Chapter 2 The J-1 and the H-1B Visas: Which Is the Best Choice for Graduate Medical Training?

• Jurisdiction: United States

International Medical Graduates (IMGs) typically have to make the difficult choice of entering the United States on either a J-1 visa or an H-1B visa to pursue graduate medical training. Whether the physician chooses the J-1 path or the H-1B path can have enormous implications for a physician’s career, so we begin our discussion of nonimmigrant options for graduate medical education programs with a chapter comparing the advantages and disadvantages of each category. We will then explore each category in depth in the chapters that follow.

After the application is submitted via ERAS, applicants may then be invited to interview with a residency program.

To some extent, the decision regarding whether to enter the United States on a J-1 or H-1B visa to pursue graduate medical training depends on the residency program. Though some programs accept either the J-1 or the H-1B, most prefer one or the other.

Programs that limit the choices generally opt for the J-1, and that is a major reason why the percentage of IMGs coming to the United States on J-1 visas is now more than 80 percent compared to H-1B visas.

The increase in J-1 visas basically represents a return to the past since the J-1 visa was the dominant category for most of the history of IMGs coming to the United States for training. Beginning in the mid-1990s, however, many teaching hospitals began to sponsor H-1B visas even though the J-1 was the preferred option.

These programs responded to pressure from competing institutions where physicians were requesting sponsorship of H-1Bs. By 2005, nearly half of the physicians entering the country were on H-1Bs. The marketplace has changed dramatically over the last decade, and physicians have become savvier about the lesser-known drawbacks of the H-1B; it is no longer seen as a clearly better option to the J-1. And many of the drawbacks of the J-1 visa for graduate medical trainees have been lessened considerably. This chapter discusses the current environment and compares the advantages and disadvantages of each category for the IMG.

From the institu-tion’s per-spec-tive, the J-1 ap-plica-tion process is far less expen-sive and bur-den-some since the J-1 pro-gram sponsor is actu-ally the Educa-tional Com-mission on For-eign Medical Gradu-ates (ECFMG) and not the resi-dency pro-gram itself.

H-1B visas require an in-stitu-tion to be the peti-tioner and comply with various legal re-quire-ments while also paying gov-ern-ment filing fees and attor-ney’s fees (if the appli-cation process is han-dled by an out-side firm).

What are requirements for and restrictions on the J-1 visa?

The J-1 visa is an exchange visitor visa. Consequently, under §212(e) of the Immigration and Nationality Act (INA), most J-1 visa holders coming to pursue graduate medical training are subjected to a foreign-residence requirement upon conclusion of the J-1 program. That requirement, explored in considerable length in Chapter 5, essentially means that a doctor must return to his or her home country or country of last residency for two years or face the following three consequences:

1. J-1s subject to INA §212(e) may not change nonimmigrant categories within the United States ( i.e., applications to change categories must be made at U.S. consulates abroad);

2. J-1 visa holders subject to §212(e) are ineligible to receive an H-1B or L-1 visa stamp at a U.S. consulate; and

3. J-1s subject to §212(e) may not obtain lawful permanent resident status.

Physicians typically have three options when they complete their programs:

1. Go back to their home countries or countries of last residence for two years and then re-enter the United States on a work visa;

2. Pursue a waiver of §212(e) by receiving the support of a federal agency or a state health agency (typically based on an agreement to work in a medically underserved

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