For Latha Achanta, M.D., it was a tense time fueled by the anxiety that one mistake could threaten her future as a physician. Fresh off a master’s degree in public health from the University of Texas, Achanta was in the United States on an F-1 student visa at the time. A native of India, she was applying for her H-1B visa to train in a United States hospital in internal medicine.
“Initially, the process was anxiety-producing,” says the 29-year-old Achanta, who recently completed her third year of residency at Abington Memorial Hospital in Pennsylvania.
The United States allows International Medical Graduates (IMGs), also known as Foreign Medical Graduates (FMGs), the opportunity to train in American medical institutions, as long as they meet minimum entrance requirements. Due to the undersupply of graduates from American medical schools, especially ones willing to go into family practice or internal medicine, this arrangement has historically benefited both the foreign physician and the hospitals.
Should you do J-1 or H-1B?
Two types of visas are offered to IMGs: the J-1 and the H-1B.
Most IMGs prefer the H-1B visa. The reason is simple: Those arriving on J-1 visas have up to seven years to complete their training. But after that time period, they must return to their home countries for at least two years or else file for what is known as a J-1 waiver.
The J-1 waiver has a major restriction that makes it less than desirable for many foreign physicians. To qualify, the recipient must serve for at least three years in a U.S. Medically Underserved Area (MUA), a Health Professional Shortage Area (HPSA), or a Medically Underserved Population (MUP). This alone might not be a significant barrier, but openings might not be available in their practice specialties or preferred geographic areas.
The H-1B has no such return provision and can be renewed, but it is considerably harder to obtain, says Robert Lubin, an immigration attorney for more than 25 years and founder of Robert Lubin & Associates in Herndon, Va. “For one thing, the H-1B requires that the IMG first pass the United States Medical Licensing Exam,” Lubin points out.
Muhammad Balouch, M.D., a 32-year-old internal medicine resident at Mount Sinai School of Medicine’s Veterans Affairs Medical Center in the Bronx, N.Y., chose the H-1B route. “You avoid having to go back home or getting an exemption,” says Balouch. “The H-1B is the quicker route to a green card.”
The IMG journey
In all cases, the process begins with an application to the Educational Commission for Foreign Medical Graduates (ECFMG), a United States organization that oversees the process of certifying the credentials of IMGs for entry into U.S. residency training. All IMGs, regardless of citizenship, must be ECFMG Certified in order to begin U.S. residency training.
IMGs, like graduates of U.S. programs, use the Electronic Residency Application Service (ERAS) to submit application materials to U.S. training programs. Competition for U.S. residency slots is highly competitive and a substantial hurdle for many IMGs.