1. Residents/fellows in NON-IMMIGRANT VISA STATUS
GME retreat
Julie Wilbers, Director of International Services
September 8, 2017

2. Agenda Comparing J-1 vs. H-1B H-1B Sponsorship
J-1 Sponsorship through ECFMG
J-1 Compliance Requirements
Reporting Requirements
Incident Reporting

3. Comparing J-1’s and H-1b’s
Please refer to GME policy on international residents/fellows
J-1 is an exchange visitor visa program administered by the Department of State (currently 70 in J-1 status here)
Ultimate goal of promoting cross-cultural exchange and public diplomacy
Physicians in J-1 status are issued DS-2019’s by ECFMG
Physicians automatically subject to the two-year home residency requirement – must demonstrate strong ties to home country and clear intent to return (statement of need required)
H-1B is an employment visa (currently 2 residents in H-1B status)
There must exist an employer/employee relationship
Filed by OIS who interfaces with the Department of Labor
Filing fees must be paid by employer
(Sometimes) advantageous for physician – No two-year home residency requirement
Purpose: Ensuring not displacing
•Statement of Need from country of last legal permanent residence (LPR) determines obligationg U.S. workers or undercutting U.S. wages

4. Who is ECFMG?
Educational Commission on Foreign Medical Graduates, Established in 1956
Private, nonprofit organization
Headquartered in Philadelphia, Pennsylvania
ECFMG has certified more than 320,000 international medical graduates.
ECFMG certification for those who received education/training outside the U.S. and Canada
Exchange Visitor Program

5. Sponsoring physician for H-1B status
Department submits complete packet to OIS at least two months in advance
OIS files Labor Condition Application (LCA) with Department of Labor (DOL) prior to filing H-1B petition with USCIS
Costs: $460 USCIS filing fee, $500 anti-fraud fee, $1,225 premium processing fee (sometimes necessary), and $750 OIS processing = currently totally $2,935 (or $1,710)
Department must pay prevailing wage, which is determined using the national AAMC survey of resident/fellow stipends, assuming DOL continues to accept this – no exceptions
Maximum of 6 years in H-1B status – minimal exceptions
Must notify OIS of any changes related to worksite location, significant changes in job duties, dismissal, resignation, or leave of absence.
We do not have to report any incidents to DOS
Department must pay cost of return transportation if employee is let go prior to end date of approval notice (even if for cause)

6. J-1 Physicians sponsored by ECFMG
ECFMG - sponsors foreign IMGs (international medical graduates) for the J-1 visa (Exchange Visitor Sponsorship Program) to participate in GME programs
OIS serves as Training Program Liaison (TPL) designated to serve as the official representative and assists in the communications between the GME training programs, the physician, and ECFMG to ensure regulatory compliance and provide administrative oversight.
OIS is not the program sponsor; we have our own program for J-1 researchers
As the program sponsor, ECFMG relies on the TPL’s to report important information about physicians

7. compliance
There are requirements even after the physician receives the ECFMG J-1 visa and checks in with the OIS. The physician, TPL’s, and programs all have certain responsibilities.
Failure to meet compliance requirements may result in ECFMG terminating the J-1 record in the federal governmental database SEVIS which would require the physician to immediately depart the U.S.
They have reporting requirements
Health insurance requirements
Update changes in OASIS
International travel

8. Physician responsibilities
Physicians are notified on multiple occasions, prior to receiving DS-2019, prior to arrival, after arrival, and periodically throughout each year by ECFMG and OIS of all responsibilities!
They are aware of two-year home residency requirement.
ECFMG has robust resources on their website.
If physician has any questions, they can reach out to OIS or ECFMG and we can get them to where they need to be.
A Statement of Need from the physician’s country of last legal permanent residence is a J-1 sponsorship requirement and serves to evidence home country support for the U.S. training and provide assurance of an applicant’s commitment to return home.
ECFMG shares with them information on U.S. laws and customs, local community resources, culture shock, emergency assistance, and they reach out to the physicians if there is any natural disaster or event that could have impacted their well-being.

9. Tpl’s responsibilities
The Training Program Liaisons (TPL’s) in the OIS serve to communicate between the program and ECFMG.
The OIS TPLs rely on the Program Coordinators, the Program Directors, and the medical residents or clinical fellows being sponsored to advise us of the mandatory compliance reporting items.
TPLs also participate in ECFMG webinars and outreach programs to stay informed of our institution’s obligations and ECFMG processes.

10. Required reporting to ecfmg
Arrival / Delays (within 30 days of SEVIS start date)
Proposed Changes to Approved Training Plan
Leave of absence
Remedial training
Resignation
Dismissal
Gaps in training (i.e. licensure delay)
Off-site rotation
Incident reporting – including legal concerns
Confirmation of full-time participation twice a year (September and January)

11. Delays in arrival
If physician is delayed for any reason including visa issuance more than 30 days from the start date of his/her program (as indicated as on the DS-2019 form), then the program must notify the OIS.
OIS will notify ECFMG and they will subsequently advise us of the next steps.

12. Leave of absence Medical, FMLA, Educational, etc.
Host institution must seek ECFMG’s pre-approval
Basic Question:
Will the institution continue to take responsibility for the physician as a member of the residency training program?

13. Leave of absence Key considerations Type of leave
Dates and total duration
Contract, salary, medical/accident ins.
Location – U.S. or abroad
Institutional contact and oversight
Non-clinical assignments /credits

14. Remedial training
Per J-1 Regulations, a maximum of 12 months of repeat training may be granted based on the request of program director:
Basic Question:
Is the request consistent with GME requirements for academic progression?

15. Remedial training Key considerations Rationale Credits / rotations
Academic plan / duration
Periodic evaluations
Delays / promotion
Amended contract
From form: Briefly describe the educational lapse or performance issue(s) related to the need for remediation. If applicable, identify any deficiencies in the physician’s performance related to one or more of the six ACGME core competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, systems-based practice). Please use an additional sheet of paper if necessary.
ECFMG followed up with us two weeks after one physician began his remedial year.

16. resignations ECFMG must be advised in advance of any resignations
Basic Questions:
What are the issues for the physician, in the short-term and long-term?

17. resignations Key considerations Notify ECFMG
Official date of resignation
Reason for resignation
Issues of professionalism a factor?
30-day grace period applies in cases of resignation
Future ECFMG sponsorship should not be assumed
At a minimum, Form I-644, “good-standing” as a J-1 required
Form includes question on physician’s immediate plans after resignation,
Did physician complete requirement for specialty/sub-specialty training, and if not, what credit awarded?

18. dismissal ECFMG must be advised in advance of any contract termination
Basic Questions:
What are the issues for the physician, in the short-term and long-term?
Form

19. dismissal Key considerations Notify ECFMG Official date of release
Grievance process / timeline, if applicable
30-day grace period does not apply in cases of dismissal
Future ECFMG sponsorship should not be assumed
At a minimum, Form I-644, “good-standing” as a J-1 required
Form:
Was the J-1 physician provided with a written notice of intent that his/her agreement was being terminated and/or not renewed prior to the formal dismissal? If yes, please briefly describe.
Was the J-1 physician afforded due process related to his/her dismissal? If yes, please briefly describe
Were there any issues related to performance/professionalism that factored into the J-1 physician’s dismissal?

20. Gaps in training
For physicians continuing on with GME, there ideally should be no gaps between contracts.
Programs should advise the OIS if there will be a gap in training program for physician and if so, detail if result of off-cycle training, reason for off-cycle (i.e. visa or licensure delays), location during gap (U.S. or abroad), institutional oversight during gap, etc.
If minimal gap, ECFMG will consider options to continue sponsorship and meet regulatory requirements.
Form

21. Off-site rotation
ECFMG must be informed at least 30 days in advance of any proposed off- site rotation or elective.
Basic Questions:
Is the location outside of the participating sites for the training program as reported to and recognized by ACGME, including international rotations?
Form

22. Moonlighting
strictly
prohibited!

23. moonlighting
Physicians on ECFMG J-1 visas are only authorized to participate in official program training activities.
If a physician on an ECFMG J-1 visa engages in unauthorized employment including internal moonlighting, ECFMG may have to terminate the physician’s visa status.
For ACGME programs, the training activities are well-defined. For non- standard programs, ECFMG will review the original program description submitted in support of the visa application. Programs may contact the OIS to determine if proposed activities are allowable.
No gift cards, trips, reimbursement of any kind – even the activity itself is not prohibited
If not required to complete the program, they can’t do it!

24. Incident reporting
As J-1 program sponsor, ECFMG must monitor the well-being of its participants and notify Department of State (DOS). DOS indicates that any incident or event that impacts the health, safety, or welfare of the physician or his/her J-2 dependent or that could bring the DOS J-1 program into “notoriety or disrepute” is reportable.
J-1 physicians or J-2 dependents must notify TPL immediately. Once aware, the TPL must notify ECFMG within one business day of incident occurrence. Failure to do so could be in violation of physician’s status.

25. NATURE OF INCIDENT OR ALLEGATION
Incident reporting
NATURE OF INCIDENT OR ALLEGATION
Death of a J-1 physician or J-2 dependent
J-1 physician or J-2 dependent is missing
J-1 physician or J-2 dependent sustains a serious illness or injury (i.e., brain injury, severe burn, major surgery, communicable disease, serious mental incidents, any condition requiring hospitalization of 48 hours or more, etc.)
Litigation (in which the J-1 physician or J-2 dependent is named a party, including malpractice)
Incident involving the criminal justice system (i.e., arrest, charges, law enforcement, etc.)
Sexually-related incidents or abuse (an incident or allegation involving sexual exploitation, harassment, or abuse)
Negative press involving a J-1 physician and/or J-2 dependent(s)
Foreign government involvement (including embassy officials)
Other situations impacting a J-1 physician’s or J-2 dependent’s safety (i.e., natural disaster, civil unrest, outbreaks of violence)
Form
Reporting Instructions and

26. Cross-cultural activities
Purpose of J-1 program to increase mutual understanding of people of U.S. and other countries.
Regulatory requirement to make available cross-cultural activities to J-1 exchange visitors
J-1 physicians expected to have opportunities to learn about the U.S. culture while also sharing their culture with Americans
OIS hosts multiple events throughout the year and suggestions included in newsletter
TPLs will be asked on an annual basis to report on cross-cultural experiences offered to their J-1 physicians – Please let us know what opportunities you present, which include informal gatherings and invitations to social activities.
In 2017 ECFMG launched a new Cross-Cultural State Resource page on its website
ECFMG reminds J-1s during phone conversations of the cross-cultural component of sponsorship
Starting in 2017, online application required J-1s to identify cross-cultural activities in which they engaged in the previous year

27. Ecfmg Workshop In Spring For Program Coordinators
Will review request process