J-1 Exchange Program
In 1965, the United States Congress passed a law to provide scholarships and programs for foreign medical graduates to study in the United States for graduate medical education on what is called a J-1 Exchange Visitor visa. Thousands of applicants apply each year to be sponsored by the ECFMG for graduate medical education; however, only a small percentage are chosen - usually the best and the brightest students from their home country. If chosen, students agree to complete their education in the United States and return home for two years before they are eligible to return to the United States on an immigrant visa or non-immigrant visa. Each year they are in the United States, they also promise to return home for two years when they execute Form DS-2019 (previously IAP-66) to continue their studies. Our government believes this program has resulted in significant progress in health care in the home countries of the J-1 exchange visitors.
The program is supervised by the Department of State. If students do not honor their commitment to return home for two years, the policies of the exchange visitors program are frustrated. Our government does not believe it is fair to take the best and the brightest students from a country and encourage them to stay in the United States.
Foreign Medical Graduates (FMGs) are subject to the two-year foreign residence requirement. If an FMG does not wish to comply with such requirement, he/she may apply for a J-1 waiver under one of the four grounds:
- Request by an interested government agency (IGA): There are typically two grounds for obtaining a J-1 waiver through an IGA which are (1) Research - if an FMG is working on a project for or of interest to a U.S. Federal Government agency, and that agency has determined that the FMG’s departure for two years will be detrimental to its interest, or (2) Clinical Care – FMG must agree to provide health care services for three years in primary care or mental health HPSAs (Health Professional Shortage Areas). There are several U.S. government agencies which are eligible to apply for the IGA waiver:
- U.S. Department of Health and Human Services (HHS)
- Department of Veterans Affairs
- Appalachian Regional Commission
- Delta Regional Commission
Conrad 30 program: An FMG who has an offer of full-time employment at a health care facility in a designated HPSA or at a health care facility which serves patients from such a designated area, may obtain a waiver. In addition to the federal guidelines which must be followed, each state may set its own requirements and deadlines. However, in all instances the FMG must sign a contract to work for at least 40 hours per week and for not less than three years.
Persecution: If an FMG believes that he/she will be persecuted upon the return to the home country, such FMG may be able to obtain a waiver on this basis.
Exceptional hardship to a United States citizen or permanent resident spouse or child of an FMG: Such waivers have stringent requirements that are very difficult to meet.
Note: “No Objection Statement” waiver is not available to FMGs.
Because we understand that it is difficult and daunting process to locate a suitable job opportunity eligible for J-1 waiver, we provide assistance with locating practice opportunities for physicians. The Texas Doctors Group. is our physician placement organization which has been recruiting physicians for over thirty years. We work with practice opportunities in Texas where there is a need for additional physicians, where other physicians will give one referrals, and most importantly where there is no professional animosity toward a new physician. Our goal is to match the needs and objectives of the physician and his/her family with the needs of the employers.
life vs. reality
J-1 Physicians should recognize the difficulty of locating suitable sponsors for a waiver and sponsorship for an H-1B non-immigrant visa and thereafter permanent residence. In addition, they should recognize that IGA and Conrad program waivers almost always include employers that cannot find a U.S. physician to work in their HPSA. Many J-1 physicians think they know what life and their practice will be in a small town.
1. Physician’s expectations of rural practice compared to the responsibility perceived by the community prove to be more than anticipated. He or she may think rural community – easy job. Though the responsibilities are different between rural and city, they are just as great and just as demanding if not more so. Physician needs to be reminded that he or she will have to treat any and every patient that walks in the door.
When employers explain how one lives in a rural town, physicians may think, “I know rural life,” when they really do not have the slightest idea of day to day living. Here are some of the problems:
2. Physician, after being in HPSA awhile, decides he or she wants bigger and better; that his or her abilities are wasted on a town this size or that he or she could make more money in a larger area and work fewer hours. Remember one must stay at least three years or even five years.
3. Physician does not want to make a personal effort to make practice work. Expects, because it is a small community, it should just happen.
4. Physician, spouse and/or children prove not to be happy with the small town environment, limited entertainment and shopping availability. Most towns are located at least 30 to 100 miles from any other access and such distance proves to be too confining for people that are not prepared for that type of life.
5. Physician and/or family fail to interact with the community, thus not achieving the trust and acceptance of the community. In a rural setting this is probably one of the most important issues. If this does not happen, the community on a whole will not use his or her services.
6. Physician’s spouse decides she or he is too good for the rural population. Feels that she or he cannot gain the social status she or he wants in a town this size.
These are just some of the problems we have observed. It seems to take about a year for the reality of rural life to set in. If you are not prepared for that type of life you are not going to be happy with it.
On the other hand, here are…
Some people say that if you live and work in a large city, you may spend a year of your life waiting for stoplights and elevators. This does not happen in a small town.
- People in the community are very appreciative of your work
Working in a small town community can be very gratifying:
- You develop close personal relationships and the sense of community
- Some communities have state-of-the-art medical facilities
- You can actually make very good income
- Small communities are a much safer environment than big cities, especially if you have children
What is another alternative? You have an education, a medical license and are probably less than thirty-two years of age. Two years back home is not a long time. Before you leave the United States, obtain a medical license in a state where you want to live and locate an employer who needs someone such as yourself in two years. We can start the labor certification when you complete your residency and either have an immigrant visa or H-1B visa waiting to be issued to you when you fulfill the two-year requirement.
WARNING: All information contained herein is offered for the purpose of providing general information only and should not be construed as formal legal advice. The author disclaims any and all liability resulting from reliance upon such information. You are strongly encouraged to seek professional legal advice from a qualified immigration lawyer before relying upon any of the information contained herein.