Internal Medical Graduates (IMGs) seeking to practice in the United States must undergo further U.S. training. This graduate medical training is typically completed in either J-1 or H1B status. Prior to admission to such programs, IMGs often enter the U.S. in B-1/B-2 visitor status for required testing and/or observerships. Other IMGs may initially enter the U.S. as F-1 students or to work in nonclinical J-1 research or other programs.

Physicians who wish to remain in the United States permanently, once their residencies and fellowships are complete, face a number of additional options and hurdles. Those in J-1 status are subject to the two-year home residency requirement, which must be met or forgiven through a waiver. This is necessary in order for the physician to be eligible to obtain either H1B or permanent resident status. As with any other occupation, physicians may pursue permanent residency through the employer-sponsored PERM labor certification process. Physicians also may pursue permanent residency via the physician-specific National Interest Waiver (NIW), which requires five years of service in designated underserved areas in the U.S. or with the Veterans Administration medical facilities.


All options require appropriate testing and licensing, which differ for each category. Requirements common to all are:

Nonimmigrant (Temporary)

Subject to limited exception, all clinical options require passage of the Test of English as a Foreign Language (TOEFL). All clinical options also require credentials screening through ECFMG and possession of the ECFMG certificate.

  • All participants in graduate medical training must meet state licensing requirements.
  • H1B petitions for IMGs may be filed by any qualified residency or fellowship program. H1B qualification requires completion of all three USMLE steps.
  • All J-1s for clinical training of IMGs are sponsored by the Educational Commission on Foreign Medical Graduates (ECFMG). The J-1 requires completion of United States Medical Licensing Exam (USMLE) Step I and II.
  • J-1s seeking waiver of the two-year home return requirement most commonly do so via the Interested Government Agency (IGA) waiver. This type of waiver requires three years of full-time service in designated underserved areas in the United States.

Permanent Resident

  • Former J-1 physicians must comply with the two-year home return requirement or complete waiver requirements in order to be eligible to obtain permanent resident status.

How We Can Help You

  • We at the Murthy Law Firm are available to consult and strategize with physicians and their employers on short-term and long-term immigration options.
  • We represent physicians in the Interested Government Agency waiver process, including Conrad 30 waivers, and have been successful with J-1 hardship waivers, and can advise on eligibility and providing representation where appropriate.
  • Our attorneys have extensive experience with physician-specific H1B issues, including cap exemptions and transitioning from cap-exempt to cap-subject employment.