- Permanent Resident Visa
Permanent residents can remain in the United States indefinitely and can engage in any type of lawful employment, training or education without limitation as to location, employer or duration. They possess a Resident Alien card also known as a “green card”. MCWAH does not provide sponsorship to individuals who are pursuing Permanent Resident visas.
- Visitor Exchange Visa (J-1)
To be appropriate for GME, this visa must be sponsored by Educational Commission for Foreign Medical Graduates (ECFMG). A J-1 visa sponsored by a medical school is very easy to obtain, but it cannot be used for GME. It is appropriate only for research. IMGs who have participated in the Exchange Visitor Program as a researcher during the twelve-month period preceding the proposed commencement of a program of graduate medical education are ineligible for sponsorship. It is very difficult to convert J-1 sponsorship from a school to ECFMG. ECFMG states explicitly that:
“Exchange Visitors who are designated as Research Scholars when they enter the United States may not as a matter of course transfer to programs of graduate medical education. Requests for such transfers shall be denied by the Department of State unless very unusual or extenuating circumstances exist.”
To obtain ECFMG sponsorship, foreign nationals must:
a) have passed Part I and Part II of the National Boards or Step 1 and Step 2 of USMLE, and pass the Clinical Skills Assessment (CSA)
b) hold a valid ECFMG Certificate; and
c) have written assurance from the home country Ministry of Health or equivalent agency stating that there is a need for persons with the skills the physician will acquire and that the physician will return home upon completion of the training.
ECFMG will not sponsor an individual for longer than seven years. J visa holders are not permitted to moonlight (internal or external). They cannot participate in any activities outside the approved training program nor are they eligible to receive any monies that are not part of the approved training program stipend. While ECFMG has no way of monitoring a J-1’s earnings, ECFMG has in the past been questioned by the U.S. Government on Exchange Visitors whose W-2s confirm earnings that are not consistent with trends seen for training stipends across the U.S.
- Temporary Professional Workers (H-1B)
Some of the MCWAH residencies and fellowships are willing to pursue an H-1B visa on your behalf, however there is always some uncertainty surrounding the H-1B process. For many years, the U.S. Citizenship and Immigration Services (USCIS) has taken the position that teaching hospitals and institutions like MCWAH are exempt from the annual H-1B cap on the basis of an affiliation agreement with institutions of higher education. MCWAH is affiliated with the Medical College of Wisconsin (MCW). MCWAH continues to have H-1Bs approved on this basis. However, on April 28, 2011, the USCIS stated it is reviewing its policy on H-1B cap exemptions for non-profit entities (like MCWAH) that are affiliated with an institution of higher education. Until further guidance is issued, USCIS is applying interim procedures to allow organizations like MCWAH to pursue H-1B cap exemptions. Unless determined to be exempt, H-1B petitions are subject to a statutory limit that would make the visa process availability and timing very unpredictable for those pursuing a GME program at the Medical College of Wisconsin Affiliated Hospitals.
Applicants seeking H-1B status for GME must have (1) a state medical license, or be exempt from a license under state law; (2) have passed FLEX Parts I and II, NBME Parts, I, II, and III or USMLE Parts I, II and III; (3) graduated from a U.S. or foreign medical school or hold a foreign medical license; and (4) demonstrate proficiency in written and oral English. Typically, this is shown by holding an ECFMG Certificate. Proof of English proficiency is not required if the individual graduated from a U.S. medical school or LCME accredited school from any location. Passage of the Canadian MCCQE/LMCC exams does not prevent the individual from having to have passed all steps of either FLEX, NBME or USMLE. Accumulating passing scores of various components of the three exams is not allowed for H-1B obtainment purposes. In addition to being exempt from the English proficiency proof requirement, individuals who have graduated from an accredited U.S. medical school are also exempt from having to prove passage of all steps of either FLEX, NBME, or USMLE in order to apply for an H-1B. The total amount of continuous time permitted in H-1B classification is 6 years, but only up to 3 years can be requested at a time. Extensions beyond the regular 6 year limit are only available in limited circumstances which will not apply to most MCWAH employees.
MCWAH will not pursue an H-1B visa for an applicant unless he/she has already passed USMLE Step 3 and the Clinical Skills Assessment.
The Department of Labor requires employers to pay all the legal and filing fees for H-1B applicants. The MCWAH Program is responsible for the expense of the H-1B visa.
It is often difficult to estimate the time that the H-1B processing will take. Premium Processing is available, for an additional $1,225. For that fee, the Immigration Service will make a first determination, which may not necessarily be an approval, on an H-1B filing within 15 calendar days. Because Premium Processing is outside the normal cost of obtaining H status for an IMG, the cost must be borne by the IMG or the department; MCWAH will not pay any part of this cost.
Housestaff on an H-1B visa are permitted to do internal and external moonlighting. If they choose to do external moonlighting, they need to pursue an H-1B through that particular sponsor. They may not receive any form of income except directly from MCWAH or from another employer that has obtained H-1B status on their behalf.
- Student Optional Practical Training
This option may be appropriate and is available for a foreign national who attended a U.S. Medical School on an F-1 student visa. It provides a twelve-month period of “optional practical training” or “OPT” during which the individual may engage in open market employment that is related to his or her field of study. Before the end of twelve months, the individual would have to apply for a J-1 or an H-1B visa in order to continue in the program.