Want to Continue Your Practice in the U.S.?

Understand the basics of J-1 and H-1B visas so you can plan for your future.

Like many other non-U.S. citizens and foreign medical graduates, you may be in the United States for a medical training program. Or perhaps you’ve landed the post-residency job of your dreams and hope to remain in the country to practice. Regardless of your situation, there are things you need to know about continuing your employment in the states.

First and foremost, your career-next steps are guided by the type of visa you used to secure training or work abroad. You have options, but with each visa type, there are specific requirements.

Types of Visas for Physicians and Trainees

If you’re here in the U.S., you are likely working on a J-1 or H-1B visa. These are the most common visas for physicians seeking to train or work in the U.S., but they have their differences.

What Is a J-1 Visa?

Most international medical residents come to the U.S. on a J-1 visa. A J-1 visa is often the only option offered by residency programs that accept international students. J-1 visas allow physicians to train in the U.S. for a total of 7 years — and sometimes up to 8, depending on fellowship requirements.

“The J-1 visa was created in the 1960s to foster cultural exchange,” says Elissa Taub, immigration attorney and partner with Siskind Susser PC. “So, the very foundation of this visa is one of give-and-take. And that give-and-take comes in the form of a home-residency requirement.”

With a J-1 visa, physicians must return to their home country for two years after medical training before applying for an H-1B visa or Green Card (permanent resident card) in the U.S.

What Is an H-1B Visa?

An H-1B visa is as close to a general work visa as the U.S. offers. H-1B visas are used by people coming to work in the U.S. in specialty occupations, like medicine. There also are some instances of H-1B visa use by physicians entering a U.S. residency program.

H-1B visas allow you to remain in the U.S. for up to six years. These visas require a sponsor — an employer or academic program — who must pay fees associated with your H-1B petition.

Only a certain number of H-1B visas are made available each year to for-profit and private-sector companies. Fortunately, academic institutions and hospitals or health systems associated with nonprofits are often exempt from this annual cap.

Options for Extending Your Time in the U.S.

Regardless of your visa type and its authorized lifespan, there are ways to extend your time in the United States.

If you’re a physician here on a J-1 visa, Taub says, there is an option if you wish to remain in the U.S. rather than return home for the required two years. That option is a waiver.

Three Types of J1 Visa Waivers

1. Hardship Waiver

For physicians who can prove their return home would present a hardship for a U.S. citizen or Green Card-holding spouse or child.

2. Persecution Waiver

For physicians claiming they would be persecuted based on some protected ground, like race or religion, if they return home.

3. Work-Commitment Waiver

For physicians who commit to working for three years in an underserved area in the United States.

“A work-commitment waiver, known as the Conrad 30 Waiver, is the most common J-1 waiver, and can set you up to then apply for an H-1B visa. This would allow you to stay in the U.S. for another six years without returning home for the otherwise required 2-year home-residency,” says Taub.

Taub cautions, though, that each state offers only 30 waivers per year. And with waiver deadlines that vary by state, it’s important that you start the application process early.

Personalizing Your Path

There are also stark differences between each waiver type. “It’s important for you to consult with immigration counsel about the path that’s right you,” Taub says.

Remaining in the U.S. is a bit more limited with an H-1B visa. However, you can extend the six-year limit if you plan to get a Green Card and meet certain milestones along that path to permanent residency.

You can also get an additional year on an H-1B visa by filing for permanent labor certification (PERM) or completing a Form I-140, also known as an Immigration Petition for Alien Worker.

If you have applied for your Green Card, but that process is backlogged, an approved Form I-140 can offer a three-year extension of your time in the U.S.

“One other thing to know,” Taub says, “is that if you are outside the U.S. for any time during your six years on an H-1B, you can add that time back to the end of your H-1B period. So, if you travel to your home country for weeks or months, keep track of those dates and make sure they are reflected in your passport.”

Figure Out What You Want and Start Planning

There’s no doubt you put a lot of time and thought into your decision to work or train abroad, but if you hadn’t considered plans beyond your visa, now is the time to start.

Taub Says to Ask Yourself Some Simple Questions:

How long might you want to stay in the U.S.?

What do you want to do while here?

Would you be willing to work in an underserved area? If so, which type?

Have you let your employer or program know about your desire to remain in the U.S.?

“Don’t be afraid to let prospective employers know about your immigration needs early on, so everyone is on the same page.”

And, Taub says, get the waiver process started early.

“If you are seeking a waiver, it is never too early to start that process,” Taub says. “You’ll want to give yourself plenty of time to deal with any complications that may arise.”

If a Conrad 30 waiver is your plan, finding a job should be high on your priority list.

“You need an executed employment agreement before you can file for a waiver,” Taub says. “I know of internal medicine residents starting their job search in year one.”

Questions to Ask Potential Employers

If you’re moving from a J-1 visa to a waiver, then on to an H-1B or Green Card, Taub says there are key questions you should ask a potential employer. These include:

  • Have you sponsored someone for a J-1 waiver or H-1B visa before?
  • What is your success rate for sponsorship? (This can be deceiving as each state handles things differently. Florida, for example, uses a lottery system to distribute waivers.)
  • How are visas distributed in your state? Is it a lottery system, or first come, first served?
  • When does the job begin? (Consider how this aligns with your training program completion and board examinations.)
  • What is the name of your immigration attorney, and can I contact them?
  • What is your policy on Green Card sponsorship?
  • Do you cover the costs associated with visa or Green Card processes for a spouse? (Don’t assume spouses will be covered.)

Watch Out for Red Flags

Regardless of your desire to remain in the U.S., watch out for red flags from potential employers. Be wary of these:

  • Employers who make the process all about you or describe their efforts as doing you a favor.
  • Employers who lack understanding about the visa or waiver process.
  • Employers who say yes to everything or describe the process as easy or routine.

“The visa or waiver process is complex,” Taub says. “How a potential employer treats the process may signal how they will treat you. The entire experience should be very collaborative, with each party having a vested interest.”

Get Support from Our Team

Have more questions about training or working in the U.S.? Ready to start looking and need to be connected with a recruiter? We can help. We can connect you to professionals experienced in immigration and work visas. Read how Provider Solutions & Development (PS&D) recruiters helped one Canadian-born physician obtain an H-1B visa, find a new job and return to the U.S. PS&D also offers complimentary resources, including one-on-one career coaching, toolkits, seminars and training.