1. New Program Director Luncheon International Services Office Overview
International Services Office, Human Resources
BCM 410 | |

2. Topics to Cover Who is a non-U.S. citizen?
How is a non-U.S. citizen different from an Foreign Medical Graduate?
How do non-U.S. citizens apply to train in the U.S.?
Overview of visa classifications for clinical training
Elective Rotations
Reporting
ISO by area of responsibility

3. Who is a non-U.S. citizen?
Anyone who is not a citizen of the United States will fall into one of the following categories:
1. Immigrant/Permanent Resident
2. Pending Immigrant
3. Nonimmigrant
Any applicant in one of these categories must submit a Housestaff/ERAS Application to ISO.

4. How is a non-U.S. citizen different from a Foreign Medical Graduate?
A Foreign Medical Graduate (FMG) is an individual that attended medical school outside of the U.S.
An FMG can be a U.S. citizen OR a non- U.S. citizen
Keep in mind that some non-U.S. citizens attend medical school in the U.S. and therefore are not FMGs
The medical school a candidate attended is not always an indication of his/her citizenship.

5. How do non-U.S. citizens apply to train in the U.S.?

6. Identify & Apply for Appropriate
Step 1
Seek
ECFMG Certification
Step 2
Secure
U.S. Training Position
Step 3
Identify & Apply for Appropriate
U.S. Visa
Obtain Visa Approval***
***Obtaining “Visa Approval” involves a variety of steps and government agencies depending on the location and current visa status of the foreign national physician at the time (s)he applies to a BCM GME program.

7. ECFMG Certification Requirements
The Examination Requirements for ECFMG Certification
are as follows (as of June 14, 2004):
Pass USMLE Step 1 Basic Medical Science
Pass USMLE Step 2 Clinical Knowledge (Step 2 CK)
Pass USMLE Step 2 Clinical Skills (Step 2 CS) includes an English communication component
(this exam replaces the previous CSA exam and the English language proficiency test)
For further USMLE exam information, go to

8. Examination Requirements
Pass USMLE 1 Basic Science & USMLE 2 Clinical Knowledge
Pass USMLE Step 2 Clinical Skills
Obtain ECFMG Certificate
Secure Training Position
Process Visa
US US Medical School
N/A
Foreign National
@ US Medical School
US Citizen
@ Foreign Medical School

9. Overview of Visa Classifications for Clinical Training

10. Nonimmigrant Visa Options
Under the nonimmigrant category, the following are possible visa classifications for clinical training:
F-1 Student Visa with Optional Practical Training (OPT)
J-1 Exchange Visitor Visa Sponsored by ECFMG
J-2/L-2/H-4 Dependent with valid Employment Authorization Document (EAD) card
H-1B Temporary Working Visa
O-1 Individual of Extraordinary Merit

11. F-1 Student Status with OPT
Graduate of U.S. medical school
Must obtain ECFMG sponsorship or alternate immigration status with work authorization in order to complete remaining years of residency, fellowship or clinical training
NOTE: If the student’s OPT is not based on completion of an MD program, the student cannot use the OPT for residency.

12. J-1 Sponsored by ECFMG Documents Needed from J-1 Applicants:
Copy of GME contract letter (Can also come from department)
Ministry of Health letter from country of last legal permanent residence, regardless of country of citizenship
Completed Form I-644 (only for J-1 continuation of sponsorship applicants; top portion completed by applicant, bottom portion signed by current program director)
Copy of passport identification page
Current C.V. (only for J-1 initial sponsorship applicant)
ECFMG Certificate (only for J-1 initial sponsorship applicant: if applicant attend a LCME-accredited U.S. or Canadian medical school, provide a copy of medical diploma and a full-frontal passport photo in lieu of ECFMG certificate)
Payment of the ECFMG administrative fee (applicant pays via OASIS)
Copy of I-94 if already in the U.S.
If necessary, passport identification pages of any J-2 dependents, as well as I-94 records and marriage and/or birth certificates
ISO Fee Form, cash, check, or money order in the amount of $300 payable to the “International Services Office” (fee can be paid by applicant or department). ISO administrative fee to be paid annually

13. J-1 Sponsored by ECFMG
Documents Needed from Department for ACGME Accredited Program:
Copy of GME Contract letter (can also come from applicant)
Fellowship program description (only if applicant entering a subspecialty training)
ISO Fee Form, cash, check, or money order in the amount of $300 payable to the “International Services Office” (fee can be paid by applicant or department). ISO administrative fee to be paid annually

14. J-1 Sponsored by ECFMG
Documents Needed from Department for Non-Standard (TMB) Program:
Copy of GME Contract letter (can also come from applicant)
Fellowship program description (only if applicant entering a subspecialty training)
Statement of Educational Objectives
ISO Fee Form, cash, check, or money order in the amount of $300 payable to the “International Services Office” (fee can be paid by applicant or department). ISO administrative fee to be paid annually
ABMS-Member Board Recognition
GMEC Endorsement and Program Verification Form
Note: Program name must match ABMS name of approved non-standard programs for ECFMG sponsorship

15. Considerations for J-1
For J-1 sponsorship from ECFMG, an application must be submitted and approved by ECFMG before the foreign national physician may begin his/her clinical training.
ECFMG processing time: approximately 6 -8 weeks
(longer processing for non-standard/TMB programs)
Maximum J-1 sponsorship is 7 years (minimum pathway, logical progression) **Please make sure that applicant has enough J-1 time to complete training before offer is extended**
Two year home residency requirement (212e) for J-1 Alien Physician and J-2 dependents
30-day grace period at completion to leave the U.S. No work authorization during this period

16. J-2/L-2/H-4 with Work Authorization
J-1 dependents enter in J-2 status.
L-1 dependents enter in L-2 status
H-1B dependents enter in H-4 status
J-2/L-2 visa holders and certain H-4 visa holders may apply for work authorization (EAD) through USCIS by filing Form I-765. Work authorization will expire in conjunction with J-1/L-1 expiration date. ISO does not file I-765 applications for dependents
A J-2/L-2/H-4 dependent who is an FMG entering a residency or fellowship must be able to provide a valid EAD in order to begin his/her clinical training, and must have valid EAD at all times to continue training without interruption
Consideration should be given as to whether or not the J-2/L-2/H-4 will have enough time to complete the program. If not, the J-2/L-2/H-4 must change to J-1 under ECFMG sponsorship

17. H-1B Temporary Working Visa
A non-U.S. citizen may be admitted to the U.S. in H-1B status to engage in graduate medical education or clinical training if (s)he:
Has graduated from a U.S. medical school or has passed USMLE parts 1, 2 and 3 and holds an ECFMG certificate
Is competent in oral and written English
Is not subject to 2 year home residency requirement due to previous J-1 status
Can provide proof of Texas medical license or PIT permit

18. Considerations for H-1B
H-1B sponsorship is contingent on obtaining a favorable prevailing wage determination from the U.S. Department of Labor
H-1B status is sponsored in 3 year increments for a total of 6 years. The ability to sponsor H-1B status presently is not a guarantee of future sponsorship for training or employment with BCM.
If training program is longer than 3 years, no guarantee that trainee will be able to complete program on H-1B visa.

19. O-1 Visa for Individual of Extraordinary Merit
Must be able to provide proof of Texas medical license or PIT permit
An O-1 visa is granted to individuals with extraordinary ability in the sciences, education, business, or athletics who are entering the U.S. for temporary work.
The O-1 applicant must demonstrate sustained national or international acclaim and recognition for achievements in the field of expertise.
O-1 cases are not filed in ISO. O-1 applicant must hire outside counsel to prepare all the required documents for ISO signature.

20. Elective Rotations
Any elective rotations must be approved by ISO before the non-U.S. citizen trainee can participate in the rotation. This may also require approval from ECFMG depending on the location of the rotation and the trainee’s immigration status.
Additionally, if there is a non-U.S. citizen from another institution participating in an elective rotation in your program, please assure that ISO has been notified and has approved this rotation.
ISO will make sure that all visa regulations are being complied with and that the program and non-U.S. citizen trainee are not violating any federal immigration regulations by participating in the elective rotation

21. Reporting
ISO relies on communication from the programs as we cannot be involved in and monitoring every non-U.S. citizen trainee on a daily basis.
ECFMG is responsible for ensuring full-time participations of all J-1 physicians in programs of graduate medical education. ECFMG is requiring reporting by ISO three times a year for all J-1 sponsored trainees. Please notify ISO if any non-U.S. citizen trainee is not engaged in ongoing, full-time participation in GME so this can be reported to ECFMG accordingly

22. Reporting
ECFMG must report the following incidences or allegations to the U.S. Department of State. In the event that any of these are to take place, please notify ISO immediately.

23. ISO by Area of Responsibility
Nonimmigrant visas (F, J, H-1B, TN, O-1, etc.):
A-E Kira Geslin
F-J Stacey Cheung
K-L Larysa Kruijs
M-S Amy Makiyama
T-Z Elisabeta Trail
Team Lead and Permanent Residency Inquiries:
Joy Dun
ISO General Number:
ISO General
ISO Overview Presented by Joy Dun, ISO 23

24. QUESTIONS?