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An Immigrant's Medical Journey: At a Glimpse

Would you imagine that international medical graduates (IMGs) currently make up about 25 percent of the physician workforce in the United States*? With all the changes that are currently facing the medical profession in the United States, it's very clear that there is an urgency for more physicians to meet the needs of our growing population. Overcoming the immigration hurdle is the first thing that comes in the way of immigrant medical families helping to meet this need.

As the spouse of a PGY4 in otolaryngology at Duke University and as a practicing immigration attorney, many physicians and their family members contact me to help them understand the complex twists and turns of their current immigration status as well as to help plan for their futures in the United States. This blog entry will aim to explain the pros and cons of the most common visas utilized by hospitals for residents and fellows during their graduate medical education (GME).

Although some immigrant physicians come to the United States during medical school, the vast majority of those who enter the United States for their GME are international medical graduates. Most immigrant physicians who are about to enter residency do not have the good fortune to have a say in their visa process, they just hold their breath and hope that everything is resolved by their hospital's human resources department during that magical time between March and July.

Most residency and fellowship programs use two types of visas: the J-1 visa or the H-1B visa. For those who have some input and involvement in their visa process, it is important to know that each visa type is unique and provides varied pros and cons.

The amount of time an immigrant physician can use each type of visa is different. The J-1 visa allows a recipient to continue their GME for up to seven years with a potential for an extension for some exceptional circumstances. This is a solid benefit for those who know that they will surely have more than six years of GME, a circumstance that is becoming more and more common. The H-1B visa, on the other hand, has a maximum of six years.

Immigrant physicians who plan on settling in the United States after their residency should lean toward the H-1B over the J-1 because the J-1 visa is subject to a two-year foreign residency requirement. That means that after the residency or fellowship application the immigrant physician must return to their home country for at least two years before reapplying to return to the United States. While the two-year foreign residency requirement doesn't seem like a big deal for most, that opinion is likely very different for a spouse or long term partner in the United States who cannot imagine two years without their significant other.

Finally, how do these visa categories affect the spouses? This is a factor highly in favor of the J-1 visa, because their immigrant spouses are able to apply for the J-2 visa. The J-2 visa category allows the spouse to work lawfully in the United States, a welcome option for the often financially challenging time of medical residency. H-4 visa holders, or the spouses of H-1B visa holders, on the other hand, are not allowed to work lawfully in the United States. Couples of two physicians often have to decide whether to apply for separate H1-B visas or apply for the J-1 and J-2 category.

While immigrant physicians often meet their visa issues with grunts and groans, the decisions that are made today are often ones that will shape their entire GME, and future in the United States. These decisions should be discussed with as much clarity as possible with the human resources counselor or immigration attorney utilized by the GME institution where the residency or fellowship will take place.

Each family needs to determine their goals, both short term and long term, with their careers in the United States. For the physicians and family members who are going through this added challenge, I urge you to reach out to one another and speak about your experiences. You can find some much needed support through similarly situated colleagues throughout the United States. I also urge that immigrant physician families, who are at a point, either at the beginning of their GME program or at the penultimate year prior to becoming an attending physician, discuss their goals and needs with an experienced immigration attorney to determine what is right for them.

*American Medical Association. IMGs in the United States. American Medical Association; Chicago, Ill: 2007.

Madhavi Patki is an immigration attorney at Fayad Law in Raleigh, North Carolina. If you have any questions for Madhavi, you may reach her at madhavi@fayadlaw.com.

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