Canadians not allowed J1 visas for subspecialties anymore.

An update from the Society of Canadians Studying Medicine Abroad:

MORE INFORMATION ON AMERICAN RESIDENCIES AND STATEMENTS OF NEEDS. We spoke to the Program Administrator at Health Canada to obtain more information about the changes to the eligibility for Statements of Need which are required for J-1 visas , the implications, and the reason for the change. What is set out below is what we were advised. This information has been reviewed by the Program Administrator prior to posting.

Our comments are marked. We welcome your observations and feedback via Facebook or by emailing us at [email protected].

REASONS FOR THE CHANGE:
1. The provincial Ministries of Health (who are the decision makers in this area) have indicated there is less need for subspecialists now and there will be less need in the future. This is because the need for subspecialists is being filled domestically through Canadian medical schools and Canadian postgraduate training programs.

THE CHANGES SUMMARIZED:
• Not much change for residency training in comparison to last year except that no area of practice is unlimited. The number of applications in the areas that were unlimited last year is less than the number of Statement of Needs that are now available. So the program administrator does not expect anyone will be denied a Statement of Need in the areas that were previously unlimited. However, the program administrator says that the expectation is that the number of Statements of Needs that will be issued will keep decreasing in the future as the domestic supply of trained physicians fills the need.
• Last year’s proposed restrictions on Preliminary Positions have been dropped. Preliminary Positions will be issued Statements of Need.
• As of 2017, subspecialties will for the most part not be eligible for Statements of Need except under Category C (which requires applicants to be qualified to practice in Canada).

ROUTE TO RETURN HOME ACCORDING TO HEALTH CANADA: The program administrator states that it is probably not possible to get through this new process using Category C without any interruption in training. It is likely the doctor will have to return to Canada to complete all Canadian medical examinations and a full licence.
SOCASMA’s note: The J-1 visa requires the physician to leave the country for 2 years once the visa has expired. But the program administrator says that this requirement does not prevent the physician from applying for another J-1 visa before the 2 years is up.
The program administrator states that it is possible to qualify to practice in Canada while in the USA even if the American training program is shorter than the Canadian. This is how the program administrator says it would work in the context of internal medicine where Canada requires 4 years of Post graduate training while the American system only requires 3 years:
a. In the spring of the last year of medical school the student applies for a Statement of Need for the position in which he or she matched.
b. In the spring of the 3rd year of residency, the resident physician attempts to find a way to do a 4th year of residency in the USA. He can apply to become the chief resident in which case he will take 4 years of training in internal medicine in the USA and will meet the RCPSC requirements. As one has to be outstanding among residents to get a chief resident position, this route will not be available to most residents. He can also apply in the USA for a one year program in areas such as geriatrics or palliative care so the additional year could be completed in this way.

SOCASMA’s note: The number of one year program is limited and entry into these programs is competitive. In 2013, 156 Statements of Need were issued for internal medicine. In 2014, 180 were issued. In 2015 195 were issued. The reality is that many internal medicine residents will not be able to complete sufficient training in the USA to qualify them to practice in Canada.

c. In August, after completing 3 years of residency training, the resident physician writes the American board exams. Results are available in the fall, ie, by September or October.
SOCASMA’s note: The website indicates that the exams are administered in August and that the results take 3 months.
d. In 3rd and 4th year of residency, the resident physician will liaise with RCPSC to arrange to write the Canadian board exams in May of 4th year residency. [On their website, the RSPSC has a chart on how to apply for the exams. Julie Waters is their resource person for USA training.)
e. In May of 4th year the resident physician writes the RCPSC exams while working in the USA.
f. By the end of June of 4th year the resident physician should have the RCPSC exam results which, along with the LMCC, will enable him to get a full license with the provincial Colleges and enable him to practice medicine in Canada
g. If a resident physician is unable to get a 4th year position in an area that is eligible for a Statement of Need, he must leave the USA.

OTHER RELEVANT INFORMATION:
1. If a resident physician does not have a Statement of Need that entitles him to get a J-1 visa to stay longer in the USA, or if he has been unable to arrange a J-1 waiver with accompanying H1B visa or an O visa, he must leave the USA. The J-1 visa states he must leave for a period of 2 years before being able to return to the USA to work.
2. Options.
a. H1B visa: he can apply for an H1B visa before or after returning to Canada. An H1B visa is hard to get because the employers are reluctant to pay the fees associated with the H1B visa. It has been estimated that only about 3% are able to get H1B visas. [H1B visas are applied for by the employer. The employer must pay the application fee which is estimated to be $10,000 to $15,000. An H1B visa is valid for 3 years. The H1B visa can be renewed for another 3 years by the employer after which the physician may be eligible for a green card which entitles him to work in the USA without further obstacles. Employees are not entitled to pay this fee as to allow this would contravene employment laws.]
b. O visa: The O-1 non-immigrant visa is for the individual who possesses extraordinary ability and has been recognized nationally or internationally for those achievements.
c. Conrad State 30 Program: he can stay in the USA by agreeing to work in an underserviced area of the USA for a set period (3-5 years) after which time he will be eligible for a green card. In these circumstances the American government will give an extension of the J-1 visa only for enough time to take his American Board exams.
d. Work in Canada. If the residency is the same length and meets the RCPSC requirements, one can take the RCPSC exams and apply to register with the provincial college. If the residency is shorter in the USA, then in some provinces those who passed the American board exams can practice under a restricted license. Every doctor should consult the licensing authority in the province or territory to find out if and how this can be done.
3. To subspecialize: After one returns and spends the two years in Canada and after one is fully qualified to practice in Canada, one becomes eligible for a Statement of Need and hence a J-1 and endorsement under Category C. Category C is for fully qualified doctors.
4. There are no numerical limits on Statements of Need under Category C. After a physician has qualified in Canada, he can apply for a Statement of Need under Category C to subspecialize.
5. There is no prohibition on applying for another J-1 visa after being outside the US for a period of time less than two years, ie, a month, a few months, a year. Nor is one required to seek the H1B visa after the two years. One can apply for J-1 after J-1. The US prohibits the doctor from applying for an H1B visa before the two year home country presence requirement has expired.
6. If the physician obtain a Conrad State 30 Program waiver, it is the employer who petitions for the H1B visa on behalf of the physician.

HOW ARE THE NUMBER OF STATEMENTS OF NEED IN EACH PRACTICE AREA DETERMINED?
This question is outside Health Canada’s involvement. They receive the numbers for each area of practice from the provinces and add them together.

Although the Statements of Needs were previously tied to the province who made the request, that is no longer the case. There is no provincial residency requirement. This can cause difficulties with distribution. For example, if there are 10 positions in anesthesiology in BC and 0 in Ontario, all the applicants can be from Ontario if they apply first. Upon completion of residency and RCPSC qualification, there is no restriction as to where these 10 physicians work.

APPEALS
If a medical graduate or resident physician applies for a SON and is denied, he can petition the provincial Ministry of Health in his home province for reconsideration. This involves writing a submission as to why the Statement of Need should be issued. Information that is persuasive includes personal hardship and information that would verify that there is a need. For example, the number of job vacancies or a statement from a particular employer is compelling. A professional tone is more persuasive than anger. It is the province that grants the exception.

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Canadians not allowed J1 visas for subspecialties anymore.