Getting a J-1 or H1B visa for US residency/fellowship

[Guest Ian Wong]

This is in response to the previous thread where the following question was asked:

I'm in my first year at the U of S. One of our upper years was saying that Saskatchewan students cannot get Visas (for long enough) to do residencies in the US. I think he said that the longest Visas available are for about 1 1/2 years, which makes it difficult to even do a fellowship.

Here's a quick primer on the J-1 and H1B visas. Some links worth checking out include the US Department of State Visa Services and the US Citizen and Immigration Services:

 

www.travel.state.gov/visa_services.html

uscis.gov/graphics/index.htm

 

If you are not a US citizen, you need a visa in order to live in the US while completing either a US residency or a US fellowship. There are three potential visas available to Canadian med students or physicians looking for further training in the US. Here's further information on these three visas:

 

www.travel.state.gov/visa;tempwkr.html

www.travel.state.gov/visa;exchange.html

 

The first is the O-1 visa. This is reserved for outstanding individuals, and suffice it to say, most med students won't qualify for this visa. As mentioned in the above website, you need to fulfill these requirements to get the O-1 visa:

O-1 classification applies to persons who have extraordinary ability in the sciences, arts, education, business, or athletics, or extraordinary achievements in the motion picture and television field;

The second is the J-1 visa. This is the most common visa obtained by Canadians when going to the US for either residency or fellowship. Here's the description in the US website:

The Immigration and Nationality Act provides two nonimmigrant visa categories for persons to participate in exchange visitor programs in the United States. The "J" visa is for educational and cultural exchange programs designated by the U.S. Department of State, Exchange Visitor Program and Designation Staff...

It can be extended to a maximum of 7 years, more than enough time to complete most residencies or fellowships. It is also known as the "bad visa", due to the following requirements.

 

1) Since the J-1 visa is an exchange student visa, you are classified as a student while doing residency. As a result, you are prohibited from moonlighting (working outside your residency program for additional money).

 

2) Also, the J-1 visa, being an exchange student visa, is not intended to allow you to stay in the US to practice. As a result, there is a requirement in the J-1 visa that forces you to return to your home country for a minimum of 2 years following residency/fellowship, before you can apply for any visas to move to the US permanently.

 

The J-1 visa requires you to get a statement of need from Health Canada. This is the official Health Canada website regarding obtaining a J-1 visa, and should be considered mandatory reading for anyone considering going to the US for postgraduate training:

 

www.hc-sc.gc.ca/hppb/healthcare/pubs/requirements2004/index.html

 

You also may require provincial approval, in that the specialty you are planning on training for in the US needs to be on a provincial list of undersupplied specialties. In other words, since the J-1 visa is intended for you to return to Canada after your US training, before you can obtain a J-1 visa, your province needs to sign off stating that your specialty is in demand in that province.

 

Here's where you might get tripped up. I talked with a Manitoba med graduate who was told by Manitoba that they would NOT sign off to allow him to get his J-1 visa to go to the US for residency training. I assume this was because there were/are unfilled Manitoba residency spots still available, and it was hoped/expected that he would take one of those spots instead of going to the US to train in a more desirable specialty. It could potentially be the same situation in Saskatoon.

 

In the above Health Canada link, if you scroll down, you will find a contact name for each province, from whom you need to get that provincial approval. It would definitely be worth putting in a call to that Manitoba contact to see if the above information is true (I heard this second hand, and this was also a few years back, so I wouldn't be surprised if there's some inaccuracies in the above account).

 

As noted already, that home residency requirement is 2 years. Where you could get tripped up therefore, is if you went down to the US on a J-1 visa for a residency like Emergency Medicine (only 3 years in the US, but 5 years in Canada). Once you finish your US residency, you get kicked back into Canada for a minimum of two years. If the Royal College of Canada doesn't recognize your US training, they may not let you sit for the FRCPC exam, and you won't be able to become Canadian board-certified in Emerg Medicine, even though you're forced to live here for those two years. If that happens, you might be cooling your heels in a non-clinical job for those two years!

 

Ways around the J-1 home requirement are few. Here's the link to getting a J-1 waiver for the home requirement:

 

www.travel.state.gov/jvw.html

www.travel.state.gov/j_faq.html

 

You can agree to work in a government organization in an underserved area for somewhere around 3-5 years (such as a Veteran's Administration Hospital), or perhaps may be able to get around the visa if you are married to a US citizen and this would cause undue hardship, whatever that means. Alternate ways include being afraid of persecution in your home country, or a no objection statement from your government, both of which are not realistic options for someone coming from Canada.

 

The third option is the H1B visa. This is the "good visa", and can be extended to a maximum of 6 years, which again should be more than enough time to complete your residency/fellowship. The website describes this visa as the following:

H-1B classification applies to persons in a specialty occupation which requires the theoretical and practical application of a body of highly specialized knowledge requiring completion of a specific course of higher education.

The major strength of this visa is that it is an employment visa, and not a student visa. This has HUGE implications, including the following:

 

1) Since this is an employment visa, you can moonlight while on this visa. This can lead to a significant increase in income throughout your residency (if you are in a residency program which allows you to moonlight, it may well be possible to double your annual income by moonlighting, if not more).

 

2) Since this is not an exchange visa like the J-1, you are not required to leave the US for 2 years after completing your residency/fellowship. In fact, since the H1B is for highly trained individuals, it is set up in such a way that you can actually apply for your Green Card while on this visa, so getting the H1B visa lines you up to get permanent resident status in the US, and would then lead to US citizenship if you desire.

 

The other advantage of this visa therefore, is that if you are doing a US residency not recognized by the Canadian Royal College, you could just stay in the US and work there after graduation. There would be no risk of getting kicked back to Canada while not being able to work as a physician in Canada.

 

The disadvantage of this visa is that it is much harder to obtain than the J-1 visa. In order to apply for this visa, you need to have graduated medical school and written all three steps of the USMLE board exams. Then you need a US institution to sponsor you (you don't need any paperwork from the Canadian government or Health Canada, however).

 

The trouble is that since 9/11, getting the H1B visa has been progressively harder. Many US institutions outright refuse to go through the paperwork to sponsor this visa. Those institutions who will are often in less desirable areas, or in less desirable specialties who are willing to offer the H1B visa as an incentive to recruit applicants. Therefore, you may well find that your "dream program" won't sponsor you for an H1B, but would be willing to sponsor you on a J-1 visa, and you then need to decide what is most important to you (going to the strongest program/best location you can, or having the increased flexibility of the H1B visa).

 

Anyway, I hope this serves as a quick primer regarding the visas that can be used to get into residency/fellowship in the US. In simple terms, the J-1 visa is offered by most institutions, but prohibits moonlighting and requires you to come back to Canada for 2 years after your training. The H1B visa is only offered by select institutions, and allows moonlighting, doesn't require you to return to Canada, and in fact sets you up for getting a US Green Card.

 

Ian

[Guest Sn22]

Thanx for the info Ian, its very helpful!

[Guest LoveMcGill]

Do you know if it's possible to change the J1 status to another during your residency (e.g.: because you marry an American during your residency)?

[Guest Ian Wong]

I don't know. That's probably worth a phone call to check up on. On the J-1 waiver page, they list the conditions that will allow you to escape the 2 year home residency requirement:

 

www.travel.state.gov/waiver_instructions.html

 

Of note, this is one of the statements listed. I am not sure if getting married to a US citizen allows you to jump out of the J-1 visa. If it doesn't, then it makes the below statement that much more poignant:

4. Exceptional hardship to a United States citizen (or permanent resident) spouse or child of an exchange visitor

 

If the exchange visitor can demonstrate that his or her departure from the United States would cause extreme hardship to his or her United States citizen or lawful permanent resident spouse or child, he or she may apply for a waiver. (Please note that mere separation from family is not considered to be sufficient to establish exceptional hardship.)

Ian