In general, most foreign medical graduates come to the U.S. on J-1 visas to complete residency or fellowship here. Those coming to the U.S. for this purpose are subject to Section 212(e) of the Immigration and Nationality Act, requiring the foreign medical graduate to return to his or her home country for 2 years upon completion of the program. All 212(e) subject individuals cannot obtain an H-1B visa or a green card (permanent residence) unless they obtain a waiver first. The most popular waivers for doctors include State 30 (or Conrad 30) and HHS waivers, both requiring service of 3 years in a medically underserved area in H-1B visa status (in addition to other requirements). Other waivers that are much more difficult to obtain include hardship waivers – by showing extreme hardship to U.S. citizen or permanent resident spouse, son or daughter, and HHS waivers based on medical research in the national interest of the United States.
Some foreign physicians qualify for H-1B status. The main requirements for the H-1B visa for doctors, apart from having a sponsoring employer, is that the international medical graduate has a medical license in the state of employment (or is qualified for one), and has passed all 3 steps of the USMLE (or previously FLEX or NBME). English proficiency must also be established, usually by passing the Educational Commission for Foreign Medical Graduates (ECFMG) English language test.
Obtaining a green card or permanent residency is more difficult. Most foreign physicians will have to go through a labor certification process called PERM – a rigorous recruitment process under DOL regulations where the employer must recruit for U.S. workers – and only if U.S. workers are not identified the labor certification can be filed. Then an immigrant visa application (I-140) is filed and finally an application to adjust status once the first two steps are approved. Some foreign medical graduates qualify for National Interest Waiver – NIW – by serving 5 years in a medically underserved area. Other international medical graduates qualify for classification of extraordinary ability (usually based on research), or through outstanding professors and researchers based on a tenure-track position in a university.