What Do IMG's Need To Practice In The U.S.?

To practice in the US, IMGs need a degree from a foreign medical school and an:

*ECFMG Certificate (to show equivalence to knowledge gained in a U.S. or Canadian medical school)

To get an ECFMG certificate IMGs must pass USMLE 1-2, pass the ECFMG administered English language exam, and pass the new Clinical Skills Assessment CSA exam.

Because fewer IMGs want to take or are able to take the CSA (which is only given in Philadelphia), the number of IMGs going into U.S. residencies is declining.

What Is A J-1 Visa?

In order to enter a U.S. residency, IMGs must get their ECFMG certificate and then obtain a visa authorizing a program of Graduate Medical Education (GME). One way to achieve authorization for GME is through a J-1 Exchange Visitors Visa.

It gives the holder seven years in which to complete GME. However, once GME is completed, all J-1 holders must return to their country of origin for two years before they are eligible to work as physicians in the U.S.

What Is A J Waiver?

The two-year residency rule can be waived if an "interested government agency" (IGA) agrees to sponsor the J-1 visa holder to work in a federally designated Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA). There are thousands of these areas throughout the United States. Immigration attorney Carl Shusterman's web site (www.shusterman.com) includes a link to pages which enable users to determine whether a particular area is in a HPSA or MUA. See http://shusterman.com/toc-phys.html.

In addition to IGA waivers, a limited number of waivers are granted to physicians whose spouse and children, if they are U.S. citizens or permanent residents, would suffer "exceptional hardship" if they had to return to the physician's home country. Moreover, a few physicians are granted waivers on the basis of asylum.

Who Sponsors J Waivers?

In the past, the Department of Agriculture (USDA), the Appalachian Regional Commission, or the VA sponsored most J physicians for waivers. The USDA has since dropped out of the program, but the Department of Health and Human Services is now acting as a sponsoring agency. This allows both urban and rural hospitals to hire J-1 physicians, not just rural hospitals as was the case with the USDA. The Federal sponsoring agencies now include Health and Human Services (HHS) , the Veterans Administration (VA), the Appalachian Regional Commission (ARC), and soon, the Delta Regional Authority (DRA).

There is also something called the "Conrad 30" program, which allows each state to to offer 30 J waivers per year. Over 45 states participate in the program. You must contact the State Department of Health in each state for guidelines (or the Law Offices of Carl Shusterman can tell you which states participate and what the requirements are).

Can Only A Hospital Located In A HPSA/MUA Recruit A J Physician?

Yes. The employer - whether a hospital, medical group, physician practice or other entity - must be in a HPSA or MUA to sponsor physicians for a waiver. Physicians seeking waivers are encouraged to identify which hospitals are in HPSAs or MUAs, because often it is the hospital that is backing the recruiting effort, even if a medical group or physician is the actual employer. This can be done by referencing the Hospital Blue Book, a directory of the nation's hospitals. Most hospitals have a copy of this book or you can usually find a copy in a public library. Using the list of HPSAs and MUAs available on Mr. Shusterman's site, you can refer to the Hospital Blue Book to see which hospitals are located in these areas. You should then send your CV directly to administrators of these hospitals, letting them know you are seeking a J waiver and are willing to practice in an underserved area.

We believe the best way to obtain a waiver is to be proactive and not rely exclusively on search firms or other organizations to get you a waiver. These firms may be able to help, but only if they have clients in HPSAs or MUAs. The best chance for success is to send your CV directly to administrators of hospitals in underserved areas, picking four or five states where you would most like to work.