Presented by Rose Mary Valencia, Executive Director MD Anderson Visa & Immigration Services Administration & UTHealth Office of International Affairs

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1 Presented by Rose Mary Valencia, Executive Director MD Anderson Visa & Immigration Services Administration & UTHealth Office of International Affairs 1

2

3 U.S. Department of State - DOS U.S. Department of Homeland Security - DHS Customs & Border Protection CBP Citizenship and Immigration Service USCIS Immigration & Customs Enforcement ICE U.S. Department of Labor DOL Educational Commission for Foreign Medical Graduates - ECFMG National Prevailing Wage Center- NPWC Medical State Board

4 F-1 with Optional Practical Training J-2 with Employment Authorization Document (EAD) L-2 with EAD Refugee with EAD Political Asylee with EAD Temporary Protective Status with EAD Pending Permanent Resident with EAD Employment Authorization Document Holders U.S. Permanent Residents

5 J-1 Alien Physician H-1B Employment Visa E-3 Employment Visa for Australian Citizens O-1 Extraordinary Ability in the Sciences

6 Founded in 1956 Organizational Membership American Board of Medical Specialties American Medical Association Association of American Medical Colleges Association for Hospital Medical Education Federation of State Medical Boards National Medical Association Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

7 An IMG is any physician who received his/her basic medical degree from a medical school outside of the US or Canada, regardless of citizenship This includes any U.S. citizen who received a medical degree from a school outside of the U.S. or Canada Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

8 Medical Education Credentials o Completion of medical school curriculum of at least 4 years o School and graduation year listed in IMED* o Primary-source verification of medical diploma and transcript(s) by ECFMG USMLE Exams o Step 1 Basic Science o Step 2 Clinical Knowledge (CK) o Step 2 Clinical Skills (CS) *The International Medical Education Directory (IMED) Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

9 Entry into U.S. GME Process Complete medical school If IMG, complete ECFMG Certification Timeframe May Previous year/s Complete residency application process ERAS Interviews etc. NRMP Match Program issues GME contract/letter of offer If foreign national, secure appropriate visa status Commencement of residency training August - February September - February March March March July July Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

10 U.S. Teaching Hospital Training Program Liaison (TPL) ECFMG Foreign National Physician J-1 Physician U.S. Department of State SEVIS Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

11 Adequate prior education Certification GME contract or letter of offer Statement of Need from Ministry of Health (home country /country of most recent legal permanent residence) For a complete list of required items view checklists *minimal requirements Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

12 Temporary, non-immigrant Full-time educational training (GME), not employment Strong ties to the home country (i.e, Ministry of Health Statement of Need) Two-year home physical presence requirement Maximum = seven years for progressive GME Government reporting in SEVIS Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

13 J-1 Physician + TPL = Complete Application Sponsorship available for participation in: ACGME-accredited base residency training ACGME-accredited subspecialty/fellowship training Non-standard programs (advanced cutting edge fellowships) Extension for board examinations Sponsorship application instructions Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

14 Application Process Complete online application 4-6 weeks to review applications Regional Advisor evaluates for eligibility If approved, SEVIS Record is created ECFMG issues Form DS-2019 ECFMG notifies applicant via , provides instructions for obtaining J-1 visa status Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

15 On-line Application Appointment submitted by hospital Physician accepts ECFMG reviews Flow * = EVNet OASIS ECFMG (Hospital ) (Applicant) (Regional Advisor) * All supporting documentation scanned and uploaded Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

16 Data exchange between DHS / DOS Immigration tracking of the activities of non-immigrant (J, F & M) visa holders and dependents Accessed by consulates, embassies, ports-of-entry, and other DHS agencies ECFMG creates and updates SEVIS records for all J-1 alien physicians and J-2 dependents Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

17 Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved. 17

18 Immigration Approval of visa sponsorship Timely consular interview abroad, security clearance or change of status if in the United States Special Considerations Change of category through U.S. Department of State Non-standard program Orientation Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

19 Continued full-time participation in GME o o Contract to progress in training Timely renewal of ECFMG J-1visa sponsorship Required reporting of any change in approved training plan Exceptional Extension or Sponsorship Authorization through the U.S. Department of State J-1s do not need to renew visa stamp annually Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

20 Initial Arrival to the program = Validation Timely renewal according to annual GME contract Any change in the approved training plan Visa delays Remediation Leave of absence Licensure delay Proposed off-site rotations Proposed early advancements Resignation Contract termination Legal concerns / allegations, internal hearings, etc. Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

21 Repeat of training year o USMLE Step 3 o Remediation Preliminary v. categorical o Prerequisite o General Surgery Specialty board credit Research Change of specialty Duration Copyright 2014 by the Educational Commission for Foreign Medical Graduates (ECFMG ). All rights reserved.

22 Employment vs. Training W-2 Wages Prevailing Wage & Actual Wage Employer obligation to comply with DOL regulations including payment of all fees related to H-1B application Processing time for H-1B petition Employment restrictions to job title, duties, percentage & location as defined on petition Numerical limitation Public Record File & Potential Audits Return Transportation Costs Six (6) year maximum period

23 USMLE I, II, & III or equivalent exams as defined in federal regulations; License or permit to practice medicine in the State; Medical degree and evidence of equivalency No two-year home residency obligation Employer s willingness & ability to sponsor

24 W-2 Wages Approved Labor Condition Form Employer obligation to comply with DOL regulations Petition processing time by travel abroad or in the U.S. Employment restrictions to job title, duties, percentage & location as defined on petition Numerical limitation If subject to two-year home residency requirement, securing the E-3 visa from abroad simply places two-year obligation on HOLD.

25 Proof of Australian Citizenship; Job Offer Letter which contains job title, salary, begin date, description of job duties, and, professional credential requirements: License or permit to practice medicine in the State; Medical degree and evidence of equivalency If subject to two-year home residency requirement, must depart the U.S. to apply for E- 3 visa at U.S. Embassy If not subject to two-year home residency obligation may apply for COS in the U.S.

26 Extraordinary ability in the field of science, education, business, or athletics IMG is one of the small percentage who have arisen to the very top of the field of endeavor [8 CFR (o)(3)(iii)]; or, IMG demonstrates sustained national or international acclaim and recognition for achievements in the field of expertise by providing such service [8 CFR (o)(3)(iii)]

27 Difficulty establishing IMG meets criterion for O-1 IMG and Program Documentation to support O-1 No Prevailing Wage or Actual Wage No Return Transportation Requirement 2 year home residency requirement does not bar O-1 eligibility 2 year home residency requirement is not waived or fulfilled by securing O-1 status Initial sponsorship can be for 3 years with annual renewals with no finite period Employer not required to pay application fees

28 Physician must be a U.S. Medical Graduate who is in the U.S. on F-1 visa sponsored by US Medical School granting the U.S. Medical Degree Restricted to 12 months maximum Must be granted EAD Employment and/or Training restricted to the period of OPT

29 IMG is eligible to participate in GME program for period of valid EAD if: IMG presents original EAD and renewal EAD timely Delay and/or interruption in GME training if evidence of valid EAD is not presented timely IMG must renew EAD timely with USCIS taking into consideration USCIS delays No fees paid by GME Program

30 Which non-immigrant visa will GME Program support? Which Program and/or Department will retain required documentation of visa sponsorship in the event of an Audit? Who will pay fees associated to non-immigrant visa application sponsored? Is IMG authorized to use Private Legal Counsel? Who will pay Private Legal Counsel fees? If IMG must travel abroad to secure visa, who will pay travel expenses?

31 Provided by: Tracy Wallowicz ECFMG DoS Case Manager and Senior Advisor (215) Rose Mary Valencia 713/ /

32 Questions? 32

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