B1 Visitor Visa to J1 Exchange Visitor Visa
Residency applications in general, and the policies and procedures for foreign medical school graduates vary and are constantly evolving, but these were the steps I took as a Canadian citizen who attended a foreign medical school in the Caribbean and was seeking a residency match in the United States.
The number of residency positions available in Canada was extremely limited so I did not apply for a Canadian position. In April of my third year of medical school, I applied for the National Resident Matching Program (NRMP) in the United States through the Electronic Residency Application Service (ERAS). However, I was offered a pre-match position at a program in October of my fourth year of medical school. After I had a signed contract with the program, I removed myself from the NRMP.
Since I was unsure if I would practice in the United States or return to Canada after residency, I applied for and wrote the Medical Council of Canada Evaluation Examination (MCCEE). There are various pathways for non-Canadians or Canadians who attended medical school outside of Canada to eventually practice in Canada. The most direct way at that stage in my career was to write the MCCEE, and then write the subsequent exams (Medical Council of Canada Qualifying Examination, MCCQE), which are analogous to the United States Medical Licensing Examinations (USMLE). The MCCEE has since been phased out, but the MCCQE’s remain. I took the MCCEE and MCCQE-1, but I did not pursue this any further after I decided, for various reasons, I preferred to remain in the United States after training. Note, this decision essentially committed me to long, but hopefully fruitful immigration process that will ultimately lead to US citizenship.
I had two additional tasks/applications. The Educational Commission for Foreign Medical Graduates (ECFMG), should be familiar to foreign medical graduates of any country wishing to apply to a US residency position. If you have not already, you need to become very acquainted with the ECFMG, which governs the sponsorship of training physicians.
As a Canadian, I also had to complete a Statement of Need. In the past, the Maple Motherland issued only a set number of visas for various residency types and fellowship types for that matter; this changed in my third year of residency. As of this blog post, however, the Statement of Need is still required.
In coordination with the graduate medical education (GME) office of my future residency program, I applied for a J1 visa through the ECFMG, and concurrently worked on my Statement of Need requirements. The result of these processes was a transition from a B1 visa as a medical student to a resident trainee on a J1 visa.
I documented in my diary the steps and blunders I took during medical school to apply for residency. Here is a rough timetable delineating those steps. I was a fourth year medical student in the fall of 2011.
Sep 17 2011:
I wrote the MCCEE.
Oct 24 2011:
I spoke with Statement of Need Liaison and we discussed my future and intentions regarding my training in the United States. This was a rather convoluted process, and the process varies depending on your province of origin and where you are in the physician career pathway.
If you are Canadian, you will have to spend considerable time acquainting yourself with the Statement of Need. You will receive a checklist, which is specific to your situation and choice of residency. Items on the check list included, but was not limited to:
Devising an Action Plan (which involved a plan on how and when I was going to return to Canada)
Completing a Category B application
Registering with Health Force Ontario
Uploading my residency contract
Sent a request for a required letter to Royal College of Physicians and Surgeons of Canada (RCPSC) via email
Waiting for results of MCCEE
November 10, 2011:
All the documentation for the Statement of Need in accordance with received checklist was complete at this point, except for certified results of MCCEE.
November 25, 2011:
I received correspondence from the Statement of Need liaison that I was too early to apply for sponsorship for a training program beginning in 2012; however, the liaison kept my application and said I would only have to submit updated information when I reapply in late December/early January.
Jan 3, 2012:
I updated my Statement of Need and resubmitted it to the liaison.
Jan 25, 2012:
The statement of Need was approved.
January 31, 2012:
I emailed training program liaison at the hospital where I would eventually do residency. For me personally, the training program liaison was an assistant in the graduate medical education office, who processed ECFMG applications for all residency programs. In a discussion with her, I was advised to wait until after graduation to contact the ECFMG for clarification regarding the application timeline. This was INACCURATE. KEY POINT: Take charge. It is your life and career. Always be skeptical unless you hear or read something from a direct source. As a “double foreigner” (foreign medical graduate and Canadian), your career path is more complicated, which means you must be proactive to succeed. There is a lot of misinformation out there. If I had waited and listened only to her advice, I would have been in an exceedingly difficult situation.
February 6, 2012:
Having my doubts, I contacted the ECFMG directly regarding the timeline for application and I discovered the application process could be initiated by the training program liaison after a training contract is signed. I did not have to wait for graduation to begin the process, contrary to what I was told. I suspect the liaison was confused because, in my situation of a pre-match, you can initiate the process before graduation, but cannot complete the process until after graduation. Not all programs accept trainees on a J1, and the training program liaison at an institution may have other responsibilities. In short, they may not be as knowledgeable about the process as you would like.
I discussed what I had learned with the training program liaison and the application was submitted. I received a notification from the ECFMG that the application process had been initiated and the processing time would be approximately 4-6 weeks. At the same time, after remitting payment for the application, I received an ECFMG checklist of required supporting documents to be uploaded to the On-line Applicant Status and Information System (OASIS).
February 20, 2012:
I submitted supporting documentation to the ECFMG via OASIS and received confirmations of those submissions.
I then awaited approval of the DS-2019 form (Certificate of Eligibility for Exchange Visitor (J-1) Status) believing my application was complete. Basically, the ECFMG and Statement of Need processes will culminate in this essential form, which allows a foreigner to reside and work in the United States as a trainee. Your training liaison should be in contact with you. He/she will receive and then forward the DS-2019 via mail to you.
March 12, 2020:
I received an email correspondence from my training program liaison that she required ECFMG certificate to complete my application and for the DS-2019 form to be issued (Oops!).
My next step was to wait to graduate then receive and forward the ECFMG certificate to the liaison. As an added precaution and pure anxiety reducing measure, I made sure all my clinical clerkship evaluations were received in timely manner and retained copies for myself.
May 9, 2020:
I received my ECFMG certificate in the mail (I was in Canada at this point). I forwarded the certificate to the training liaison and was informed my application was complete. The training program liaison received the DS2019 and mailed it to my address in Canada.
June 15, 2012:
I received my DS-2019 in the mail, filled out the remainder of the form and signed. If you leave the United States, you must travel with your DS-2019. You cannot renter the US without it. A DS-2019 is renewed yearly in conjunction with training program contract renewal. Save prior DS-2019 forms. You may need them in the future if you are considering a J1 waiver. Hint hint wink wink: I have obtained a J1 waiver in the past and there will be a future blog post.
June 22, 2012:
Packed and ready!
As an Ontarian, I went to the Toronto Pearson airport and presented my DS-2019 to the immigration officer and stated that I was starting a residency training program in the United States. Not surprisingly given my tortuous path, he was utterly dazed and confused and sent me to secondary inspection, which eventually issued an I-95 departure/arrival record after informing me that I should not have been sent to secondary inspection (*sigh). After this minor hiccup, I was headed to the United States with DS-2019 in hand to start residency. Hooray!!!
Reference for employers considering sponsoring a J1 visa candidate:
