International Medical Graduates

International Medical Graduates (IMG)

60% of the residents who matched into the field of Endocrinology were International Medical Graduates (IMGs) in 2019. IMG physicians play a critical role in the delivery of health care by bringing talented individuals to the U.S. to make significant contributions in research, education, and patient care. IMG’s currently account for approximately one fourth of the practicing physician workforce and they help promote diversity in academic, research, and clinical institutes. IMGs represent 70% of the physicians practicing in rural America.

To help IMG physicians transition to practicing medicine in the U.S., below are resources and answers to frequently asked questions.

FAQs

There are four major types of visa status physicians can use in the U.S.

  1. H-1B
  2. J-1
  3. O-1
  4. TN

Learn about each type of visa including, how to apply, scope of practice, renewal process, and more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Before obtaining employment after training in the U.S., the following may be required:

  • DOL—The U.S. employer must obtain foreign labor certification from the U.S. Department of Labor, prior to filing a petition with USCIS.
  • USCIS—U.S. Citizenship and Immigration Services approval of a petition or application (The required petition or application depends on the visa category you plan to apply for.)
  • Knowledgeable and experienced immigration lawyers.

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

The H-1B visa is available to graduates of foreign medical schools who have passed the necessary examinations and have a valid state medical license. The H-1B process requires your future employer to sponsor the visa on your behalf.

(J1 visa waiver applicants are eligible once waiver approved)

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

The J-1 visa is an exchange visitor program. A physician on a J-1 visa must return to their home country for two years after finishing training. A physician may apply for a J-1 waiver to waive the 2-year home country requirement to be able to practice in the U.S.

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

According to the AMA, the following governmental agencies have sponsored waivers for international medical graduates:

In addition, check websites for the Medically Underserved (MUSA) areas as well as Health Performance Shortage Areas (HPSA). Review your respective department of health website for the J1 Waiver application, crucial deadlines, and required documents. Remember, J-1 waivers are provided on a first come first served basis, so planning is crucial. Previous J-1 waiver candidates advise hiring an immigration lawyer to help navigate the process.

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

The O-1 visa is less commonly used; however, it is for IMGs on a research track or IMGs with extraordinary abilities in the field of science. 

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

The TN visa is accessible to only Canadian and Mexican citizens qualified for full-time employment as professionals in an eligible field. The North American Free Trade Agreement (NAFTA) allows citizens from these two countries to use this temporary non-immigrant status with specific requirements for each country.

Learn more at AMA: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

Reference: The American Medical Association (AMA)

Mentors are experienced and trusted advisers that can guide IMGs with all aspects of their training, including clinical skills, patient interactions, and workplace transitions. It is beneficial for an IMG to have one or more mentors to support their professional career. Receiving guidance from a mentor that has already taken the same journey will help an IMG transition smoothly while enhancing their professional development.

Coming soon: How to find a mentor at AACE.

Reference: The American Association of Clinical Endocrinology (AACE)

J-1 visa holders are eligible for a 3rd year fellowship, keeping in mind that the duration of a J-1 Visa should not exceed 7 years total

Learn more at NIH: https://grants.nih.gov/grants/who-is-eligible.htm

Reference: National Institutes of Health (NIH)

It is possible for J-1/H-1 visa holders to do a 3rd year fellowship not related to NIH grants. Some examples are being sponsored by your institution as an extra non-ACGME accredited year, or sponsorship through the Veterans Administration (VA). Contacting an immigration attorney can help guide you through the process.

H-1B Visa holders-The process of looking for a job will first entail screening potential employers on their capability to sponsor the H-1B visa. It is important that the applicant starts looking for jobs a year prior to finishing training and also consider whether the potential employer is H-1B cap exempt or subject to it. Often, training institutions are not-for-profit and exempt from the H-1B cap but if the trainee is leaving the academic setting and trying to get employment with a private employer, they will become subject to the cap. Since the H-1B visa is limited to 6 years, potential employers will also need to agree to sponsor a lawful permanent residency (green card) application so that the H-1B visa can be continually renewed till the green card application is approved and the applicant’s status changes to permanent resident of the United States.

For J-1 Visa holders-The process of looking for a job will first entail screening potential employers on their capability to sponsor the J-1 waiver. It is important that the applicant starts looking for jobs a year prior to finishing training. Check your respective department of health website for the J-1 Waiver application, and crucial deadlines, namely for J-1 waiver application submission and required documents. Remember J-1 waivers are provided on a first come first served basis limited by state.

Some recruiters and websites specialize in assisting physicians to get jobs specifically in J-1 waiver areas. Example: https://www.3rnet.org

Learn more at USCIS: https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/conrad-30-waiver-program

Reference: U.S. Citizenship and Immigration Services (USCIS)

References:

Disclaimer:

The information expressed about international medical graduates (IMGs) are those of the American Medical Association (AMA) authors and The American Association of Clinical Endocrinology (AACE). The statements, opinions, and recommendations presented are for general information only and any reliance on or use of the information provided is done at your own risk.