Important Updates
Important Updates
July 31, 2025 | 🌐Minimum Salary Changes Announced
August 1, 2025 | MalaysiaMalaysia: Enhanced Online Interview Feature for Certain Applications Forthcoming
August 1, 2025 | United KingdomTimes Higher Education: More Universities Put on ‘Action Plans’ as Home Office Gets Tough
August 1, 2025 | United StatesUnited States: Federal District Court Postpones TPS Terminations for Honduras, Nepal, and Nicaragua
July 31, 2025 | United StatesLaw360: Grappling With Workforce-Related Immigration Enforcement
July 31, 2025 | 🌐Minimum Salary Changes Announced
August 1, 2025 | MalaysiaMalaysia: Enhanced Online Interview Feature for Certain Applications Forthcoming
August 1, 2025 | United KingdomTimes Higher Education: More Universities Put on ‘Action Plans’ as Home Office Gets Tough
August 1, 2025 | United StatesUnited States: Federal District Court Postpones TPS Terminations for Honduras, Nepal, and Nicaragua
July 31, 2025 | United StatesLaw360: Grappling With Workforce-Related Immigration Enforcement
July 31, 2025 | 🌐Minimum Salary Changes Announced
Subscribe
Fragomen.com home
Select Language
  • English
  • French
  • French - Canadian
  • German

Select Language

  • English
  • French
  • French - Canadian
  • German
ContactCareersMedia
Search Fragomen.com
  • Our Services
    For EmployersFor IndividualsBy IndustryCase Studies
  • Our Tech & Innovation
  • Our People
  • Our Insights
    Worldwide Immigration Trends ReportsMagellan SeriesImmigration AlertsEventsMedia MentionsFragomen NewsBlogsPodcasts & Videos
  • Spotlights
    Navigating Immigration Under the Second Trump AdministrationTravel & Mobility Considerations: Situation in the Middle EastImmigration Matters: Your U.S. Compliance RoadmapHumanitarian and Evolving Legal Pathways (HELP)Vietnamese ImmigrationAustralian Immigration: New Skills in Demand Visa
  • About Us
    About FragomenOfficesResponsible Business PracticesFirm GovernanceRecognition

Our Services

  • For Employers
  • For Individuals
  • By Industry
  • Case Studies

Our Tech & Innovation

  • Our Approach

Our People

  • Overview / Directory

Our Insights

  • Worldwide Immigration Trends Reports
  • Magellan Series
  • Immigration Alerts
  • Events
  • Media Mentions
  • Fragomen News
  • Blogs
  • Podcasts & Videos

Spotlights

  • Navigating Immigration Under the Second Trump Administration
  • Travel & Mobility Considerations: Situation in the Middle East
  • Immigration Matters: Your U.S. Compliance Roadmap
  • Humanitarian and Evolving Legal Pathways (HELP)
  • Vietnamese Immigration
  • Australian Immigration: New Skills in Demand Visa

About Us

  • About Fragomen
  • Offices
  • Responsible Business Practices
  • Firm Governance
  • Recognition
Select Language
  • English
  • French
  • French - Canadian
  • German

Select Language

  • English
  • French
  • French - Canadian
  • German
ContactCareersMedia
  • Insights

The June 30 Milestone in a Physician’s Journey: How Immigration Delays Impact an IMG’s Ability to Transition into Medical Practice

June 27, 2024

The June 30 Milestone in a Physician’s Journey: How Immigration Delays Impact an IMG’s Ability to Transition into Medical Practice -

Country / Territory

  • United StatesUnited States

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

By: Sarah K. Peterson, Nicole R. Bennett

June 30 marks a pivotal juncture in a doctor's journey, as it is when most finish their medical residency and fellowship training across the United States, permitting them to transition into medical practice.

For an International Medical Graduate (IMG)—a doctor who received medical education from a medical school located outside the US or Canada—this date is even more critical, as the US immigration system needs to run smoothly to permit these IMGs to transition into practice after completing their medical residency and fellowship training. If the US immigration system fails, these IMGs are forced to depart the country, causing significant burdens to both the IMG and our healthcare system alike.

Requirements for Medical Practice

To practice medicine in the US, IMGs must receive certification from the Educational Commission for Foreign Medical Graduates (ECFMG) by completing the first two steps of a three-step United States Medical Licensing Examination (USMLE).

Additionally, IMGs must meet certain requirements before they are eligible for the required license to practice medicine. In most states, IMGs, whether they are US citizens or not, must complete at least one year of accredited graduate medical education (ACGME) in the country before they may obtain an unrestricted state medical license. Some states require two or even three years of ACGME training.

While there is a movement across the US to introduce alternative pathways to licensure for IMGs by removing or reducing the overall ACGME training requirements, the lack of immigration modernization for IMGs remains a significant roadblock.

Currently more than 15 states have passed or are considering legislation to establish alternative pathways to licensure for IMGs. Because medical licensing requirements are governed by state laws, IMGs need to verify the licensure requirements for the state they plan to practice in ahead of time to ensure they meet all requirements.

The Immigration Timeline

Most IMGs who receive medical training in the US do so on a J-1 visa, which requires a two-year home residency under section 212(e) of the Immigration and Nationality Act. This legal requirement means that all US-trained physicians in J-1 status must either return to their home country for two years after they complete their training programs or obtain a waiver of their residency requirement before they are eligible to pursue H-1B status to work in the US and pursue permanent resident status.

The process to qualify for a J-1 waiver is long and time-consuming, imposing additional burdens on IMGs in their journey to practice medicine in the US.

First, IMGs must obtain a job offer months to a year earlier than their US-educated counterparts, because a J-1 waiver requires employer sponsorship. IMGs commonly pursue J-1 waivers from either state departments of health through the Conrad 30 program, or from interested government agencies such as the Department of Health and Human Services (HHS) or regional commissions. Each state’s Conrad 30 program has 30 J-1 waiver slots available each year, and almost half of the states in the US receive more than 30 J-1 waiver applications each year, making this lengthy process even more stressful and a real barrier to entry for many IMGs.

Applying for a J-1 waiver is a three-step process:

      • Obtain an initial recommendation from the state Department of Health or another interested government agency. Each state and agency has different processing times, which can range from a few weeks to a few months.
      • The initial recommending agency then sends the waiver to the Department of State’s (DOS) Waiver Review Division (WRD) for recommendation to the United States Citizenship and Immigration Services (USCIS). Current DOS processing times range between two and six months.
      • The DOS’ WRD sends the waiver to USCIS for final approval of the waiver. At the time of this writing, USCIS states processing times for J-1 waivers, excluding hardship and persecution waivers, are estimated at four weeks.

This entire process, including the time it takes to prepare a J-1 waiver application, can take many months from initiation to final USCIS approval. The IMG must then obtain USCIS approval of H-1B status to start employment. As such, beginning early is key to ensuring minimal interruptions for IMGs seeking to practice medicine in the US.

The J-1 waiver simply prevents the need for an IMG to return home for two years in exchange for full-time work in underserved rural and urban communities. When there are delays at any of the three levels involved in the J-1 waiver process, it dramatically impacts the ability of the US Health Systems to employ these critically needed physicians to ensure access to healthcare in rural and urban underserved communities.

While advocates continue to press for modernization to the US immigration system for physicians, current laws have not been changed for more than 20 years. With this in mind, it is never too early for IMGs undergoing ACGME training to start educating themselves and preparing for the best J-1 waiver options early in their training programs.

Need to know more?

For further information or if you have questions about immigration timelines for IMGs, please reach out to Partner Sarah Peterson at [email protected] or Associate Nicole Bennett at [email protected].

This blog was published on June 27, 2024, and due to the circumstances, there are frequent changes. To keep up to date with all the latest updates on global immigration, please subscribe to our alerts and follow us on LinkedIn, X, Facebook and Instagram.

Country / Territory

  • United StatesUnited States

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

Related contacts

Sarah K. Peterson

Partner

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8100

Photo of Nicole Bennett

Nicole R. Bennett

Associate

Minneapolis, MN, United States

Email

[email protected]

T:+1 612 351 8102

Related industries

  • Healthcare Industry

Related offices

  • Minneapolis, MN

Share

  • Twitter
  • Facebook
  • LinkedIn

Share

  • Twitter
  • Facebook
  • LinkedIn

Explore more at Fragomen

Media mentions

Times Higher Education: More Universities Put on ‘Action Plans’ as Home Office Gets Tough

Senior Manager Jonathan Hill noted that stricter UKVI audits and asylum claim reviews are driving more student visa action plans.

Learn more

Media mentions

Law360: Grappling With Workforce-Related Immigration Enforcement

Partner K. Edward Raleigh and Associate Anna I. Perina explore how changing immigration enforcement is affecting workforce planning and compliance for US employers.

Learn more

Blog post

Updating Articles of Association (AoA) in Saudi Arabia: What Companies Need to Know

Corporate Services Manager Asfandyar Sheikh and Assistant Corporate Services Manager Ka-Ying Leung provide guidance for businesses on the legal and procedural requirements for amending their AoA in Saudi Arabia.

Learn more

Blog post

Green Card Backlogs and Visa Bulletin Trends: What Employers Can Do In 2025 and Beyond

Counsel Susan Steger discusses how US employers can navigate ongoing green card delays and shifting visa bulletin trends to better support foreign talent and workforce planning.

Learn more

Media mentions

C21 Media: How to Prepare for Immigration Reforms Under the UK Industrial Strategy

Senior Manager Sean Rhodes and Associate Milosz Skorupski outline how UK immigration reforms will affect creative businesses and highlight key considerations for planning ahead.

Learn more

Awards

WirtschaftsWoche Recognises Fragomen and Partner Axel Boysen as Best in Migration Law

WirtschaftsWoche names Fragomen to its "Best Law Firms 2025" list and Partner Axel Boysen to its "Best Lawyers 2025" list in the field of migration law for private individuals. 

Learn more

Media mentions

Arab News: Saudi Arabia’s High-End Dining Scene Fuels Culinary and Cultural RevivalLearn more

Awards

Fragomen Ranks as Band 1 in Chambers and Partners High Net Worth Legal Guide 2025

Fragomen is ranked in Band 1 in Chambers & Partners High Net Worth Legal Guide 2025.

Learn more

Media mentions

Toronto Star: Ford and Other Premiers Want Provincial Work Permits for Refugee Claimants. It May Not Solve Anything

Partner Rick Lamanna discusses the potential option of decentralizing work permit issuance in Canada, emphasizing the need for clear coordination between the provincial and federal governments.

Learn more
Generic Insights

Video

Transfer Tactics & Talent Pipelines – The UK Angle with Alex Hood ⚽ | #FragomenFC - Ep. 10

Fragomen FC hosts are joined by Manager Alexander Hood to examine how immigration rules are reshaping global football, from EPL transfers to the rise of international transfers into the Women’s Super League.

Learn more

Media mentions

The PIE: More Declines Loom in “Seriously Concerning” US Visa Trends

Partner Aaron Blumberg noted that enhanced screening measures, including social media vetting, may be contributing to delays in US student visa processing.

Learn more

Media mentions

Construction Management: Immigration Reforms: What’s Next for Construction Employers?

Associate Ilaria Iovieno outlines how recent UK immigration reforms will impact construction employers and their ability to sponsor overseas talent.

Learn more

Media mentions

Times Higher Education: More Universities Put on ‘Action Plans’ as Home Office Gets Tough

Senior Manager Jonathan Hill noted that stricter UKVI audits and asylum claim reviews are driving more student visa action plans.

Learn more

Media mentions

Law360: Grappling With Workforce-Related Immigration Enforcement

Partner K. Edward Raleigh and Associate Anna I. Perina explore how changing immigration enforcement is affecting workforce planning and compliance for US employers.

Learn more

Blog post

Updating Articles of Association (AoA) in Saudi Arabia: What Companies Need to Know

Corporate Services Manager Asfandyar Sheikh and Assistant Corporate Services Manager Ka-Ying Leung provide guidance for businesses on the legal and procedural requirements for amending their AoA in Saudi Arabia.

Learn more

Blog post

Green Card Backlogs and Visa Bulletin Trends: What Employers Can Do In 2025 and Beyond

Counsel Susan Steger discusses how US employers can navigate ongoing green card delays and shifting visa bulletin trends to better support foreign talent and workforce planning.

Learn more

Media mentions

C21 Media: How to Prepare for Immigration Reforms Under the UK Industrial Strategy

Senior Manager Sean Rhodes and Associate Milosz Skorupski outline how UK immigration reforms will affect creative businesses and highlight key considerations for planning ahead.

Learn more

Awards

WirtschaftsWoche Recognises Fragomen and Partner Axel Boysen as Best in Migration Law

WirtschaftsWoche names Fragomen to its "Best Law Firms 2025" list and Partner Axel Boysen to its "Best Lawyers 2025" list in the field of migration law for private individuals. 

Learn more

Media mentions

Arab News: Saudi Arabia’s High-End Dining Scene Fuels Culinary and Cultural RevivalLearn more

Awards

Fragomen Ranks as Band 1 in Chambers and Partners High Net Worth Legal Guide 2025

Fragomen is ranked in Band 1 in Chambers & Partners High Net Worth Legal Guide 2025.

Learn more

Media mentions

Toronto Star: Ford and Other Premiers Want Provincial Work Permits for Refugee Claimants. It May Not Solve Anything

Partner Rick Lamanna discusses the potential option of decentralizing work permit issuance in Canada, emphasizing the need for clear coordination between the provincial and federal governments.

Learn more
Generic Insights

Video

Transfer Tactics & Talent Pipelines – The UK Angle with Alex Hood ⚽ | #FragomenFC - Ep. 10

Fragomen FC hosts are joined by Manager Alexander Hood to examine how immigration rules are reshaping global football, from EPL transfers to the rise of international transfers into the Women’s Super League.

Learn more

Media mentions

The PIE: More Declines Loom in “Seriously Concerning” US Visa Trends

Partner Aaron Blumberg noted that enhanced screening measures, including social media vetting, may be contributing to delays in US student visa processing.

Learn more

Media mentions

Construction Management: Immigration Reforms: What’s Next for Construction Employers?

Associate Ilaria Iovieno outlines how recent UK immigration reforms will impact construction employers and their ability to sponsor overseas talent.

Learn more

Stay in touch

Subscribe to receive our latest immigration alerts

Subscribe

Our firm

  • About
  • Careers
  • Firm Governance
  • Media Inquiries
  • Recognition

Information

  • Attorney Advertising
  • Legal Notices
  • Privacy Policies
  • UK Regulatory Requirements

Our firm

  • About
  • Careers
  • Firm Governance
  • Media Inquiries
  • Recognition

Information

  • Attorney Advertising
  • Legal Notices
  • Privacy Policies
  • UK Regulatory Requirements

Have a question?

Contact Us
  • LinkedIn
  • Youtube
  • Instagram
  • Facebook
  • Twitter

© 2025 Fragomen, Del Rey, Bernsen & Loewy, LLP, Fragomen Global LLP and affiliates. All Rights Reserved.

Please note that the content made available on this site is not intended for visitors / customers located in the province of Quebec, and the information provided is not applicable to the Quebec market. To access relevant information that applies to the Quebec market, please click here.