What are the challenges of engaging in graduate medical training while in H-1B status?
Just as J-1 foreign physicians must deal with the onerous two year home residence requirement by either waiving or satisfying it, so too do H-1B foreign physicians encounter some obstacles in their legal status.
First, many graduate medical programs will not sponsor physicians for H-1Bs. Some programs believe that J-1 status is the more appropriate visa category to use for training programs. Others are concerned about problems with the H-1B cap (see the discussion below). Some programs do not want to assume the various obligations of an H-1B employer and potentially be subject to applicable civil and criminal violations. Others do not feel comfortable with the more complicated H-1B visa application process.
Second, there is the H-1B cap issue. Every fiscal year, only 65,000 H-1B visas are permitted to be issued, except in cases where an employer or applicant is exempt. These cap numbers are highly coveted and are typically exhausted within the first week of April (when employers can first apply for applicants who start in October). Many residency and fellowship programs are exempt from these numbers, but not all.
Even if a physician can get into a program that is exempt from the cap, he or she may still be “bitten” by the H-1B cap when the program ends. That’s because if a person enters to work in a job that is exempt from the cap and then switches to a job that is not cap-exempt, the applicant is again subject to the H-1B cap. This is especially a problem for physicians because their training programs end in the summer, traditionally the period when the H-1B cap is a serious problem. This can frequently result in a significant delay in starting employment since new visa numbers do not become available until October.
Third, another problem for physicians using H-1B status for training is the six-year limit in the category. If a physician is in a training program that lasts more than six years, the physician may run out of time. It might be possible to pursue a green card during this period of time, which would allow for the possible extension of the H-1B, but qualifying for permanent residency while one is engaged in training can be very tricky and the physician may not be qualified to apply.
This post is not meant to dissaude a physician from choosing to complete his or her graduate medical education in H-1B status. Rather, it is some guidance to help the physician in evaluating which visa category to pursue.