If you are an International Medical Graduate (IMG) looking for elective, research or observerships as part of your USMLE journey, you want to ensure you have the right visa.
The first step to applying for an elective or an observership involves applying to the program, ofcourse.
Once you have received an invitation or acceptance letter from the program or the hospital, the next hurdle is obtaining a visa. Here we discuss the different categories of visas as relevant to IMG physicians. But the focus is not on the post-match (J or H1) visa.
 
Remember it the Discretion of the Embassy/consulate whether to issue or deny a visa. The hospital or the program has no say in it. It can only advice you in the process. 
 
More importantly: Our team does not offer legal advice. This is just an information post. For any specific questions on your case, you may want to seek legal advice.
 
There are three basic categories of visa that you can be issued.

• B1/B2 also called the business class/ tourist visa
• F1 student visa
• J1 student exchange visitor visa (the home rule may apply to this category of visa class. Explained in details later in the article).

APPLYING FOR A VISA- Step by Step guidance

Log into your regional Consulate website (we have used an example from India). The process may vary for different nationalities, so do your due diligence.

1. Determine your visa type by reading Common Non-immigrant Visas . Each visa type explains the qualifications and application items. Choose the visa type that applies to your situation.
2. ​The next step is to complete the Non-immigrant Visa Electronic Application (DS-160) form. All information must be correct and accurate. Once the form is submitted, you cannot make any changes. If you need assistance, please consult an immigration lawyer or translator. You will need your DS-160 number to book your appointment. 
3. Once you have determined the correct visa type and completed the DS-160, you must pay the visa fee. The visa fee page lists the visa types and correlating visa fee in US dollars and native currency.
4. You are almost ready to schedule your visa appointment! Now you will need to login to your profile with the same credentials you used to pay your visa fee. Once you are in the system, you will see your dashboard.
5. Click on Schedule Appointment on the left-hand side menu. This will start the process for scheduling your appointment.  
6. You must schedule two appointments, one for the Visa Application Centre (VAC) and one for the visa interview at the Embassy or Consulate.
   1. First, schedule your appointment at a Visa Application Centre. This appointment will allow you to go to one of the five Visa Application Centre locations to have your fingerprints and photo taken. This appointment must be at least 1 day before your visa interview appointment at the Embassy or Consulate.
   2.  Second, schedule your visa interview appointment at the Embassy or Consulate. 

7. You will need three pieces of information in order to schedule your appointment:

• Your passport numbers
• The visa application fee receipt number.
• The ten (10) digit barcode number from your DS-160 confirmation page.

 

•  As you go through the process you will be able to select your visa type, enter personal data, add dependents, select your document delivery location, confirm visa payment, and schedule your appointment.

8. Following your visit to the Visa Application Centre to have your photo and fingerprints taken, you will then visit the U.S. Embassy or Consulate on the date and time of your visa interview. You will need to take along:

• A printed copy of your appointment confirmation letter,
• Your DS-160 confirmation page stamped at the VAC
• Your current and all old passports, Supporting Documents as per your visa type

TYPES of VISA
 

The B1/B2 visa 
 
The most common visa applied by IMG applicants is the B1/B2 visa as it has many advantages. You may also take the Step 2 CS exam with this visa category although there are limitations and the State Department has not provided any direct information about visa category for Step 2 CS.
 
For electives/ observership, the B1 visa is permitted by the State Department. However, remember that this is not always the case. There have been applicants who have been called into second screening during and immigration officers have questioned the validity of this visa class for electives. Be prepared to articulate, explain and show the immigration officer your intend is just for the electives (and you will not receive any remuneration for it). You may state that the State Department website has clearly permitted B1 holders to pursue electives in their FAM manual- the official guidelines to visa classes and process.
 
NOTE: Many immigration officers in the Custom and Border patrol are unaware of this!!!
 
The State Department website has the following information regarding the B1/B2 visa
 
B1: Business associates, travel for a scientific, educational, professional or business convention,
B2: tourism/recreation-non-scientific/business purpose.
 
The B1/B2 visa is usually issued together but it is advisable to Mention the B1 class when applying.
 
Important Tips:

1. the B1/B2 visa class only permits you to stay for six months. Any rotation more than six months is not permitted under the B1/B2 visa class.
2. All activities must be unpaid and you cannot receive any form of payment or work under this class of visa.
3. It is advisable to stay less then six months at all times and extensions may be sought but may jeopardize your future travel to US. 

The F1 visa – (Full time) Student visa

The F1 visa is a student visa and is different from the B1/B2 visa. The biggest advantage of the F1 visa is that it allows you to travel for a complete period time for your study. If, for example, you have applied for an MPH program this is the class of visa you will be applying for. The process is essentially the same for applying however you would need an I20 Form issued and an additional processing fees is required called the SEVIS fees the student exchange and visitor information system.  The fees are 180$ currently but can change.
 
You must show you are able to support your stay and study in the U.S.A when you apply for this class of visa.
 
You may be eligible to apply for a  Social Security Number with this class of visa and also for a US driving licence.
 
There is no home rule or “2-year rule that applies for a student visa”.
Please note you must be enrolled in a full-time course and there are limitations to how many working hours you may be permitted to work in on a student visa. If you are applying for only electives, observerships or any other hands-on experience from outside US, you are not eligible for this visa.


The J1 visa – The student exchange visitor Visa

This is also the  “residency visa for physicians" in many cases (The residency programs mainly offer this class of a visa or the H1B visa). It has the two-year home rule- which means you must return to your home country or country from where the visa is issued and upon return and for two yearsyou will be ineligible to apply for another class of visa - the State department website does allow waivers application under certain circumstance and most IMGs after residency will file apply for waiver jobs.
 

There is an exception to the rule which you should know as you apply for research jobs.

Many IMG applicants to residency programs also secure this visa for research jobs (prior to residency). 
A special class of visa for medical researchers who are not under the 2-year rule can be permitted in a few cases.
If you get a ‘research J1’ Please make sure no two-year rule annotations are made on the visa sticker once you have received it.  The application process is essentially the same. However instead of an I20 you will receive a DS2019 form that will be approved by the Department of Homeland Security and you will need this form to pay your SEVIS fees and apply for the visa.
 
You may apply for a Social Security Number with this class of visa and will be eligible to even apply for a driving licence.
 
J1 can be a tricky visa specially for IMGs seeking research positions, please be sure to talk with the immigration and legal department prior to applying for this visa.
However, majority of J1 visa are approved and this remains the best visa to get approved.
 
As mentioned above once you secure your USMLE residency spot, applicants may apply for a J1 waiver in the USA and will be eligible to remove the 2-year home rule conditions.  
 
It is best advice to read the guidelines from the FAM manual of the State Department to be well versed with which class of visa is best suited. Read below for some important sections from the FAM manual. Remember every country will have different wait times and delays in visa processing its best to apply early.

Good luck in your visa application. 

THE FAM MANUAL ON THE B1/B2 VISA CLASS:
 
(Copy from the official FAM Guidelines).
FAM 402.2-5(E)(3) (U) Clerkship
(CT: VISA-412; 07-21-2017)
a. (U) Except as in the cases described below, aliens who wish to obtain hands-on clerkship experience are not deemed to fall within B1 visa classification.
b. (U) Medical Clerkship:  An alien who is studying at a foreign medical school and seeks to enter the United States temporarily in order to take an “elective clerkship” at a U.S. medical school’s hospital without remuneration from the hospital.  The medical clerkship is only for medical students pursuing their normal third- or fourth-year internship in a U.S. medical school as part of a foreign medical school degree.  (An “elective clerkship” affords practical experience and instructions in the various disciplines of medicine under the supervision and direction of faculty physicians at a U.S. medical school’s hospital as an approved part of the alien’s foreign medical school education.  It does not apply to graduate medical training, which is restricted by INA 212(e) and normally requires a J-visa.)
c.  (U) Business or other Professional or Vocational Activities:  An alien who is coming to the United States merely and exclusively to observe the conduct of business or other professional or vocational activity may be classified B1, provided the alien pays for his or her own expenses.  However, aliens, often students, who seek to gain practical experience through on-the-job training or clerkships must qualify under INA 101(a)(15)(H) or INA 101(a)(15)(L), or when an appropriate exchange visitors program exists (J). 
FAM 402.2-5(F)(3) (U) Medical Doctor
(CT: VISA-288; 02-22-2017)
(U) A medical doctor otherwise classifiable H1 as a member of a profession whose purpose for coming to the United States is to observe U.S. medical practices and consult with colleagues on latest techniques, provided no remuneration is received from a U.S. source and no patient care is involved.  Failure to pass the Foreign Medical Graduate Examination (FMGE) is irrelevant in such a case.

Every one of us want to be compassionate pioneering doctors that bring a difference in the society in their own way. The method to decide the optimum route to that ideal depends on how we paint the image of such a Doctor. Is it with innovate hues of research, colors of compassion for patient care etc. Our priorities of how we see ourselves in the future is highly important to decide this path. Each country has its own set of positives. Some international educational hubs include USA, UK, Singapore, Australia. If one ventures abroad its always to learn something new so that they can make a difference back home and the world at a large scale. 
Steps to decide that include:
1. Setting up priorities: how do you envision your future, where your passion lies. Some particulars to consider include diversity of patients, clinical exposure, research potential, fellowship prospects while balancing one’s personal life.

2. Research: if research is something close to someone heart they need to analyze research potential along their education. Pioneer institutes in U.S.A. and U.K. provide platforms for cutting edge research with appropriate technology and support in form of grants for deserving candidates.

3. Quality of education is a very important factor. This along with clinical exposure in terms of quantitative and qualitative patient exposure is highly important.

4. Match rate: the degree of acceptance of international students is important to consider.This varies for each specialty in different countries and it would not be proper to generalize it into one statement. It can vary across surgical and medical branches.
This can be analysed by looking into appropriate match statistics provided by international bodies for their programs.
Some of these include:

1. A) For U.S.A.: Match data provided by National Resident Matching Program (NRMP) is an ideal way to analyze it the match rate in the specific specialty of  your choice. (http://www.nrmp.org/main-residency-match-data/)
2. B) For U.K.: Competition ratios can be looked into, which provide a measure of approximate no of candidates for a seat available in the said specialty.  (https://specialtytraining.hee.nhs.uk/Competition-Ratios)

5. Clinical exposure: number of cases and degree of clinical exposure and clinical experience available. This is based on the setting university hospital/private hospital and further streamlined based on the logistics of the hospital one gets the opportunity to learn in.

6. Acceptability of current education: It is important to research the validity and acceptance of your current educational qualification in the 'registrable' degrees register of the country you want to study in. You should check that your medical school is a part of world directory of medical schools which is generally widely accepted.  (https://www.wdoms.org/)

7. Prospects for fellowship: is important to be considered if one wants to specialize in a particular field to gain expertise. Countries like U.S.A., U.K. and Australia provide unique fellowship opportunities leading to exposure to latest medical advancements which add as a valuable skill set once you return to your home country. One must also ensure that if one has completed post-graduation/residency in one’s home country then international institutions that have formal affiliation with one’s home school offer a potential bright pathway to pursue further higher academic opportunities like clinical physician observerships and fellowships.

8. Value upon returning to home country: is a factor that needs to be considered. As bringing a new skill set and most importantly acceptability of the international qualification/ degree is highly important in the place you want to settle. For example, for India one must check the list of recognized post graduate/residency qualifications.
 
9. Experience of seniors: is like the guiding torch to decide the pathway. Discussion with seniors who are studying abroad or have returned home after their international education is important to understand the social and economic factors which play a vital role besides the academic aspects. It helps chalk out possible routes and academic opportunities besides providing unflinching emotional and moral support.
All the best!

Dr. Nitya Beriwal, USMLESarthi's campus ambassador from Lady Hardinge Medical College, New Delhi, wrote this informative post.