Navigating Psychiatry Residency in the United States

A Guide for International Medical Graduate Physicians

Immigration

After being accepted into a U.S. residency program, IMGs who are not U.S. citizens or permanent residents must obtain a visa that permits clinical training to provide medical services. Although several visa types are available, the two most common visas are the H1-B (Temporary Worker) and the J-1 (Exchange Visitor).

H-1B Visa Eligibility and Requirements

The H-1B visa is for temporary workers in specialty occupations who hold professional-level degrees. The visa allows a foreign national to enter the U.S. for professional level employment for up to 6 years, without having to return to the original country for 2 years after residency and fellowship training. (See Figure 1. Requirements to join the U.S. physician workforce, below.)

The H-1B visa is available to graduates of foreign medical schools who have passed the necessary examinations, have a license or other authorization required by the state of practice, and have an unrestricted license to practice medicine or have graduated from a foreign or U.S. medical school.

J-1 Visa General Eligibility & Requirements

(As per Educational Commission for Foreign Medical Graduates (ECFMG) and U.S. Department of State Exchange Visitor Program)

The ECMFG is authorized by the U.S. Department of State to sponsor foreign national physicians for the J-1 Exchange Visitor visa. The J-1 visa is a temporary, non-immigrant visa reserved for educational training purposes. (Spouse and children are referred to as J-2 dependents.) Full-time participation in the approved training program is required to maintain J-1 status.

Foreign national physicians seeking J-1 sponsorship to enroll in programs of Graduate Medical Education (GME) or training in the U.S. must fulfill a number of general requirements, detailed in ECFMG's Exchange Visitor Sponsorship Program (EVSP) application materials. At minimum, applicants must meet all of the following requirements:

  • Hold a Standard ECFMG Certificate with unexpired examination dates, if applicable. (Note: Graduates of LCME-accredited U.S. and Canadian medical schools are not required to be ECFMG-certified.)
  • Have passed United States Medical Licensing Examination® (USMLE®) Step 1 and Step 2 Clinical Knowledge (CK); or the former Visa Qualifying Examination (VQE), National Board of Medical Examiners® (NBME®) Part I and Part II, or Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS); or an acceptable combination thereof.
  • Hold a contract or an official letter of offer for a position in an approved GME or training program.
  • Provide a "Statement of Need" from the Ministry of Health in the country of most recent legal permanent residence.

The J1 visa prohibits "immigrant intent." Immigrant intent is a concept under U.S. immigration law which presumes that foreign nationals generally intend to remain in the U.S. permanently as permanent immigrants, although they are applying for a temporary, non-immigrant status.

Upon completion of training (general residency and subspecialty fellowship training), IMGs on J-1 visas must either return to their home country for a period of two years before being eligible to return and work in the U.S. or obtain a waiver of this obligation. (See Figure 1. Requirements to join the U.S. physician workforce, below.)

Occasionally, the two-year home country residency requirement of the J-1 visa is waived if:

  • The applicant can demonstrate he/she will be persecuted in his or her home country;
  • The applicant can demonstrate that returning to home country to fulfil the residency requirement would bring significant hardship to the his/her spouse and/or children who are U.S. citizens or permanent residents; or,
  • The applicants can participate in Conrad-30 waiver program where they find an Interested Governmental Agency (IGA) to sponsor their waiver in exchange for agreeing to practice in an underserved area for at least three years. The Conra-30 waiver program allows each state's Department of Health to sponsor up to 30 international medical graduates each year for waivers of the requirement that they reside in their home countries for two years after their visas expire before applying to change their immigration status. Those approved for Conrad-30 waivers are required to serve in rural or urban federally designated health professional shortage areas or medically underserved areas. Further information may be obtained here.

Source: U.S. Immigration Policy on International Medical Graduates Nyapati R. Rao, MD, MS http://virtualmentor.ama-assn.org/2012/04/pfor1-1204.html

The number of the pool of certified, unmatched applicants (20% per year) in the above chart represents all the specialties, not only Psychiatry.

Note: "IMG" refers to both foreign-born, non-U.S. citizens/permanent residents (F-IMGs) and U.S. citizens/permanent residents who went to medical schools outside of the U.S. (USIMGs).

Applicants for residency are encouraged to visit the American Association of Directors of Psychiatric Residency Training (AADPRT) site, General Psychiatry Residency Application Process Guidelines. The AADPRT's guidelines have been reviewed and endorsed by National Resident Matching Program (NRMP), Association of Directors of Medical Students Education in Psychiatry (ADMSEP), APA Council on Medical Education and Lifelong Learning (APA CMELL) and resident representatives of APA.

Further Resources

Authors

Nyapati Rao, M.D.
Saeed Ahmed, M.B.B.S., M.D.
Jaspreet Sangha, M.D.

SEPT 2018

Physician Reviewed

Steven Epstein, M.D.
James Griffith, M.D.

References