If you plan to do a fellowship in the United States, you’ll need to get a U.S. visa or apply for TN status. What are your visa options, and is one type better than another? Here is an overview of the visas you may be offered, depending on your situation.
H-1B visa lets you stay after the fellowship
The H-1B is an employer-sponsored visa. The biggest advantage is the ability to stay and practise medicine in the United States after you complete your fellowship, although some conditions do apply. However, it’s becoming increasingly difficult to obtain.
Employers must pay for the visa, and the H-1B could cost a few thousand dollars. There are caps for the number of H-1B visas issued in the country, and employers are required to pay a prevailing wage.
To get this type of visa, you have to pass the USMLE® (Step 1, Step 2 CK and Step 3). Your visa is valid for three years initially and can be extended for another three years.
If you’re offered the H-1B, your children under the age of 21 and your spouse/partner can get H-4 visas, allowing them to stay with you for the duration of your status. Your spouse can legally work or start a business in the United States as long as your H-1B visa is valid.
J-1 visa is the most common for fellows
Most programs offer fellows the J-1 visa, which is a type of “exchange visitor visa” sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG).
The ECFMG issues Form DS-2019, “Certificate of Eligibility for Exchange Visitor
(J-1) Status” in conjunction with the school. You will have to pay the SEVIS fee (currently US$220) though some schools may cover the cost.
Tip: Include this fee in your negotiations or ask about the program covering the cost.
To be eligible for the J-1 visa, you have to pass USMLE Step 1 and Step 2 CK (or equivalent). One benefit of this type of visa is that spouses can seek employment authorization — something the other visas don’t allow.
With the J-1 visa, there’s a two-year home-country physical presence requirement: after you complete your fellowship in the United States, you must return to Canada for at least two years before you are eligible to work in the United States again. (The intention of this exchange visitor program is for foreign nationals to gain new ideas and then return to their home country to share that knowledge.)
It’s possible to get a waiver and avoid the two-year home-country physical presence requirement, but it’s extremely difficult to do so. Each state is allowed five waivers per year for specialist occupations under the Conrad 30 Waiver program.
O-1A visa admits those with extraordinary ability
The O-1A visa is for foreign nationals with extraordinary ability in the sciences, arts, education, business or athletics — defined as “one of the small percentage who have arisen to the very top of the field.” If you’re involved in research and have articles in journals, or have spoken at conferences, you could qualify for the O-1A visa.
Your employer has to file a petition on your behalf along with the required evidence. The initial period of stay is up to three years, with a possibility of extensions for up to one year. The visa expense is paid by you, not your employer. International medical graduates, and those who haven’t completed all of the USMLE steps might be good candidates for this visa. Spouses of O-1A visa holders can accompany their spouse on an O-3 visa but cannot work in the United States or anywhere else in the world.
TN status allows for research or teaching
The TN (Treaty NAFTA) status allows qualified Canadian citizens to seek temporary entry into the United States to engage in business activities at a professional level. As a Canadian citizen, you don’t need a TN visa — you can apply for TN status at U.S. ports of entry or U.S. preclearance facilities with the required documentation. However, it is likely that the fellowship program will require your visa documents in advance, creating a requirement for you to obtain your TN status prior to entering the country for fellowship.
The TN can be used for fellowships with research or teaching responsibilities, but not clinical work. There are no minimum wage requirements, and you can stay for up to three years.
B-1 visa is suitable for a short-term fellowship
The B-1 Temporary Business Visitor visa lets you into the United States for up to six months and can be used for short-term training and scientific, educational, professional and business conferences.
As a physician, you can observe U.S. medical practices and consult with medical colleagues on techniques while on this type of visa. You cannot provide patient care in the United States or receive compensation from a U.S. source. Your spouse can accompany you under their own B-2 visa for tourism but they cannot work.
Have a sound plan before you leave for fellowship
When applying for a fellowship match in the United States, find out what kind of visa your program is willing to sponsor.
Once you’ve been accepted into fellowship and arranged your visa, there are many other important factors to consider:
- Which country do you have to pay tax to?
- What insurance do you need for your stay in the United States?
- Will you have any investment constraints while outside Canada?
It’s important to have a sound plan before you leave and when you return to Canada.
Contact Melissa Allan today. Melissa is an MD Advisor* with extensive geographical licensing who works with tax and accounting partners to get you the information and advice you need throughout this transition period in your life.
*MD Advisor refers to an MD Management Limited Financial Consultant or Investment Advisor (in Quebec), or an MD Private Investment Counsel Portfolio Manager.
The above information should not be construed as offering specific financial, investment, foreign or domestic taxation, legal, accounting or similar professional advice nor is it intended to replace the advice of independent tax, accounting or legal professionals.