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Saturday, August 28, 2010

The Doctor's guide to American Visa

  (The article is taken from "Another Road to Residency" compiled by class of 2003 and 2004 of Agha Khan University, Karachi Pakistan.)
B1 / B2 VISA                                                       Class of 2003
          In order to go for residency interviews and the Step 2 CS, you need to apply for a US visit visa (B1/B2). Try and apply as early as possible. Ideally, you should have taken Step 1 and Step 2 CK before you go for the interview. However, the minimum is Step 1, i.e. you should have your Step 1 score with you when you apply. You can take the Orange permit for Step 2 CK and tell the consular that you are going to take it soon.

You get the application materials from American Express offices in Karachi, Lahore and Islamabad. They are also available online at the web site of Islamabad’s US Embassy. Fill those up and put them in the application. Nowadays, they do not accept any extra documents to be attached with the application materials as every one is called for an interview. Once your application is processed, take the earliest date available. The American Express also gives out the interview dates.

Do you mention Step 3 on the visa application and during the visa interview? The answer is NO. Step 3 is a big no-no. The reason is that people who have gone previously for residency interviews had to stay longer to do Step 3 and many of them took extensions. Visa consulars know that. So, on the application and during the interviews, mention your reasons for visit as Step 2 CS examination and residency interviews…that’s all.

Documents to take with you for the interview:
All original documents should be along with you for the interview. Needless to state, you will also take your passport and visa application.

1- Print out of Step 2 CS date and testing center
2- Print out of Scheduling Permit
3- Visa Letter from the ECFMG
4- Step 1 score
5- Step 2 CK score
If not available, then Prometric center document that says that you appeared for Step 2 CK on a certain day
If you have not yet appeared for the exam, then Orange permit for Step 2 CK and print out of Prometric date.
6- AKU documents (which include Medical School Diploma, Transcript, Dean's letter etc.)
7- Job letter (if you are doing a job e.g. Teaching Assistant, Research Assistant, then ask your supervisor to write you a letter saying that you are working at this place and once you come back from the US, you will continue your job). + Pay slips.
8- Evidence of last trip to US: If you have gone to US before, what did you do there? Most of the students have gone for electives. It is worthwhile to keep US recommendation letters as proof of your visit.
9- Affidavits of support from your parents (saying that my son or daughter is going abroad for medical board examinations and I will be bearing his/her expenses).
10- Affidavit of Non-immigrant Intent (saying that you will return and giving reasons why you are going to do so).
11- Proof that you can afford the trip. This proof can be in the form of Bank Statement, Property Documents and/or credit Card summaries.
12- All educational documents from Matric/O levels to AKU.
13- Print out of your OASIS account.
14- Print out of your ERAS account (if applicable).

Know which document is where otherwise you would not look good in front of the interviewer. Dress professionally but make sure that you are comfortable as well. Arrive at the Convention Center parking no later than six o’clock in the morning. The system changes but at the time of writing, this is how they do it.

You get to Convention center. Get rid of your mobiles and stand in the line where they give out bus tickets to the US embassy. Once you get the tickets, you make a run for the line where they are loading the buses for the US embassy. Please note that there are other buses for other embassies too so you need to check where to go. Once you sit in the bus, the bus takes you to Diplomatic Enclave and drops you in front of the US Consulate. There, you form two lines; one for immigrant visas and one for non-immigrant visas. You will stand in the non-immigrant visa line. Then, the security guards will call you and after a thorough security check, you go inside the Consulate where your fingerprints are taken and your passport and visa application is taken. Then, you wait for the interview. Good luck!!!

After the interview, your passport is sent to USA for security clearance (if you are a guy). This takes a very variable amount of time. Officially, the consulars tell you that it would take anywhere from 2 weeks to three months.

H1B VISA                                                           Class of 2003

The H1B is visa which is issued by the US government. It allows one to stay in the USA for a total of six years. The H1B is a dual intention visa, that is to say, one can apply for a green card while on this visa. The visa is the primary method used to bring professional level foreign employees into the USA. To be eligible for the H1B visa, one has to demonstrate a passing score in their Step 3 examination.

Initially, the H1B is a three year visa which may be renewed for another three years. Hence, in the first three years, one can leave the USA and reenter with no problems. However, if one leaves the USA after three years have elapsed, one will have to revisit Islamabad for the purpose of renewal, and will have to undergo FBI clearance again. (Recently, there have been cases of USCIS nastiness whereby they have approved H1B visas for a single year only!)

Since the H1B visa is issued by the US government, once it has been approved, Islamabad cannot deny you the visa (unless it finds some sort of forgery in your documents). However, they may defer your visa (in the light of insufficient availability of documentation) or hold you back on the basis of FBI clearance. Furthermore, I have been told that FBI clearance takes longer for H1B visas as opposed to J1 visas. Again, this is due to the fact that it is a dual intention visa.

The number of H1B visas issued each year is determined by the US government. This “H1B cap” is currently set at 65,000. You will hear this term frequently as it often limits the number of H1B visas which an institution can offer. However, many hospitals are exempt from this cap as they are classified as non-profit organizations.

Not all residency programs offer H1B visas. Some offer it freely, some may need convincing and others will not offer it at all. Another important point is that many fellowship programs will not offer you a spot on an H1B visa. So, if you are on an H1B visa, your chances of getting into a fellowship position drop quite a bit. However, there is the possibility of converting the H1B visa into a J1 visa. I am not exactly sure how this is done as I have heard mixed opinions on it. Some say that it cannot be done because one applies for the fellowship while one is doing their residency, and so your fellowship application will state your current visa (i.e. H1B) without indicating your intention to convert. This would lead to the immediate rejection of your application. On the other hand, I have also heard that it is an avoided possibility due to the mass of paperwork which one must undergo. Whoever writes the 3rd edition of Road to Residency may include the actual fact therein. Until then, you’ll have to find out for yourself.

A safe method which one may use is to apply for a green card immediately after one’s residency. Meanwhile, one may get a job with whatever qualification one has achieved thus far. After securing the green card, one may then apply for a fellowship, hence relieving visa issues. However, this process would prolong your training considerably. So consider it only if you intend on being in the USA for a few extra years.

The dependent visa is called the H4 visa. This may be issued to the spouse and children of the H1B visa. This is a weaker visa than the respective J2 visa. This is because one cannot study, train, work or earn on the H4 visa.

H1B visa holders have to pay more taxes than J1 visa holders. So, expect a good amount cut from your salary!

The process of application for the H1B visa will generally end up taking more time than that of the J1. It is also more expensive (and this is probably why most programs don’t offer it!) One should employ an attorney to file for the visa. Don’t worry about looking for one! The program will tell you about the attorneys that they recommend. Depending on the program, they may offer to pay for the cost of filing of the visa along with the attorney’s fee, however, this is not necessary. Another fee which you will have to pay for is that of ‘premium processing.’  Usually, the processing of the H1B visa takes 90 to 120 calendar days, however, when premium processed, the time period is shrunk to only fifteen calendar days. The program may offer to pay for premium processing too (if you’re lucky!)

Another point is that one cannot file for the H1B visa before receiving the health license for the state. This is not the case for the J1 visa, where the two processes can occur simultaneously. Note that certain states (e.g. Georgia) waive the requirement of being licensed – a fact that greatly expedites the H1B visa procedure.

The process of application for the H1B visa is as follows:

Sit for the Step 3.
Make sure the program knows that you have given the Step 3, expect to pass it, and hence would like the H1B related documents to be sent to you with your information packet. Also request your program secretary to courier your documents to you (to speed things up)
Wait until you receive the information packet from the program at which you matched.
Apply for the (educational limited) health license of the state. (Forms will be given to you in the information packet. You may even download these from the internet, but this is sometimes discouraged as it interferes with the records of the residency program. There are three parts to the application. One is to be partially filled and sent by your medical school, the second is to be partially filled and sent by your program director and third by you yourself. Don’t forget to ask Nasreen Sheikh to courier the AKU side of the story. She’ll charge you a thousand rupees, but it’s worth it! The processing of your license will take a variable amount of time depending on the state. I think 4-6 weeks is a reasonable average estimate. They will let you know.
Submit documentation (and fee) to your attorney. Again, information should be made available to you in the information packet. The attorney will prepare your case for you, but cannot file for the visa until both your Step 3 has been passed and your health license has been issued. Although you may, it is best not to delay this. Deal with this immediately after dealing with the health license documents.
Make sure you update the residency program administration of your status.
Your health license will be sent to the residency program administration, and they will in turn fax it to the attorney.
Your attorney will file for your visa. With premium processing, the process will take fifteen days.
Once your visa is accepted, your documents will be sent to you and you can then prepare to go to Islamabad. Again, request them to be couriered.
On receipt of the documents, apply to Islamabad for your visa interview (the process is similar, but not identical, to that of the B1 application).
When your application is processed, fly to Islamabad. The H1B visa enables you to go for a walk in interview in Islamabad. So, no need to get an interview date as you did for the B1.

The cost will also vary. I can only give my own example:

Educational Limited Health License          $170
Attorney Fee                    $1000
USCIS (Immigration Service Filling Fee)      $685
Premium Processing Fee            $1000

Note that the Educational Limited Health License fee will also be applicable for people who are applying for a J1 visa.

Regarding the total time taken, you can do the math yourself. Remember that the transmission of documents takes time, even if couriered. A rough timeline is given below (applicable if Step 3 result is available at the time of receiving the information packet, or perhaps a little beyond):

March        3rd week    Match result announced
        4th week    Information packet received (if secretary efficient!)
April        1st week    Documents sent to program, state and attorney
        2nd week    Processing of health license begins
May        2nd week    License received by program and faxed to attorney
June        1st week    H1B visa premium processed
        1st week    H1B documents received in Pakistan   
        2nd week    Islamabad processes visa application       
        2nd week    Walk in interview at Islamabad
        3rd week    FBI clearance completed (for girls)
July        2nd week    FBI clearance completed (for guys) (HOPEFULLY)

So, unless you prematch, the H1B visa will probably cause you to be late. If you arrive late, the time has to be made up for in your vacations, elective time or perhaps even after your residency (that is, you will not graduate with the rest of your class and will consequently waste a year if you planned to do a fellowship). So, make sure you hurry everything maximally.

J1 VISA                                                               Class of 2003

The J1 visa is a training visa. While on this visa, you can work only in training jobs like residencies and fellowships. It allows you to stay in the USA for a maximum period of 7 years. Thus, the visa allows adequate time for completion of training.

Unlike the H1B which is stamped for 3 years, the J-1 is stamped for 1 year only. For the rest of the duration, you get your status changed from the USA. However, you do not get your passport stamped. This means that after the first year, if you leave the USA to go anywhere in the world, you will have to get the passport stamped again (from Islamabad) so as to re-enter the USA.

In the good old days, when visa issues were not a major problem, one could travel freely on J-1. You usually get a three to four week vacation block. People used to come to Pakistan, re-apply for the J-1 and got it stamped before they returned. However times have changed now. Since visa processing requires FBI clearance, which could take weeks, it follows that you can only travel within the first year. The ECFMG also discourages traveling during the course of your training.

With female doctors, it’s a complicated issue. If the passport does not go for clearance, then you can travel. But, if it does, then you can not return back to your program within the vacation period. The US visa policies keep on changing. Get an update before you make a decision.

The principle of J-1 is that a doctor from a third world country is going to the USA for training. Thus it follows that you have to return to your home country to serve for at least two years. This also means that the visa consular at Islamabad gets to decide whether you should go or not. This is in sharp contrast with H-1 where the visa consular at the embassy cannot refuse.

Pros and Cons of J-1:

J-1 visa is easier to get. It requires less processing, less money and therefore less hassle. No Step 3 result is required. Like residency programs, all fellowships sponsor J1 visas, however, a much lower proportion of fellowships (as compared to residencies) sponsor H1B visas. Thus, J1 visa applicants get an advantage over H1B visa applicants. The spouse of a J-1 may enter the USA on a J-2 visa, on which one can work or study in the US. You get to pay less tax (but you do pay it!!!).

On the other hand, J-1 can get rejected at Islamabad. You cannot travel much except during the first year (the internship year). You cannot do moonlighting so J-1 is NOT a financially beneficial visa. It cannot be converted into a Green Card unless you return to your home country or do a J-1 waiver in the USA for two years.

Processing for J-1:

You need the DS-2019 (previously known as IAP 66) form from the ECFMG in order to apply for the visa at the Visa Consulate. In order to get the DS, you need a NOC (No Objection Certificate) from the Government of Pakistan. In order to get the NOC, you need a valid PMDC certificate.

So here is how you do it.

1- First thing apply for PMDC renewal. For that you need your previous certificate. The form is available at records Office at AKU and online at PMDC website. Renewal fee is Rs. 300/= for one year. Urgent fee is Rs. 200/=. If you already have a valid PMDC certificate than you don't need to worry about it and you will save some time. Do this before you have matched.

2- Than you apply for NOC. The form is again available at Records Office AKU. You need to attach attested photocopies of your
a) NIC,
b) Passport, (the form does not ask for it...but you still got to give it)
c) PMDC certificate,
d) AKU Degree
e) And an affidavit saying that you are not a Government servant and stuff like that.
f) You also need the OFFER LETTER from the program where you have matched. So you can apply for NOC only after you have matched and have the offer letter from the program.

Once you have the NOC, than you apply for the DS 2019 from the ECFMG. You download the EVSP application form from the ECFMG website, fill it, attach all the documents and send it to your program. The EVSP application has a checklist included so you know which documents to send along with it. The program forwards it to the ECFMG. Pay the US$200/= fee on OASIS before you send in the form.

The ECFMG takes a week or two to process your DS and sends it back to the program. When you get the DS form back, you will need to pay US$100/= as SEVIS fee. SEVIS stands for “Student and Exchange Visitor Information System”. ECFMG registers you with SEVIS and gives you a SEVIS ID number that starts with N. Once you have that number, you log on to and make that payment. More info on that is available on the EVSP application form. Once you have done that, you are now eligible to go for J1 visa interview. So that’s when you need all your luck!!

The J-1 does not require state license or Step 3 result. So the processing of Residency permit or Temporary State license is independent of your visa application.

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