Exchange visitor physicians who enter the United States for the purpose of graduate medical education are automatically subject to the 2-year home physical presence requirement of the Immigration and Nationality Act as amended. This means that prior to applying for H (temporary worker), L (Intracompany Transferee), permanent resident, or immigrant status, the exchange visitor must reside and be physically present in the country of most recent legal permanent residence for an aggregate of at least two years.

Foreign nationals who are graduates of Liaison Committee on Medical Education (LCME)-accredited US and Canadian medical schools and who wish to enter the United States for the purpose of graduate medical education are also eligible for ECFMG sponsorship. They are not required to hold a Standard ECFMG Certificate. However, they must meet the other requirements for exchange visitor sponsorship and are held to the two-year home country physical presence requirement.

An uncommon, but possible case, occurs when an exchange visitor is a medical trainee in J-1 student status at a US college or university. Such trainees who graduate from US LCME-accredited medical schools are eligible for up to 36 months of postdoctoral academic training in the field of study. Graduates of US medical schools may, therefore, use academic training authorization to undertake a residency that can be completed within the three-year time limitation. This work must be authorized by the school from which the student graduated. The J-1 “responsible officer” at the US medical school can usually provide information necessary to make employment eligibility determinations for these graduates.

Foreign national physicians who wish to enter the United States for advanced training may do so in programs involving observation, consultation, teaching, or research with or without patient contact incidental to one or more of these activities. The Educational Commission for Foreign Medical Graduates (ECFMG) is authorized to sponsor foreign national physicians for this purpose. The United States Information Agency (USIA) may also authorize universities and other health science institutions to sponsor foreign national physicians for this purpose.

J-1 (exchange visitor) status physicians who enter the United States in the J-1 visa categories of student, research scholar, or professor may not, as a matter of course, change their J-1 visa category to alien physician to allow them to engage in graduate medical education or training sponsored by the ECFMG. Said physicians must (through the ECFMG) present a request for visa category change to USIA for review and decision. The request must demonstrate unusual and extenuating circumstances. Exchange visitors in programs involving observation, consultation, teaching, or research may remain in the United States for a maximum of three years with a possible six-month extension under specific circumstances.

Foreign national physicians use the exchange visitor J-1 non-immigrant visa class most often for graduate medical education and training. The Exchange Visitor Program is regulated by the United States Information Agency (USIA), which designates various organizations and educational institutions as Exchange Visitor Program sponsors. Each designation is designed for a specific purpose appropriate to that sponsor. The USIA has designated the Educational Commission for Foreign Medical Graduates (ECFMG) as the only organization authorized to sponsor foreign national physicians to engage in graduate medical education or training. Such education or training is defined in the US Code of Federal Regulations as participation in a program in which the foreign national physician will receive graduate medical education or training, which generally consists of a residency or fellowship program involving the provision of health care services to patients. This program may consist of a medical specialty, a directly related medical sub-specialty, or both.

To be eligible for ECFMG exchange visitor sponsorship for graduate medical education, the foreign national physician must pass either the National Board of Medical Examiners (NBME) former Part 1 and Part 2 examinations, or an examination determined to be equivalent to the NBME by the Secretary of the US Department of Health and Human Services. The following examinations have been determined to be equivalent to the NBME Part 1 and Part 2 examinations for this purpose:

Day 1 and Day 2 of the former Visa Qualifying Examination; OR
Day 1 and Day 2 of the former Foreign Medical Graduate Examination in the Medical Sciences; OR
Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE).

1. Hold a valid Standard ECFMG Certificate;
2. Have a contract with an ACGME-accredited program that is affiliated with a US medical school; and
3. Provide a written statement from the Ministry of Health in the country of most recent legal permanent residence that attests to the need for physicians trained in the exchange visitor’s specialty and that verifies that the exchange visitor has filed written assurance that he/she will return to the country upon completion of training.
   
   Note: The duration of participation for exchange visitors in graduate medical education is the time required to meet the educational requirements for certification by an American specialty board that has been recognized by the American Board of Medical Specialties. Duration of participation is further limited to a maximum of seven years.