Jashodeep Datta, MD, Dahlia M. French, JD, Stephanie Rowe, Catherine Kling, MD, John L. Tarpley, MD, Kyla P. Terhune, MD

Introduce and Define the I-USMG Contrast J1 vs H1B F1 and OPT as means to H1B Visa choices make a difference Coordinator comments Institutional issues Other visas

Questions

Jash Datta: Calcutta, India Colgate University

(Hamilton, NY) Vanderbilt School of

Medicine

University of Pennsylvania PGY-2

Catherine Kling: Melbourne, Australia Dartmouth University Vanderbilt School of

Medicine

Vanderbilt University PGY-3

2011 NRMP Match Data

23,421 total positions 16,559 US Seniors 1,364 prev US Grads 2,178 US osteopathic 11 Canadian

20,112/23,421=85.9%

IMGs

General Surgery 1.1 Anesthesiology 1.2 Plastic Surgery 0.6 ENT 0.9 Family Medicine 2.0 Overall 1.4

GS Spots 1,108

U.S. “Preferred Choice” 1,041

U.S. Matched 897

Foreign –Trained Physicians 108

Matched 1,106

9.8% IMGs

US Immigration

ACGME

US Citizen US Med School

US Citizen US Graduate

US Citizen International Med School

US Citizen IMG

Non-US Citizen US Med School

IMG US Graduate

Non-US Citizen International Med School

IMG IMG I-USMG

IMGs US-IMGs Non-US citizen IMGs

I-USMGs

IMGs: H-1B J-1

I-USMGs (case): F-1 student visa during MS4 year Eligible for Optional Practical Training (OPT) Can use this for PGY-1 year, then H-1B or J1

J-1 (ECFMG) H-1B Maximum training 9 yrs 6 yrs

Renewal Yearly Every 3 years

Home country requirement 2 years** None

Moonlighting Not permitted Permitted

Non-ACGME programs Not permitted Permitted

246 surgery programs (ACGME): 196

Coordinators were asked: Are non-US citizen housestaff enrolled? Are any of these US graduates? What category of visa is sponsored (J-1, H-1B)?

Total programs 246 -- Participating

programs 196 79.7%

PROGRAM TYPE University-affiliated 101 51.5%

Independent 86 43.8% Military-sponsored 9 4.6%

PROGRAM SIZE Large (≥ 5 chiefs) 102 54.5%

Medium (3-4 chiefs) 60 32.7% Small (1-2 chiefs) 24 12.8%

VISA SPONSORED Only J-1 120 64.2%

H-1B or both 61 32.6% No visa sponsored 6 3.2%

NE 10.7% East

13.9% SW 4.3%

South 20%

SE 13.9%

MW 23%

West 11.2 %

GEOGRAPHIC DISTRIBUTION

VISA H-1B J-1 p-value

All programs 61 (32.6%) 120 (64.2%) --

PROGRAM TYPE University 40 (39.6%) 60 (59.4%)

0.027 Independent 21 (24.4%) 60 (69.8%)

PROGRAM SIZE Large (≥ 5 chiefs) 39 (38.2%) 62 (60.1%)

0.14 Medium (3-4 chiefs) 15 (24.6%) 43 (70.5%)

Small (1-2 chiefs) 7 (29.2%) 15 (62.5%)

P=0.19

I-USMG enrollment YES NO p-value

VISA SPONSORED

H-1B or both 44 (83.2%) 17 (12.7%) <0.001

J-1 only 9 (17.0%) 111 (82.9%)

PROGRAM SIZE

University-affiliated 41 (77.3%) 60 (44.8%) <0.001

Independent 12 (22.6%) 74 (55.2%)

PROGRAM SIZE

Large (≥5 chiefs) 41 (77.3%) 61 (45.5%)

<0.001 Medium (3-4 chiefs) 10 (18.9%) 51 (38.0%)

Small (1-2 chiefs) 2 (3.7%) 22 (16.4%)

Programs prefer J-1 Independent (70%), University (60%) University more likely to offer H-1B

Residents enroll in H-1B programs

Discordant goals

By offering H-1B, programs can increase applicant pool (including I-USMGs)

OCTOBER 1st

I-USMGs can start July 1

F-1 in medical school OPT for internship

DO NOT NEED USMLE Step 3

Apply for H-1B during intern year

Issues for applicant: ability to visit home (all visas) ability to become permanent resident ability to complete training (may need to change

visa status) ability to complete research in residency (grants) ability to remain in US after training* Moonlighting

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1, GC (WP)

IMG

R-1 R-2 R-3 R-4 R-5

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

R-1 R-2 R-3 Res Res R-4 R-5

Academic

Community

FELLOWSHIP?

FELLOWSHIP?

OPT J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

OPT

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

J-1/ H-1B

I-USMG (US medical school)

(F-1)

(F-1)

Academic

Community

Issues for the program: Expenses *** Repatriation (H1-B termination of employment prior

to expiration date– pay for employee airfare) Paperwork (J1 renewed yearly) Lack of certainty of start time Public perception (branding) Duty to train US residents (CMS salary) Limitation of remediation (ECFMG– advancement

only– J1 only)

J-1

$200-300 (applicant)

H-1B

$820-1820 (program)

Specific Info Needed for J1, H1B, E3

Differences in visas from coordinators perspective

Temporary worker visa One “who possesses extraordinary ability in

the sciences, arts, education, business or athletics…” (O1-A is medical)

Three years Can be extended yearly after that, no limits

(Tarp: case, SAR: coordinator)

E-3: Australian citizens similar to H-1B spouses may work (E3D)– need EAD renewable every 2 years (no limit)

L-2: Spouse of an L1 (intra-company transferee, e.g.

Microsoft) Need an EAD

H-1B1: H-1B for Chileans (1,400) and Singaporeans (5,400)

J2 (spouse of J1) Need EAD

Green Card: US permanent resident card

Work Permit (EAD): Employment Authorization Document Legal right to work– in addition to visa status Visas that cannot be used for clinical work: TN, B,

rest of the alphabet…

Refugee/Asylum/Displaced Person