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RESIDENCY IN THE US

In order to enroll in residency in the United States, whether AOA or ACGME, you will need a new visa. There are two possible visas for this:

 

H-1B VISA
J-1 VISA

 

ACGME residencies are much more likely to issue visas than AOA residencies, and since ACGME residencies are required to practice in most of Canada these are the programs you will be interested in. Not all ACGME programs will issue a visa, so it is important to contact each program you are considering to get their policy in this regard. Do not apply to hospitals that don’t sponsor visas. Usually this information can be found on the residency program website. 

 

Here is the bottom line: You will need either an H1B or J1 visa to pursue residency in the US. The preferred visa is H1B because it allows you to get a green card and work in the US upon graduation from residency. It also allows you to moonlight in your residency program. The downfall is that many programs do not sponsor them because they are expensive (and no, you can't pay for them - by law). If you are fortunate enough to be sponsored an H1B for residency, you will complete your first year of residency on an OPT-visa. This visa is an "extension" of your F1 visa. Your school will help you with this. You must complete your first year on this visa because in order to get an H1B, you must have completed COMLEX Level III, which you can not take until your PGY-1 year. You will begin your PGY-2 year on the H1B visa.

 

The other option is a J1 visa. These visas are sponsored by almost every residency program. To get a J1 visa, you have to get a statement of need from Health Canada. Basically, every year Health Canada releases a list of medical specialties Canada needs physicians in. Each specialty will have a certain number of Statements of Need that Health Canada will issue to Canadians training in the US.

 

More information about each visa is discussed below.

 

H-1B VISA

 

The best visa to be on as a Canadian for a US residency, as it allows the resident to stay in the US for 6 years before needing to be renewed, and opens up the possibility of obtaining a Green Card. Unfortunately, many US residency programs do not offer it, as it is expensive and significantly more paperwork than a J1 visa. The requirements for an H1B visa include having graduated medical school, and successful passage of COMLEX Level 1, 2, 3 OR USMLE Steps 1, 2 and 3.

 

If you are a US medical school graduate, you can do your PGY-1 year on something called an OPT, which is an extension of the F-1 visa that you used to attend the US medical school. OPT stands for Optional Practical Training, which gives you an entire year to get the COMLEX 3 or USMLE Step 3 completed, as well as apply for, and receive your H1B visa. The H1B visa would then go into effect at the start of your PGY-2 year. This OPT year is key, because otherwise, you would need to graduate med school in May, send in COMLEX level 3 or USMLE Step 3 application (requires med school graduation as a prerequisite), take and pass COMLEX 3 or USMLE Step 3 and receive said results, and apply for and receive your H1B visa, all before July 1 in order to start a US internship/residency on time (pretty much impossible).If you can use the OPT year, then the H1B visa becomes a much more viable strategy. The strategy here is to contact each institution prior to applying there for residency, and see if they offer H1B visas. If not, do not apply there. Note that as the competitiveness of a specialty or its location increases, the likelihood of them offering the H1B visa decreases, since they will fill their spots regardless of whether you interview there or not. Conversely, if you are applying for something like Internal Medicine, Family Medicine, Pediatrics, Psychiatry, etc, all of whom are relatively less competitive and often fill their vacant spots with international medical graduates, you are much more likely to ask for, and receive H1B sponsorship. Intermediate difficulty specialties will be somewhere in the middle in their stance on offering H1B visas.The H1B visa allows you to be employed in the US, allows you to moonlight during residency, and also is on the pathway to obtaining a green card, which lets you live and work permanently in the US.After completion of residency on a H1b visa, you must either leave the country or find a new job in the US that will sponsor you for another H1b visa. While on an H1b, you can apply for a green card, the wait times for getting a green card are based on your country of birth (not the country of citizenship), the wait can be anywhere from 2-12 years depending on the country of birth. During the wait, you can continue to work in the US as long as you have a H1b from an employer.

 

J-1 VISA

 

The second option for a Canadian training in a US residency. This visa is a student visa, which means you can not moonlight on it. Additionally, once you finish your training, there is a home residency requirement, which means you need to return to Canada for 2 years before you can reenter the US on a different visa (such as an H1B visa).

 

Ways to get around that include working in a federally or state designated underserved area for 3 years, or working in a government institution (such as the VA hospital) for 3 years. Once you are signed up to a J-1 visa, you cannot convert over to an H1B visa without either fulfilling the home residency requirement, or obtaining a waiver through one of the above two mechanisms. Even marrying a US citizen at that point will not get you past the requirement. Of course, if you married that US citizen and got your green card before starting internship/residency, then you would be set and would not need a visa at all...

 

Alternatively, if you choose a US residency that is recognized as equivalent in Canada, you can take the Canadian Royal College exams, and if you pass them, come back to work in Canada or do a fellowship while simultaneously fulfilling the 2 year home residency requirement. After fulfilling that requirement, if you can find a hospital or private practice group willing to sponsor you for an H1B, then you can reenter the US to work. Otherwise, you can always stay in Canada to practice.

 

The major advantage of the J-1 visa is that the paperwork requirements are much less, and many more residency programs offer the J-1 versus the H1B visa. The J-1 visa requires Health Canada to issue a Statement of Need. You also need to make use of a US organization called the ECFMG, who will act as your J-1 visa sponsor. The ECFMG paperwork is relatively easy. The Statement of Need can be hit or miss, depending on the specialty you want.

 

Starting 2016 all specialties have limited endorsement for statement of needs (SON), this means that canada will only issue a certain number of SON on a first come first serve basis. Family medicine continues to have the largest number of SON. COMSA recommends third and forth year students to check the updated limits every year, they are usually released in august. It is also very important to be familiar with the process and apply for SON on time, the earliest you can apply is the day NRMP match results are released. In the event you match a residency and can't secure a SON, you will not be able to get a J1 visa and start residency. You do not need to apply for a SON every year of residency, it is applied before you start and is valid or the entire length of training. More information about timelines and limits can be found on the health canada website.

 

The Health Canada administrator for the Statement of Need program can be contacted at:

 

Ph: 613-952-1912
Fax: 613-948-8081
j1visa@hc-sc.gc.ca