Some IMG’s come into the country on an H1B visa rather than a J1.  This loophole is being examined by the Federal Government and will probably be changed so that all IMG’s will have the 3 year requirement in Underserved Area’s no matter what visa you would come in on if you want to get your greencard. 

There is some confusion about the merits of coming in on the H1 visa rather than the J1 visa.  Here is basically the breakdown:

J-1 VISA

Who gets it: This student visa covers international medical graduates, professors, research assistants, students, scholars and teachers participating in a training program approved by the U.S. State Dept. For IMGs, this visa is for a medical residency. The Educational Commission for Foreign Medical Graduates is the visa sponsor.

Restrictions: After completing the program, J-1 visa holders must return to their home country for two years. A medical resident who receives a waiver of this requirement must work in an underserved area for at least three years.

H1-B VISA

Who gets it: This temporary work visa is awarded to professionals such as medical residents, nurses, computer analysts, engineers and scientists. The visa may be granted for up to six years.

Restrictions: A maximum of 65,000 H-1B visas are issued each year. In 2007, more than 125,000 applications were filed in one day. Employers exempt from the cap are universities, nonprofits associated with a university, and nonprofit or government research organizations. After residency, if a visa holder does not work for an employer that falls within the exemption, that person would compete for one of the 65,000 visas issued.Sources: U.S. State Dept, ECFMG As you can see, the cap can make it very difficult and the restrictions can be daunting. Also, some recent statistics also show that the number of J1’s have declined quite dramatically:

IMGs beginning U.S. residencies typically enter the country on J-1 or H1-B visas.

IMGs arriving on J-1 visas

1995-96      10,901

1996-97      11,471

1997-98      10,920

1998-99      10,330

1999-00        9,400

2000-01       8,629

2001-02       8,124

2002-03       7,242

2003-04       6,592

2004-05       6,094

2005-06       5,945

2006-07       6,033

Source: Educational Commission for Foreign Medical Graduates

And fewer J1’s are staying in the US:

The number of international medical graduates entering the United States for residencies on a J-1 visa is

declining. That means fewer IMGs are seeking waivers to stay after completing their training.

Physicians sponsored for J-1 waivers:

                                 1995             2006

Federal programs   1,285                37

State programs           89               866

Total                      1,374               903

Sources: U.S. Government Accountability Office, Texas Primary Care Office, Appalachian Regional

Commission, Delta Regional Authority, Dept. of Health and Human Services

It is believed that the requirments of IMG’s coming into the country on an H1 visa will change in the near future.  Because of these declining numbers, many underserved areas are not being fully staffed.  There is a sentiment that will require ALL FMG’s, no matter what visa they are on, will have to serve 3 years in underserved America.  This of course will dramitically change the nature of the J1 as it will become more attractive as it would not be subjected to the cap and with the H1 having the same requirements. 

And what about physicians that have started working in non-underserved areas on an H1 and never worked in an underserved area?  What happens to them when they attempt to get their greencard? 

There will be some inequities and some perceived unfairness if and when this occurs.  But we should all be aware that the US Government will act in the best interest of the US Government and not of the IMG necessarily.