange Visitor Network (EVNet). The TPL is responsible for providing details on the appointment of the physician, and ECFMG is will send information 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 forms have been completed by the physician and the TPL, and they have submitted all the required supporting documentation, ECFMG will begin reviewing the application.

ECFMG will then generate an electronic record in the Student and Exchange Visitor Information System (SEVIS) for the J-1 and each J-2 dependent. SEVIS is a database jointly administered by the U.S. Department of State and Homeland Security. Form DS-2019, Certificate of Eligibility for Exchange Visitor (J-1) status is created through SEVIS, confirming the approval of the J-1 sponsorship. ECFMG must use SEVIS throughout the J-1 and J-2’s time in the United States to document that they are maintaining their status for the duration of their stay.

Once ECFMG approves sponsorship of a J-1, it will mail the original Form DS-2019 to the TPL through regular first-class mail, except if the TPL specifically requests courier service and provides ECFMG with a pre-paid/pre-addressed airbill along with the supporting documents for the J-1 application.

What documentation does ECFMG expect from a physician applying for J-1 sponsorship?

ECFMG lists the following items for the physician to upload in OASIS.

• Contract or letter of offer;
• Statement of Need;
• Training Program Description, visit https://www.ecfmg.org/evsp/evspgfpd.pdf if entering sub-specialty training;
• Current curriculum vitae; and
• Copy of passport name page(s).

Additional documents required 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 of LCME-accredited U.S. or Canadian medical schools, a copy of the diploma (with a certified English translation, if applicable_ and a full0face 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 https://www.ecfmg.org/evsp/evspcocmemo.pdf. Detailed about the change of category request process also can be found in this document.

How does a J-1 physician include a spouse and minor children?

When submitting his or her initial information through OASIS, the J-1 physician can place a request to sponsor J-2 visas for a spouse and any minor children. Minor children are considered to be those under the age of 21. Parents, siblings, other family members, or domestic employees are not permitted to seek J-2 visas, though in certain cases they can seek a visitor visa to accompany the K-1. If the J-2 request is not made at this time, then a paper application must be submitted to ECFMG. If approved, ECFMG will issue separate DS-2019 forms for each J-2 family member, a requirement for applying 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 integral document in the administration of the J-1 exchange visitor visa program.

The DS-2019 contains the following information:

• The exchange visitor’s name;
• The designated sponsor (ECFMG);
• A brief description of the exchange visitor’s program, including the beginning and end date, category of exchange (graduate medical training), and in an estimated cost of the exchange program in addition to the source of the financial support; and
• Whether the J-1 is subject to a home-residency requirement.

After the J-1 has demonstrated that he or she has met all the ECFMG requirements for the J-1 visa program, ECFMG will issue the DS-2019 to the physician.

What does the physician need to do with the DS-2019 form after it is issued?

Upon receiving the form, it is a good idea for the physician to thoroughly review it to verify its accuracy. For example, the country listed on the form should be the country in which the physician is required to satisfy the home-residency requirement. Therefore, if the physician does not actually have the right to return to that country upon conclusion of the J-1 training, the physician’s country of nationality should be listed on the form.

The DS-2019 will be an extremely important document for the physician for many years, so it is imperative the physician retain, at the very least, a copy of the document. Given the document’s importance, it is best to retain multiple copies of the documents, with at least one copy existing in a cloud-based storage service, such as Dropbox or Google Drive.

How long might a physician pursuing graduate medical training stay in J-1 status?

ECFMG sponsorship is limited to the time typically required to complete specialty/subspecialty training as determined by the American Board of Medical Specialties (ABMS) but does not exceed seven years.

Can spouses or children enter with the J-1 exchange visitor?

Yes. Spouses and unmarried children under the age of 21 are eligible to accompany a J-1 applicant to the United States under 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 requires an applicant to prove strong ties to the home country and a clear intent to return home upon either the physician completes the J-1 program or withdraws from the training early.

Can a physician coming to the United States for a research position obtain a J-1?

Yes. Physicians may come to the U.S. as J-1 “research scholars” to participate in programs of observation, consultation, teaching or research. ECFMG has a separate J-1 for these types of positions. Additionally, many academic medical centers can sponsor physicians for research positions under their own J-1 programs.

Far fewer requirements exist for sponsoring J-1 “research scholar” positions. A physician only needs to demonstrate 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 form the employer that the physician will have no patient contact, even if that contact is incidental.

For how long can a J-1 researcher physician remain in J-1 status?

The maximum duration for research scholars is five years.

Can a physician in a J-1 research scholar position change to a graduate medical training J-1?

No. The Department of State prohibits such changes. According to DOS regulations, professors and researchers may not have participated in a J visa program for the entirety or part of the 12-month period immediately preceding the start date of a professor or research scholar program.

Can a physician change specialties after arriving as a J-1?

Yes. Physicians are permitted to change their designated program of graduate medical training once and may do so no later than two years after the date the physician enters the United States as a J-1. This is not the same as physicians who are 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 ECFMG strongly discourages this and would only be considered based on the J-1’s graduate medical education program director’s strong recommendation.

What insurance requirements are imposed on J-1 physicians?

It is required that J-1s and J-2s have health, accident, medical, and evacuation and repatriation of remains insurance during their J-1 and J-2 stays in the United States. As of the writing of this, the specific requirements are as follows:

1. Medical benefits of at least $100,000 per accident or illness;
2. Repatriation of remains in the amount of $25,000;
3. Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000’ and
4. A deductible not to exceed $500 per accident or illness.

ECFMG provides evacuation and repatriation 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. Physicians will generally be capable of obtaining 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. Moonlighting, a term which refers to physicians engaging in employment outside of their graduate medical training, is prohibited for J-1 visa holders and employment outside of approved residency or fellowship training is therefore barred. ECFMG is explicit that no compensation may be provided to physicians training on J-1 visas from any source other than their residency/fellowship program.

How does a physician obtain J-1 status?

Physicians in the United States in a valid nonimmigrant status, with the exception of physicians in visitor status under the Visa Waiver Program, are able to seek to adjust their status to J-1 for graduate medical training by applying with USCIS. However, these applications have unpredictable timing, so most physicians avoid exercising this option.

The most commonly pursued option is the filing of an application for a J-1 visa at a U.S. consulate in the home country or the country of residence. In order to apply for J-1 status, J-1 and J-2s should first file a nonimmigrant visa application.

In addition to supporting documentation, J-1 and J-2 applicants should bring the following items with them to their interview:

• The DS-2019 form (one for the J-1 and separate ones for the J-2 applicants);
• Documentation of nonimmigrant intent;
• The contract or offer letter from the graduate medical training program;
• While not technically a requirement, it is a good idea 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 the relationship, including a copy of the marriage certificate and/or birth certificate (including a certified translation).

Once the U.S. consulate is satisfied the applicant meets the J-1 visa requirements, the applicant’s passport and the passports of his or her dependents will be stamped with machine-readable visas.

For further reading, including what J-1s and J-2s need for travel in and out of the United States, view Chapter 4 in The Physician Immigration Handbook.

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