Physicians & Biomedical Researchers Employment opportunities in the United states for International Medical Graduates (IMG's) focuses on two areas, the Primary Care Health Services Provider and the Medical Research/Physician. There are some opportunities available for certain sub-specialists in certain areas such as Geriatric Psychiatry. The bulk of this page is devoted to Primary Care Physicians which is defined as Internal Medicine, Family Practice, General Pediatrics and General Ob/Gyn. If you have not contracted with the ECFMG for sponsorship under its J-1 Waiver program, and you are ECFMG certified, you should consult an experienced Immigration Attorney before undertaking any action related to a visa for the purpose of undertaking post graduate medical training in the United States. Careful initial planning early on may prevent many problems from arising in the future. If you have already accepted sponsorship from the ECFMG, you are subject to the two year home residence requirements before becoming eligible for an Immigrant Visa or another type of nonimmigrant visa (except for an O-visa). One means of avoiding a potential career ending two year absence from United States medical practice is to obtain a waiver of the §212(e) requirement. Generally speaking this is accomplished by finding an interested government agency (IGA) to sponsor your request for waiver to the United States Information Agency (USIA) which in turn requests Immigration and Naturalization Service to grant the sought after waiver. By far the most utilized method is to contract with a Health Care Provider in what has been determined to be a medically under served area. This can be either rural or urban in nature, and also determinative of the selection of IGA. Currently IGA's which may sponsor a waiver request may include Department of Agriculture (USDA), Department of Commerce (DOC), Department of Veterans Affairs (VA), Department of Defense (DOD), Department of Health and Human Services (mostly researchers) (HHS), Appalachian Regional Commission (ARC) and individual State departments of Health (limited to 20 per year per state). The selection of an IGA may depend upon the location of your practice. All of these IGA's require service for three years with a H-1B visa prior to being eligble for an immigrant visa, with rather severe penalties for early departure in the nature of automatic revocation of the waiver previously granted. Please note that ARC and some states under their Conrad 20 programs will not accept Physicians who have either completed sub-speciality training and are board eligble, or are board certified in a sub-speciality. Some IGA's will not sponsor applicants if it falls within a geographic area served by ARC. Some agencies are concerned with the early departure of waiver recipients from their agreed practice location. If you choose to proceed with this avenue of approach, you should be prepared to honor your commitment. Doing less could affect not only you, but those who follow. The Process 1. Find a job in a predetermined medically under served area. 2. Determine which IGA is actively participating in waiver programs in that area. 3. Comply with all IGA requirements in providing documentation necessary to that specific IGA in its application package. 4. Submit your application and wait - usually months. Some individuals attempt this process without qualified assistance, and some of those succeed. Errors of ignorance can sometimes be very difficult to overcome, so it is suggested that competent legal assistance be obtained prior to undertaking any Immigration action. Once the J-1 waiver is granted, it will be necessary to change the nonimmigrant H-1B status for a period of three years. There are two options available for those who wish to stay in the United States. Either go through the Labor Certification process or seek a National Waiver. ILC has successfully obtained such national interest waivers for primary care Physicians and Geriatric Psychiatrists working in HPSA designated medically under served areas. The labor certification process takes about eighteen to twenty four months (Alabama), while the national interest waiver can take two to four months.