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To Serve in America

The Hospitalist. 2007 December;2007(12):

He had been waiting a full year for the J-1 visa waiver, which allows IMGs to remain in the U.S. in exchange for five years of service in an MUSA. But, he also liked teaching and was attracted to the opportunity to pass on a legacy to the junior residents and incoming interns. He elected to proceed with the waiver because it offered the opportunity to “stay here in the States and to be able to practice medicine for good.”

Born in the Philippines, Dr. Fajardo says his family was wary about his locating to a remote area in Mississippi—but he wasn’t. “When I make a decision, I go for it 100%,” he says. “In everything I do I always do my best and leave the rest to God. I was very fortunate to find out that the community was very involved in and engaged with my waiver.

“Also, to my surprise, I didn’t feel discriminated against at all. They made me feel like I’m a part of the family. There is a strong sense of community here, indeed. The only problem then was, of course, being in a small town, that whatever you do, everybody knows about it.”

Although Dr. Onunkwo moved to Wausau, Wis., a small town in a predominantly white area, he says it was not difficult for him to adjust to life there. Part of the reason, he says, is that his first overseas experience was in Ireland, where he obtained a diploma in tropical medical at the Royal College of Surgeons in Dublin and practiced in a small village nearby. In addition, he and his wife were together in Wausau. “It was probably easier for both of us because we had each other,” he says.

And then there were their great neighbors, says Dr. Onunkwo. ”They made the transition seamless,” he says. “We have formed lifelong relationships with some of our neighbors in Wausau.” The strength of those relationships became apparent on Christmas Day 2005. “They really don’t know what they have done for us,” Dr. Onunkwo recalls warmly. “When we were going through our travails, they knew something was wrong, but we didn’t tell them exactly what we were going through. They made our day for us, because they just rang our bell and here they had the three-course Christmas dinner for us.”

Dr. Patel

Know Your Visas

To enter a residency program in the U.S., an IMG must pass steps one and two of the U.S. Medical Licensure Examination, then the Clinical Skills Examination. To obtain legal visitor status, most IMGs apply for:

  • J-1 visa: This is administered by the INS and allows an IMG to complete residency training at an Educational Commission for Foreign Medical Graduates-accredited program. If the IMG brings a spouse or other dependents, they usually obtain a J-2 visa. The J-1 visa carries a requirement that an IMG return to his or her native country for two years following completion of residency. Many IMGs want to remain in the country, which is why they often make use of the J-1 visa waiver.
  • J-1 visa waiver: This is a mechanism that allows IMGs to stay in the country and eventually apply for permanent status in exchange for five years of working in a medically underserved area. New post-9/11 restrictions of J-1 visas and attendant waivers have led a trend for IMGs to secure the H1-B visa.
  • H1-B visa: This allows the IMG to remain in the U.S. as long as they are employed full-time by an agency, academic institution or employer (such as a hospital) certified by the INS as exempt from immigrant caps on the annual number of H-1B visas granted. Spouses and other dependents of employed H1-B visa holders, then, obtain the H-4 visa in order to remain in the country.—GH