What is a Foreign Medical Graduate (FMG)?

The ECFMG defines an FMG as a physician who received his/her basic medical degree from a medical school located outside the United States and Canada. The location of the medical school, not the citizenship of the physician, determines whether the graduate is an FMG. This means that U.S. citizens who graduated from medical schools outside the United States and Canada are considered International Medical Graduates (IMGs). The term “IMG” is interchangeable with “FMG”. Non-U.S. citizens who graduated from medical schools in the United States and Canada are not considered FMGs.

J-1 Foreign Medical Students: Change of Status v. Consular Processing


What is the ECFMG?

The Educational Commission for Foreign Medical Graduates (ECFMG) is designated by the US Department of State as the visa sponsor for all J-1 physicians who participate in clinical U.S. training programs. The ECFMG must ensure that J-1 physicians and host institutions meet the federal requirements for participation.

Qualifications for Eligibility 

To apply for a J-1 Visa applicants must:

  • Passed the USMLE step one and step two CK (or the equivalent);
  • Have a valid ECFMG certificate;
  • Have a contract or official letter of offer for a position in a program of Graduate Medical Education or training with a medical school; and
  • Provide a statement of need from the Ministry of Health of the country of the applicants last legal permanent residence.

Going from F-1/F-2 to J-1 Visa

Students on an F-1 Visa may opt to apply to change their visa status from F-1 to J-1. They may either do so through an Change of Status while they remain in the United States, or they can leave the United States and apply through the consulate of their country, or a country that processes third-country visa applications, such as Canada or Mexico. There are advantages and disadvantages to both methods, so it is best to consult with an attorney about which options best meets your individual circumstances, and then make an informed decision.

J-1 Foreign Medical Students: Change of Status v. Consular Processing

Consular Processing vs Change of Status

Consular processing can sometimes lead to a visa faster than through a Change of Status application, which can take at a month or more to be adjudicated. Additionally, there are different costs associated with each. The application fee for a Change of Status may be more than the application fee for a visa application through Consular Processing. However, there may be additional travel costs with Consular Processing.

For someone in the United States, a Change of Status application might be the preferred option as an applicant who is denied may challenge the denial through an administrative or judicial appeal process. A denial through Consular Processing is essentially a non appealable decision, there are only limited exceptions that may allow for review. Additionally, a person who applies for a Change of Status can always abandon their application and go overseas to apply for the visa through Consular Processing.

Changing Your Visa Status to an Immigrant or Work visa as a J-1 FMG

Upon completion of their training or program in the United States, a Foreign Medical Graduate on a J-1 visa must return to their home country for a period of two years before being eligible for a change of visa status to certain types of US visas. These visa types include:

  • H – Temporary Worker
  • L – Intra-company transferee
  • US Permanent Resident

In most cases the applicant will apply for a work or immigrant visa after having fulfilled the two year home residency requirement. This must generally be done from abroad, through a US consulate or embassy.

If an applicant has received a waiver, they can apply for an immigrant or work visa through a Change of Status, provided that they are in the United States. However, they still have the option of applying through a consulate or embassy.

Two Year Residency Requirement Waiver

J-1 Foreign Medical Students: Change of Status v. Consular Processing

The only exception to the 2-year home residency requirement of the J-1 visa program is to receive a waiver. The following three circumstances can provide a waiver:

  • The waiver applicant can demonstrate that he or she will suffer from persecution in his or her home country or country of last legal permanent residence;
  • Fulfillment of the residency requirement would bring proven exceptional hardship to the applicant’s spouse and/or children who are U.S. citizens or permanent residents; and
  • The applicant is sponsored by an Interested Governmental Agency (IGA) that is interested in the physician’s continued employment in the United States.
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