ECFMG 101: Managing IMG Recruitment Eleanor Fitzpatrick, ECFMG 2011 APPD Fall Meeting Arlington, Virginia

ECFMG 101: Managing IMG Recruitment Eleanor Fitzpatrick, ECFMG 2011 APPD Fall Meeting Arlington, Virginia

Learning Objectives Review what you need to know when recruiting IMGs and foreign national physicians: I. The Non-negotiables: ECFMG Certification Legal immigration status to train J-1 regulations and ECFMG process II. Other Challenges, Benefits, and Global Opportunities

Applicant Pool for Pediatrics U.S. Grads (MDs & DOs) = Diploma + USMLE and/or COMLEX U.S. Citizens, Canadians*, Other Foreign Nationals* Canadian Grads = Diploma + MCEE and/or USMLE Canadian Citizens*, U.S. Citizens, Other Foreign Nationals* International Medical Graduates (IMGs) = ECFMG Certificate U.S. Citizens, Canadian Citizens*, Other Foreign Nationals*

Typical Pathway into U.S. GME 1. Medical School Graduation Complete ECFMG Certification, if IMG 2. Apply for U.S. Residency Training Position Apply via ERAS Interview with programs Enroll in the NRMP Match Secure a contract / letter of offer Obtain the appropriate visa / visa status, if foreign national physician

ECFMG Certification All international medical graduates (IMGs) who receive a basic medical degree from a medical school outside of the United States or Canada must be ECFMG certified to enter U.S. GME. IMGs can apply and Match to a GME program with passing scores on USMLE Step 1, Step 2CK, Step 2CS To begin GME, the final diploma & transcripts must be primary source verified and the ECFMG certificate must be issued

ECFMG Certification Requirements http://www.ecfmg.org/cert/index.html Medical Education Credentials Complete 4-year medical school curriculum School & graduation year listed in IMED http://imed.ecfmg.org *By 2023 medical school must be accredited ECFMG primary source verifies final diploma & transcripts USMLE Exams Step 1 Basic Science Step 2 Clinical Knowledge (CK) Step 2 Clinical Skills (CS)

Legal Immigration Status All foreign national physicians must obtain an appropriate U.S. training visa / visa status before they are permitted to begin GME training Visa entry document stamped in passport Visa Status reflects the approved activity associated with each visa type and the length of authorized stay in the United States

Visa - Permit to Enter United States Issued by U.S. Consulate abroad and stamped in passport Expiration date applies to use for U.S. entry only Can expire once in the United States

Visa Status - Approved Activity Issued by Customs & Border Patrol at U.S. port-of-entry (I-94 card), or Regional Service Center of U. S. Citizen and Immigration Services (USCIS) as Change of Status (I-539)

Most Common Visas for U.S. GME J-1 Alien Physician ECFMG sponsored USMLE Steps 1, 2CK, 2CS, 2 yr home physical presence requirement, SEVIS tracking, 7 yr max H-1B Specialty Worker Employer sponsored USMLE Steps 1, 2CK, 2CS, 3, fees, no service obligation, 6 yr max J-2 Dependent Employment Authorization Document (EAD) Spouse of J-1 visa holder, tied to timeline of J-1 principle F-1 Student Optional Practical Training (OPT) One year extension only sponsored by U.S. Medical School

J-1 Requires Home Country Support J-1 Statement of Need - Central Ministry of Health There currently exists in (country) a need for qualified medical practitioners in the specialty and/or subspecialty of Pediatrics. Dr. (Applicant) has filed a written assurance with the government of this country that he will return to his/her country upon completion of training in the U.S. and intends to enter the practice of medicine in the specialty/subspecialty being sought. MUST FOLLOW REGULATORY LANGUAGE

J-1 Imposes Two-Year Home Residency Requirement INA 212(e) All J-1 physicians (and J-2 dependents) are obligated to reside in the home country for at least two years before being eligible for certain changes or adjustments in U.S. visa status (H, L, K, or green card) J-1 /J-2 physician couples hold one obligation which must be fulfilled by the J-1 principle Marriage to a U.S. Citizen does not waive the obligation J-1 waivers are available through state and federal programs; most common are Conrad 30 employment in MUAs/HPSAs or VA

J-1 Researchers & GME Positions Foreign national physicians often enter the United States initially as J-1 research scholars to gain experience and take the USMLEs If a clinical GME position is secured, they have to work with ECFMG to request a Change of Category from J-1 research to J-1 clinical through the U.S. Department of State In some cases they may be H-1B eligible 13

J-1 Change of Specialty / Repeat Years J-1 physicians are permitted to change medical specialties only once within their first two years in J-1 status J-1 may repeat up to twelve months of GME training for remedial purposed

J-1 Sponsorship Applications J-1 physician + GME program (Training Program Liaison / TPL) 4-6 weeks to review applications ECFMG Regional Advisor evaluates for eligibility If approved, SEVIS Record is created and updated ECFMG issues Form DS-2019 ECFMG notifies applicant via e-mail, provides instructions for obtaining J-1 visa status

J-1s Tracked in SEVIS Student and Exchange Visitor Information System 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 physicians and J-2 dependents

Form DS-2019 ECFMG-issued Certificate of Eligibility for Exchange Visitor (J-1) Status Legal document needed to apply for J visa/visa status Reflects electronic record SEVID ID (N000######) assigned to all J-1s and J-2s

Applying for Initial Visa Status Option 1: Apply at US Embassy or Consulate abroad Option 2: Apply for Change of Visa Status within the U.S. (I-539 process USCIS Regional Service Center) https://egov.uscis.gov/cris/processtimesdisplayinit.do

Initial Arrival in J-1 Visa Status J-1 Physicians May enter United States 30 days prior to training start date listed on contract and SEVIS DS-2019 Program must confirm physician s arrival in J-1 status to ECFMG within 30 days of SEVIS start date or record will deactivate ECFMG in turn validates the SEVIS record Application for Social Security Number requires SEVIS validation plus 10 days from date of U.S. entry

Maintaining J-1 Visa Status Continued full-time participation in GME Contract to progress in training Timely renewal of ECFMG J-1visa sponsorship Required reporting of any change in approved training plan Remediation, leave of absence, off-site rotations, transfer request, change in contract dates, resignation or termination, etc. J-1s do not need to renew visa stamp annually

EVNet On-Line J-1 Sponsorship Application Will replace sponsorship application forms TPLs will use on-line application to submit: Contract details Requests & notifications re: leaves of absence, travel validations, request to add non-standard & research programs, etc. View reports on currently sponsored J-1 physicians by program, sponsorship expiration dates, etc. Applicant physicians will be able to submit on-line information Biographic information & provide supporting documents Stay Tuned for Dates & Details on System Roll-out

Issues & Opportunities IMGs & Foreign National Physicians in GME Communication: language, accents, idioms, ideas Behavior: learning styles, supervisory roles, gender issues Professionalism: interpersonal skills, patient care, team Personal needs: support, family, religion etc. Diverse / Global Perspective: opportunities, leadership

Questions? efitzpatrick@ecfmg.org (215) 823-2127