Processes & Procedures for International Medical Residents & Clinical Fellows
Table of Contents
International Residents and Clinical Fellows (Visa Types: J-1 ECFMG)
International medical residents and clinical fellows (i.e., international physicians) enter the U.S. as non-immigrants for the purpose of receiving advanced medical training. Due to the clinical nature of their duties, international residents and clinical fellows enter the U.S. on very strict visas. Almost all enter on the J-1 Exchange Visitor Physician Program sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). International physicians participating in J-1 ECFMG sponsored programs are allowed to participate in such programs for a maximum of seven (7) calendar years, provided the training programs are accredited by the American Council for Graduate Medical Education (ACGME). This 7-year period, however, is not guaranteed and remains contingent upon approval from the ECFMG. Immediate dependents of J-1 international physicians arrive as J-2s.
On very rare occasions, an international resident or clinical fellow may enter the U.S. in H-1B1 status as a non-immigrant worker. At this time, The Johns Hopkins University School of Medicine policy requires the J-1 ECFMG visa be used for international physicians.
Invitation
Departments or divisions wishing to invite international residents and clinical fellows must first contact the OIS. All international residents and clinical fellows must be ECFMG certified in order to process their visa paperwork (Exception: Canadian Medical Graduates). Additional materials such as Ministry of Health letters from the home countries are also be required. Because the process is complex, departments and divisions must work closely with OIS staff to ensure that correct procedures are followed. For more detailed information about the invitation process, including a checklist of materials that must be submitted to the OIS and/or to the ECFMG, click HERE.
When the paperwork for incoming international residents and clinical fellows is complete, the OIS staff will forward the paperwork to ECFMG for review. If there are no problems, ECFMG will issue an IAP-66 Form for each incoming international physician. However, often ECFMG will "follow up" with additional questions pertaining to proposed training programs (especially in cases where the training programs are not ACGME-accredited). In such instances, ECFMG will only issue the IAP-66 Form once the questions are answered. ECFMG will then send these forms to the OIS Liaison who, in turn, will send them to the international physicians overseas. Supplemental information is included in the mailings about consular processing and U.S. health insurance obligations under the J-1 ECFMG program.
Once international physicians receive their Forms IAP-66, they present the documents to a U.S. Consulate or Embassy in the home country to obtain the appropriate visa stamps to enter the U.S.
NOTE: ECFMG will only issue Form IAP-66s in one year increments. Most likely, international physicians will need to extend their forms while in the U.S.
All correspondence regarding visa issuance with ECFMG must come through the OIS-ECFMG Liaison. Do not send completed paperwork to ECFMG directly.
H-1B1 visas require that international fellows be paid by The Johns Hopkins Medical Institutions.
If departments or divisions have compelling reasons to request an H-1B1 visa instead of a J-1 visa for international physicians, special permission must be obtained from the School of Medicine Dean's Office. The filing process for H-1B1 visas can take up to 4 months and requires extensive paperwork from international physicians and departments or divisions. Close contact with the OIS is essential. If a department or division is interested in pursuing this exception, please contact the OIS immediately.
Arrival
When international residents and clinical fellows arrive at The Johns Hopkins Medical Institutions, they must check in with the OIS located on the 1st Floor of Reed Hall, 1620 McElderry Street. During check in, the OIS staff reviews the visa documents and provides a brief orientation, discussing visa responsibilities while in the U.S.
Extenstions
IAP-66 visa documents issued by ECFMG contain expiration dates.
If an international physician anticipates that the program will last beyond the expiration date stated on the IAP-66, the physician must apply to ECFMG for an extension of visa status. Approximately three months prior to the IAP-66 expiration date, ECFMG will contact the OIS-ECFMG Liaison with extension documents. The extension process is complicated and requires the assistance of the international physician and the department or division. The process must be completed in full before the visa documents expire. For more detailed information about the extension process, click HERE.
Severe penalties exist for international physicians who do not extend their documents in a timely manner.
The H-1B1 clinical visa may also require an extension. Like the J-1 ECFMG extension, the process is complicated and requires the assistance of the international physician and the department or division. The process for an H-1B1 extension can take up to 4 months to complete and must be completed in full before the original visa documents expire.
Whenever possible, departments and divisions should help international residents and clinical fellows complete their extension documents in a timely manner.
Changes in Program
International residents and clinical fellows may not change programs without authorization from ECFMG. If a department or division becomes aware of an international resident or clinical fellow who plans to change programs, refer the international resident or clinical fellow to the OIS immediately.
Employment Issues
International residents and clinical fellows are strictly limited in their employment opportunities while in the U.S. They may only engage in employment related to their programs at the institutions stated on the IAP-66s. Engaging in unauthorized employment in the U.S. is a serious offense and can result in severe penalties, including deportation.
"Moonlighting" and billing are not allowed under the J-1 ECFMG program.
Issues of dependent employment must be addressed individually by the OIS.
For information on payroll procedures and tax issues related to international students, simply click on the appropriate link.
