The Time Between
I am hoping that one day this article becomes a thing of the past, where all States have waivers for forensic pathologists in place and one can apply for such waiver in fellowship and have a smooth transition into their career without having to deal with moving. It is still a long road ahead, but a lot of progress has been made with several states recognizing the need for forensics to be on the list of needed specialties on the CONRAD 30 list.
If you find yourself in a situation where you do have to leave the United States to wait for a waiver, the following article will take you through my experience as well as some general, helpful tips on what to take with you.
During my fellowship year, I found it very overwhelming to find a position in forensics and navigate the United States Immigration process, so I decided to consult a law firm who specializes specifically in immigration for physicians (Siskind and Susser). During those phone and email conversations, I came to learn that there were historically only three States that had sponsored a forensic pathologist, however, there was no one in recent times that had sponsored. I was not sure how I was going to proceed, aside from contacting the J1 liaisons of those States and when I did, the responses I received were of generalized confusion.
I had to think fast and hustle, so I decided it would be best to attend the National Association of Medical Examiner’s conference which occurs annually in October. I was hoping to get my name out there and get some contacts to help me work through this process. Fortunately, I did find a county that was willing to go through the sponsorship for the first time; however, that sponsorship took 18 months to establish, despite them starting in my fellowship year (we started the process around November/December of 2016). I found myself without at job at the end of fellowship and an unknown probability of being successful at attaining and attending this job offer. So how did I survive 8 months of unemployment while waiting for a visa? Keep reading to find out!
The important thing is to prepare for the unknown prior to leaving the country and the way to do that is to budget. At the time that I started this journey in residency, I did not know if I was going to end up practicing in Canada or the USA, nor did I know how much money it would cost for the whole process, so I decided against investing in retirement funds for all of residency and fellowship. I had about $30,000 in my bank account at the time of graduation and had to find creative ways to make that money last for an unknown period (which turned out to be 8 months).
COBRA coverage
Since I was still on a J1 visa as a trainee in fellowship, I had the ability to file for an extension to write the boards through the ECFMG sponsorship . One could consider risking not having health care coverage for 4 months but that also depends on if you are in a state that will serve you a penalty (cost vs benefits must be assessed in your own personal journey). I did take on the health care coverage because I was driving my car across the country via the Southern Route from Southern California to New Jersey and did not want to risk a calamity in the desert. Out of state COBRA coverage is significantly more expensive than in state COBRA coverage and at the time, for the 4 months that I spent in the USA, I used $8,000 of my $30,000 just for health insurance.
Moving back to Canada
After moving to the USA in 2010, I accumulated quite a few things even though I had moved every 1-2 years and although I had a one-bedroom apartment of accumulated items, I was not sure if I needed it or not and opted to store it rather than starting all over as I had a limited budget. Storage of my items cost $177.50 per month, and I used that service for 8 months. I also opted for full insurance coverage but did not know that if any of my items were damaged, etc. that you could not ask for a replacement item. Instead, the insurance company decided what course of action they would take.
For example, when I finally moved to Wisconsin and had my belongings transported from California, my couch ended up smelling horrible. The insurance company decided to send someone to spray it with heavy perfume/cleaning which only rid the smell for a week. I called again and they pursued the same course of action, despite me asking for a replacement couch. I eventually pulled out all the stuffing from the couch and replaced it and the smell was gone. That was a lesson learned to not get full insurance coverage or to fully do your research and not assume that an item that was damaged will be fully replaced with something new (read that fine print!).
I made the best of my move by touring the USA in my 2010 Honda civic (which I still own and drive, to this day) and stopping off to see the cool sights that the United States has to offer. So, what did I bring that I could stuff in my little civic? Well, anticipating the future is not my forte, but I carried everything that I thought I would need for not only living with my now husband (boyfriend at the time) and living with my parents in Canada but also what I would need in a bare apartment in Wisconsin:
1) Spare car key (in case I lost my original)
2) All immigration documents, including all documents that could identify me as me (anything personal that would be a pain to replace from your home country)
3) All original diplomas
4) Clothing for a week (I also took work out clothing with me too as my husband purchased a gym membership for me for the 4 months that I was living with him)
5) A small sauce pot
6) A small frying pan (you can make toast on a frying pan!)
7) Disposable forks, spoons and knives, cups, and mugs (you can wash the plastics for reuse!)
8) Dish soap and sponge
9) A blow-up mattress with pump, pillow, and sleeping bag (the same one I used in medical school for on call nights because those rooms were cold!)
10) Essential toiletries (hairbrush, toothbrush and paste, a hair tie, soap, shampoo, conditioner, etc.)
11) Cash: I did not keep a large amount on my person as I mostly used my credit card
12) Moving contract from your moving/storage company (this becomes incredibly important when crossing the border)
13) Your phone and charging cord
Although this is not an all-inclusive list, it gives you an idea if you choose to keep certain items with you and your location is within driving range. If you must fly home, you still may be able to pack these items in one or two suitcases or pack a portion and buy the rest upon your return.
Remember in that list above, I said that the moving contract was important? When I crossed the border from the USA to Canada, I told the border agent that I was returning home and waiting for a work visa to be approved. I did not realize that I needed a rather detailed list of all the items I had left in the United States. I was told (very sternly) that I had to pull over and fill out a form that documented in detail all the items that I had in storage.
When you are preparing to pack your items or have them packed, be sure to have a general idea of what things you have (“clothing” is good enough and in how many boxes) but be as detailed as you can to avoid wracking your brain at the border.
One of the upgrades that I decided on was a new and bigger bed to purchase on my return to the USA and got rid of my twin mattress which saved room (and money) in storage. During my time at my parents’ house in Canada, I had also bought suit jackets and blouses to wear for my new job as that was a requirement of the office (unfortunately, they did not offer a stipend to pay for the clothing like you would find in the private industry in other professions).
Another issue that I had encountered at the border was my car. My Civic, I came to learn, was originally manufactured in Canada, and exported to the USA where I purchased it. Because it had air conditioning, I had to pay an Air Conditioning tax of importation (approximately $300-$400) at the border and had a sticker placed on the driver side door jam of my car. I then had 45 days to register my car with Ontario to make it legal to drive, otherwise face exportation. I decided to not drive my car and use my parent’s car to run any errands/see friends/go to the gym, etc.
While in Canada, I had to pause my Verizon phone service in the USA so I would not be paying for their services while my phone was not in use. Using my phone in Canada would have cost a fortune for “traveling/roaming” and I ended up setting up a cheap line with FIDO and switching out the SIM card for use in Canada. Interestingly, Verizon could only hold my phone number for 6 months, otherwise, I would lose my phone number in the USA. Thankfully, I was only in Canada for 4 months so that did not become an issue. I joined a gym for a monthly payment to keep sane and drop all the fellowship weight that I had gained being fueled by donuts during homicide cases (oopsie!).
Once I received the J1 waiver and subsequent H1b visa (February 2018), I drove to Wisconsin with the same friend that did the road trip from NJ to CA and back. I had about $5,000 remaining in my bank account (immigration costs and flying to Florida to write my Forensic board exam took a substantial amount of the $30,000) by the time I started to make a paycheck again. Thanks to my road trip friend for offering for me to live with her in her 600 sq ft. apartment while using my car trunk as my dresser for 2 weeks, living with my husband and parents, I managed to save a lot of money on housing and food.
The time between seems overall mundane and a little annoying but with some preplanning and help from family and friends, the time between can be balanced with some enjoyment of freedom after a long road of training.
