How to Immigrate and Work in the U.S. as a Doctor?

What is an ECFMG Certification?

ECFMG Certification evaluates the credentials of IMGs entering the US healthcare system. IMGs are expected to:

• Enter Accreditation Council for Graduate Medical Education-accredited residency or fellowship programs (ACGME)
• Take the third of three steps of the United States Medical Licensing Examination (USMLE)
• Acquire a license to practice medicine in the U.S. with no restrictions.
• Sponsorship for a J-1 Visa
• The application fee is $75.

The Ordinary ECFMG Certification contains the following:

• The applicant’s surname
• The Certificate ID
• The dates on which the examination criteria were fulfilled
• The certification’s issuance date

What are the Requirements for ECFMG Certification?

• Completion of the ECFMG Certification Application
• Taking the USMLE Step 1 exam, Step 2 clinical knowledge, and Step 2 clinical skills and passing them
• Confirmation of medical education qualifications using primary sources
• Fulfillment of a medical school program for at least four academic years
• The medical school and year of graduation must be mentioned in the International Medical Education Directory (IMED)
• Fulfillment of all criteria and receipt of final medical diploma documented.
• ECFMG provided the primary source verification of the medical diploma and transcripts.
• International medical students/graduates must complete the USMLE Steps and Step Components necessary for ECFMG Certification within a 7-year timeframe, according to ECFMG regulation (usually begins seven years after passing the first USMLE Step or Step Component). When a student passes a Step or Step Component, the student has seven years to complete the remaining Steps or Step Components necessary for ECFMG Certification.

If all requisite Steps and Step Components are not accomplished with a passing score within seven years, the most recent USMLE passing performance will be invalid for ECFMG Certification. ECFMG does not warn students of looming deadlines or tell students if passing performances turn ineligible for ECFMG Certification.

If a passing performance on a Step or Step Component becomes ineligible for ECFMG Certification, the student may seek an exemption to retake the test. The USMLE program restricts the bunch of times a test taker can take the very same Step or Step Component to six.

What is USMLE?

The USMLE comprises three phases to measure a physician’s ability to use a broad range of information, ideas, and concepts to assess the physician’s essential patient-centered competencies.

Step 1 (multiple-choice exam)

This exam is intended to assess the examinee’s ability to apply fundamental, essential scientific ideas to clinical circumstances.

Step 2 (two separate exams)

The Step 2 Clinical Knowledge (CK) test is a multiple-choice exam designed to assess if the examinee has the medical knowledge and clinical science understanding required to provide patient care under supervision. The Step 2 Clinical Abilities (CS) exam is a distinct “hands-on” exam that assesses the examinee’s clinical and communication skills by having them collect information from standardized patients, do a physical examination, explain the results to the patient, and write a patient record.

Step 3 (multiple-choice exam)

This test assesses the examinee’s competence to use medical knowledge and comprehension of biological and clinical science, which are required for the unsupervised practice of medicine, focusing on patient treatment in ambulatory settings.

Is the USMLE Necessary for Doctors?

For a doctor to obtain a license to practice medicine in the United States, they must pass all four tests of the United States Medical Licensing Exam (USMLE) sequence.

What are the Educational Differences in the American Physician Training System?

Unlike most other world areas, there is no fundamental training in the United States since medical students can opt to specialize or not after receiving their M.D. For instance, Bachelor of Medicine and Bachelor of Surgery programs are unknown in the United States. In addition, before entering medical school, it is pretty unusual for an American physician to have completed a Bachelor of Arts in Sociology and a Master of Health Sciences.

US Medical Licensing Exam Requirements

With the previous in mind, an American doctor is more likely to practice abroad successfully than a foreign equivalent, and this is due to license and schooling. Therefore, in the United States, FMGs must interact with the Educational Commission for Foreign Medical Graduates.

Therefore, how can foreign physicians practice in the United States? The following are the US medical test criteria for international medical graduates and practicing physicians seeking ECFMG certification:

• Certifying that the FMG got a degree from a medical school recognized in the World Directory of Medical Schools
• Completing any outstanding educational prerequisites
• Requirements for Medical Science. Bringing your USMLE Step 1 and USMLE Step 2 CK (Clinical Knowledge) scores together is mandatory.
• Clinical Skills Requirement. To practice medicine in the United States after graduating from a foreign country’s medical school, you must additionally pass the USMLE Step 2 CS (Clinical Skills)
• Participate in a residential program
• Getting the ultimate ECFMG certification

You are qualified for ECFMG certification if you take and pass all three of these US medical license tests. You do not have to wait until you finish medical school to apply. Please apply as a medical student. Nevertheless, you will not receive confirmation until you produce proof of graduation.

After receiving ECFMG certification, you can start your residency in the United States. However, you must apply for residence well before graduation and certification. Therefore, the application procedure may take some time.

While many overseas physicians work and learn at US hospitals, they are frequently engaged in special cooperation programs funded by diplomatic exchange channels or the US Agency for International Development. As a result, FMGs who have already worked at a well-established practice in another country will find the equivalence, licensing, and certification difficult.

Types of Doctors in the U.S.

In the USA, various SOC codes refer to doctors and physicians:

What Specialties can Immigrant Physicians Practice in the U.S.?

According to BioExplorer, there are around 44 distinct types of physicians, although as the medical sector evolves, additional specialties emerge. Therefore, as a foreign physician, you have at least 44 potential employment opportunities as a healthcare practitioner in the United States. Here is a partial list of some of these specialties:

Family Medicine Physician

This is the broadest form of doctor, capable of treating various patients of all ages. If this type of doctor discovers something problematic, they would generally send the patient to a specialist.

Gastroenterologist

This doctor examines the pancreas, the stomach, and the large and small intestines.

Endocrinologist

A doctor of internal medicine who studies the body’s hormone levels.

Neurologist

A doctor who studies the brain and how it works.

Ophthalmologist

Eye surgery is the area of expertise.

Orthopedist

This sort of specialist will specialize in foot diseases, injuries, and therapy that affect the muscles, nerves, bones, and so on.

Pediatrician

Pediatricians work with children. Because these kids are still maturing and growing, this type of doctor concentrates on their physical health and their emotional and psychological well-being.

Periodontitis

Doctors who study the health of the mouth.

Surgeon

Although many of these doctors do surgical operations, being a professional surgeon will keep you significantly involved in removing and transplanting body parts and organs.

Veterinarian

It’s not like all doctors are employed in the treatment of humans. Veterinarians are trained to treat animals. You can focus on treating agricultural animals, domestic animals, or exotic animals in this field. Some veterinarians treat people of all types!

What are the Visa Types to Immigrate to the U.S. as a Doctor?

H-1B Visas for Doctors

The H-1B visa is one of the most popular possibilities available today. While professionals from various industries may utilize this visa type, doctors commonly use it. You must have a current work offer for full-time employment with a US firm to be authorized for this type of visa. For example, it might be a clinic, college, hospital, university, doctor’s office, or assisted living facility.

Furthermore, you must have previously finished your medical degree from a US-based institution or an accepted overseas school. You will also need to file for and obtain your medical license for the state you intend to operate in. Ultimately, you must pass the U.S. Medical Licensing Examination (parts I, II, and III) or qualify for one of the few exceptions to this requirement. Every year, the H-1B limit is swiftly filled, so you’ll need to plan ahead of time with the guidance of a competent company immigration attorney like those at FordMurray. Alternatively, if feasible, find work with an H-1B Cap Exempt employer, including a non-profit hospital with strong links to higher education institutions.

O-1 Visas for Doctors

Plenty of good doctors who want to work in the United States may find the O-1 visa to be a desirable alternative. This visa, nevertheless, does need a substantial quantity of documents. To be eligible for this visa, you must demonstrate outstanding achievement in the medical area (through awards, publications, or other proof). Furthermore, the position you are applying for must demand someone with above-average abilities and experience. Finally, consultation letters, which are thorough letters of recommendation from other reputable experts in your specialized industry, must be used to back up your abilities.

While gathering all of the papers and proof required to file for an O-1 Visa might take some time, the approval process is really pretty quick. O-1 visas are often accepted or refused within a few weeks of submission, which is quicker than the H-1B visa or most other possibilities. Furthermore, physicians who qualify for the O-1 visa are excused from taking the USMLE.

TN Visas for Doctors

If you come from Canada or Mexico, the TN visa might be ideal for you as a doctor. This visa was formed as part of the North American Free Trade Agreement. However, it is critical to emphasize that this visa is only for physicians who want to work in the United States as either teachers or research doctors. While you may be able to work directly with patients, the overall amount of time spent providing patient care should be less than 10% of your entire tasks.

J-1 Visas for Doctors

The J-1 Visa is a fantastic choice for foreign doctors who want to participate in an educational exchange program. However, there are certain things to keep in mind. First, the visa enables doctors to pursue residency and fellowship programs in the U.S. This entails passing the ECFMG test and being accepted into the training program. If you wish to remain in the U.S. after finishing your training (or file for a Green Card), bear in mind that a law requires you to first return to your home country for two years. Of course, this is a significant difficulty for many individuals.

If your spouse or child is a US citizen and will have significant difficulty with the relocation, you may be granted a waiver for this two-year requirement. They can also be given if you face severe persecution if you move back home. Typically, however, a waiver is granted when an interested government agency recommends you or if you qualify for one of 30 Conrad waivers that American states may give in exchange for three years of service in an area with an underserved medical population.

E-2 Visas for Doctors

The E-2 Visa is intended for investors who wish to travel to the U.S. However, it can also be utilized by doctors in certain circumstances. For example, if you are a physician wishing to invest extensively in a medical firm in the United States and have an E treaty nation, this may be a terrific choice. Physicians, for example, can travel to the United States and begin a medical practice while qualifying for the E-2 Visa.

This visa requires a minimum investment of $100,000, a business that employs at least 2-3 people, and you must be the company’s primary owner. This visa is not suitable for physicians wishing to practice clinical medicine, but it may be beneficial for individuals wanting to establish healthcare-related businesses. An E Visa allows you to hire personnel from your own country.

L-1 Visas for Doctors

The L-1A and L-1B visa categories are for intracompany transfers, which allow directors, managers, or specialist personnel to relocate from an offshore location to existing or new employment in the United States.

The L-1 visa allows multinational firms to relocate executives, managers, or specialist staff from an overseas site to a U.S. location. To be eligible for an L-1 visa, they must have worked in a foreign place for at least one year in the previous three years.

EB1-1 Green Card for Doctors

The EB1-1 visa is a U.S. green card that allows the visa owner to reside and work in the U.S. indefinitely. The EB1-1 classification is for “exceptional talent,” which can apply to a broad spectrum of medical practice or research. Being first in a specific field might even be advantageous.

To qualify, you must achieve at least three of the following criteria, but the primary goal is to be able to demonstrate that you have advanced to the pinnacle of your profession.

• National or international prize winner
• Membership in the elite demands exceptional accomplishments
• Media coverage in major newspapers or trade magazines
• Significant contributions to the field
• Scholarly article authorship
• A good salary
• Holding a vital position in a prestigious organization
• Comparable proof

The USMLE tests are required in several states in the United States. Two of these can generally be taken outside of the United States, while the third must be taken within the United States.

EB1-3 Green Card for Doctors

The EB1-3 is an immigrant visa, often referred to as a green card, granting the visa bearer the ability to reside and work in the U.S permanently.

The EB1-3 visa, like the L-1 visa, is intended to allow foreign enterprises with operations outside of the U.S. to send executives, directors, or specialist staff. The L-1 visa is a non-immigrant or temporary visa, although the EB1-3 visa grants permanent status.

To qualify, a firm, like the L-1, must demonstrate that it has enough people to fill management and executive roles. Furthermore, compared to the L-1, in our experience, a firm indeed requires at least five people to justify having three tiers of seniority, thus at least one executive, one manager, and at least three additional permanent staff.

It is critical to note that the relationship is crucial. One of the firms (whether situated in the United States or elsewhere) could be a subsidiary or affiliate of the other. They must have worked for at least one year during the past three years, much like the L-1. This does not preclude transferring from an L-1A or L-1B to an EB1-3.

How Much is the Salary of Immigrant Doctors in the U.S.?

• The yearly salary of a specialist is $ 370,000.
• The median annual wage of a general practitioner is $ 230,000.

A doctor’s salary is determined by where they practice and their sex. Male doctors in the U.S. make 36% more than their female peers. Physicians in the anesthesia and radiology fields experienced the narrowest pay gaps (12%), followed by family physicians (14%). Physicians with an average yearly compensation of 443,000 dollars (salary, bonuses, and profit-sharing contributions) are ranked first. Cardiologists receive an average annual reward of 410,000 dollars, dermatologists receive an average yearly compensation of 381,000 dollars, and pediatricians earn an average yearly wage of 204,000 dollars.

The 10 Biggest Immigration Mistakes Physicians Make in the US

Here are the 10 biggest mistakes doctors make when Immigrating to the U.S.:

Choosing the Wrong Visa to Attend Medical Training

Physicians intending to enter the U.S for graduate medical programs and training can often do so when they have an H-1B or J-1 nonimmigrant visa. However, the great majority (about 90%) enter the country on J-1 exchange visitor visas, particularly designated for graduate medical studies. Most arrive on the J-1 visa because their training programs tell them they need it.

However, this is mainly because, operationally, programs find it simpler to bring doctors over on J-1 visas since the ECFMG, the single sponsor of all J-1 doctors in clinical training, does the hard lifting. Furthermore, the Immigration and Nationality Act (INA), Section 212(e), has required that physicians entering the United States on J-1 visas train in graduate medical education in a clinical setting and return to their home countries or last places of residence for two years after entering the country. Doctors can apply for a waiver of this rule, but the procedure is time-consuming.

If the doctor ultimately intends to live in the U.S., the H-1B visa is typically the best option. The importance of avoiding the home residence requirement under INA Section 212(e) cannot be stressed for many doctors, especially those following career paths that do not lend themselves easily to a waiver plan. However, acquiring an H-1B visa is not always straightforward, and even attaining an H-1B status is not without complications.

solution

International doctors and their immigration counsel should closely examine their long-term aspirations when selecting a training visa. Many of these programs may defer to the doctor’s request while determining the visa category.

Failure to complete all three steps of the United States Medical Licensing Examination

A doctor must generally pass Step 3 of the United States Medical Licensing Examination to be eligible for an H-1B visa (USMLE). Unfortunately, several overseas physicians, primarily Canadians, do not sit for the exam since state licensing boards frequently recognize Canadian qualifications and do not need Step 3 of the USMLE. In addition, only the first two stages are required for physicians to attend a training program in the U.S. In these circumstances, the immigration criteria in the United States are more robust than the state licensing requirements, and a doctor will most likely be refused an H-1B visa for lack of qualifications. And, because most J-1 waiver programs need doctors to work three years on an H-1B visa once the home residence requirement is waived, being unable to acquire an H-1B visa might be a severe problem.

Solution

Clinicians should not avoid taking USMLE Step 3.

Failure to Consider a Visitor Visa Application

To enter the U.S. on a J-1 or an H-1B visa, a doctor must first enter the country on a guest visa to complete particular credentialing tests that are only accessible in the United States. For example, to complete the USMLE Step 2 clinical skills examination, a physician coming on a J-1 visa must first arrive on B-1 visiting status. This battery of clinical exams is only available a few times each year in five places across the United States. To take the USMLE Step 3 for the H-1B visa, physicians must enter the nation on B-1 visiting status.

Sadly, many doctors believe, sometimes incorrectly, that obtaining a visiting visa to come to America to take the test will be simple. Instead, Visa processing can be prolonged owing to security clearances. In addition, they are frequently refused because applicants fail to demonstrate that they have the finances to sustain themselves on their trip and are unlikely to overstay their visas.

Solution

If feasible, physicians should apply for a guest visa many months before travel. They should adequately document their application and attach a copy of their round-way airline ticket demonstrating that the journey is solely for the duration of the test and departure from the country. Applicants should produce a letter from their employer detailing their leave period to demonstrate that they are returning to work. Finally, they must provide documentation that they have sufficient finances to cover the expenditures of the trip.

Registration documents for the exam should also be submitted. Married candidates should apply for a visa exclusively rather than for their spouse because consular authorities are more likely to assume that the applicants will come back home since their spouse has stayed. Any other proof indicating that the applicant is expected to return to their native country once the exam is completed would also be beneficial. Finally, having a lawyer create a cover letter stating why the application should be authorized might be helpful. Even hiring a lawyer can assist in demonstrating that a medical candidate is serious about following visa criteria.

Not Looking for Work Quickly Enough Before Completing Medical School

J-1 waivers typically require physicians to secure employment in a physician shortage area, to find a job with an employer who has strategically recruited for the position, to find a state waiver program that has slots available, or to find a federal program available in the region, and to satisfy the employer’s willingness to go through all the necessary paperwork to obtain a physician’s employment.

Considering the doctor’s scarcity, finding an employer ready to go through all of this is difficult. Doctors who wait longer may find themselves unable to find work before completing their training. Even if they do find work, they have not given themselves enough time to prevent a gap in their capacity to work without interruption.

Solution

Physicians should start looking for work as soon as possible to have enough time to get a J-1 waiver and an H-1B visa. They should, preferably, allow at least a year for the paperwork to be processed.

Choosing the Wrong Employer

It is difficult to change jobs after a J-1 waiver has been granted. The US State Department will only hear a waiver once; after that, only US Citizenship and Immigration Services will be able to authorize a change of employers. Therefore, the USCIS believes that the correct procedure to change employment is to file an H-1B change-of-status application. The application must prove that the physician will complete the remaining three years of their commitment in an underserved region. There are extraordinary circumstances necessitating the move (e.g., breach of contract by the employer, facility closure, or similar events). Being dissatisfied with one’s neighborhood or seeking a better chance elsewhere is insufficient.

Solution

Physicians should ensure that the employer they choose is one with which they are prepared to stay for three years and properly analyze their contract before signing it.

Ignoring the H-1B Cap

The quantity of H-1B visas accessible each year fell from roughly 200,000 to 65,000 on October 1, 2003. As a result, many physicians will be unable to obtain a visa when needed and will have to wait for a fresh quota to become accessible when a new fiscal year starts every October. On the other hand, many people will be lucky enough to locate a job not subject to the H-1B quota. Employers connected with or related to a university or non-profit research institution are free from the cap, as are other nonprofits affiliated with or related to a school or university, or non-profit research employer. Furthermore, the USCIS continues to classify Conrad 30 waiver posts as exempt from the limit, even though the exemption ended on September 30, 2003.

Congress has been debating legislation to enhance H-1B cap exclusions for doctors, but nothing has come of it. Furthermore, physicians should be aware that the exclusion from the cap is related to an employer: doctors who transition from an exempt employer to an organization subject to the H-1B cap must get a new visa number. This is especially problematic for physicians on an H-1B visa doing residency training at an exempt facility. Their programs conclude in July, and if there are no H-1B visas available, they may not be able to begin their subsequent employment until October.

J-1 waivers can be time-consuming to process. Furthermore, available spots in the famous Conrad state 30 programs can soon fill up, which means that the waiver procedure can easily take more than six months, even when it takes to complete an H-1B application. Because of the H-1B category limits, physicians may be forced to wait even longer.

Solution

H-1B petitions can be submitted up to six months before the employment start date. However, if the H-1B quota is severely overloaded, physicians should submit as soon as feasible and pursue opportunities with cap-exempt employers.

Not involving an immigration lawyer early in the job search

J-1 waiver employment might be hard to come by. Going through the interview process and proceeding with the waiver application might be even more disappointing to find out that the position is not eligible for a waiver. Conrad 30 doctor waiver programs and four federal programs are available. However, the regulations for each program change, and it is simple for someone who is not well-versed with medical immigration laws to get perplexed.

Solution

Physician waiver methods should be discussed with an immigration lawyer as soon as possible. An immigration lawyer may assist in screening employment to discover if they are eligible and review contracts to verify they conform with immigration regulations.

Failure to Consider Other Waiver Strategies

Many doctors are unaware that the J-1 home residence requirement does not exclude them from obtaining a nonimmigrant visa without a waiver. They are merely forbidden from transferring from a J-1 to another category within the US, obtaining an H-1B visa at a US consulate, or obtaining permanent status. However, a physician can apply to a US consulate overseas for visas other than the H-1B. The O-1 visa is provided for exceptional physicians who have demonstrated outstanding skills. The TN visa is accessible to Canadian and Mexican doctors who wish to work in non-clinical roles in the United States. The E-2 visa is accessible to physicians who invest in establishing a physician practice.

Solution

If a J-1 waiver is not available, physicians may seek other visa alternatives.

Selecting the Incorrect Green Card Category

Physicians can choose between two primary green card strategies. The Physician National Interest Waiver, for example, is offered to physicians who agree to work in primary care for five years in a physician shortage region. The restrictions around what was meant to be a simple initiative to incentivize physicians to serve lengthy periods in impoverished areas have proven to be quite convoluted. The labor certification strategy is the second strategy.

In labor certification situations, an employer must demonstrate that it has been unable to find the U.S. or permanent resident physician with the required credentials who is promptly available to fill a position. These cases have a high clearance rate due to the seriousness of the shortage of doctors in the U.S. The main issue has traditionally been the duration of the labor certification procedure. The US Department of Labor plans to deploy an electronic filing system for labor certifications in late 2004, which would significantly speed up the process. National Interest Waivers have several advantages over labor certifications. Spouses, for example, can get work permission paperwork immediately. Furthermore, the entire processing period for these situations is faster than the labor certification.

Solution

When deciding on a green card strategy, doctors should consider their objectives (e.g., having their green card processed fast, moving out of an underprivileged location). They should also remember that they can pursue many green card strategies simultaneously.

Choosing a Bad Job (or No Job) Over Satisfying the J-1 Home Residency Requirement

Many physicians feel that if they leave the USA after completing their home residency obligation, they will have little opportunity of returning to work. As a result, physicians sometimes take low-wage employment to evade leaving the nation. However, by returning home for two years, doctors will be able to get an H-1B visa to work in any position, not only those in shortage areas. Given the present situation of the US physician market, US-trained doctors who can rapidly obtain a visa to practice in any type of clinical environment are still in high demand, even if they are not currently in the US.

Solution

Suppose physicians cannot locate suitable employment, and their home country provides chances. In that case, they might consider returning to the U.S. on an unlimited H-1B visa that permits them to work in any field, not just a shortage one.

FAQs

How can I immigration to the US as a doctor?

• Obtain the Services of an Immigration Lawyer.
• Choose a state to live in.
• Get a medical license.

How much is the salary of doctors in the U.S.?

• The yearly salary of a specialist is $ 370,000.
• The median annual wage of a general practitioner is $ 230,000.

I am a Doctor? What US visa can I apply for?

• H-1B
• O-1
• TN
• J-1
• E-2
• L-1
• EB1-1
• EB1-3