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A Piece of My Mind
December 6, 2016

Alienated

Author Affiliations
  • 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 2Now with the Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
  • 3Weill Cornell Medical College, New York, New York
  • 4Safety, Quality, Informatics and Leadership, Harvard Medical School, Boston, Massachusetts
  • 5Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
JAMA. 2016;316(21):2191-2192. doi:10.1001/jama.2016.10319

“It’s that time of the year again when you have to get your visa paperwork renewed,” commented our mother in her comfortingly concerning tone, just to reinforce that I had remained cognizant of the annual deadlines for J-1 visa renewal, this year for a seventh time in succession.

J-1 visa is a nonimmigrant visa category that brings thousands of foreign national physicians into the United States each year for postgraduate training. It is primarily facilitated through the Educational Commission for Foreign Medical Graduates’ (ECFMG’s) Exchange Visitor Sponsorship Program.1 In order for the US Department of State to process J-1 visas for foreign or “alien physicians,” as we are called, international medical graduates have to submit a Statement of Need issued to us by our respective countries’ (of most recent legal permanent residence) Ministries of Health.1 The Statement of Need is proof of shortage of a trained physician workforce in respective specialties for which foreign national physicians are seeking postgraduate training in the United States and also states that a written assurance has been filed by us to return to our home countries following successful completion of training. The maximum duration for J-1 visa is seven years, following which physicians have to return to their home countries for a period of two years before regaining eligibility for legal permanent resident status in the United States, if we so desire.2 Alternatively, we can sign up for a limited (30 positions per state) number of “waiver jobs” in underserved areas in the United States that waive our 2-year home country return requirement under the 1994 Conrad 30 Waiver program established to meet the diminishing physician workforce requirement in these areas by recruiting and retaining physicians in rural and inner-city urban practices.3 In rare circumstances, physicians can apply for academic or “hardship” waivers to maintain legal permanent resident status in the United States. Postgraduate training that requires time beyond the traditional American Board of Medical Specialties or ECFMG-approved 7-year duration falls under the category of nonstandard training, requiring more paperwork to be furnished by foreign national physicians. Additional paperwork for approval of nonstandard training includes an Exceptional Need Certificate or letter from respective ministries of health, in addition to Statement of Need that enables an additional maximum 1-year extension beyond the permissible 7-year duration.4

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