H1b visa

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.

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, 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. 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.

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:

1)    Sit for the Step 3.
2)    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)
3)    Wait until you receive the information packet from the program at which you matched.
4)    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. 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.
5)    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.
6)    Make sure you update the residency program administration of your status.
7)    Your health license will be sent to the residency program administration, and they will in turn fax it to the attorney.
8)    Your attorney will file for your visa. With premium processing, the process will take fifteen days.
9)    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.
10)    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).
11)    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.

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.

The biggest change that has occurred over the last couple of years is that H-1 visa interview is not a walk-in affair any more. You have to submit the documents once you get them from the program to the American Express. They’ll take a fortnight and then give you the interview date once the passport comes back. Even though they prioritize H-1 interviews and usually give the date within a week or so but still this is a point where things can go wrong. So with the already constrained timeline, now it has become even more difficult to get the visa on time. Therefore it becomes even more imperative that you start the processing as quickly as possible. The first step, as explained earlier is getting the state Graduate Medical Training license. So start bugging your program coordinator right away, especially if its a program which doesn’t offer H-1s routinely. Explain to them how long it takes to get the visa in our part of the world. Rather than waiting for the information packet, ask them to send you the state license form immediately and instead of getting it couriered, get it emailed or faxed to you.

Different states have different licensing procedures. Some states are really nice and all they want is your part of the form and the hospital’s part. Others want more paperwork e.g. Pennsylvania board requires one part to be filled by you, one by the hospital, another by your home medical school and USMLE transcripts by the ECFMG. You can either send copies of all your USMLE score reports plus the ECFMG certificate or you can get the transcript sent directly to the board by ECFMG through the Credential Verification Service (CVS). They charge $25, however remember this will set your application back by a couple of weeks. The whole process shouldn’t take more than four weeks.

Try to get the license made as quickly as possible because until its ready, your petition cannot be filed. Your program will direct you about the attorney hiring process once you reach that stage. Another thing that you can do to expedite the whole process is that get your approved I-797 scanned and emailed to you once your attorney recieves it from the USCIS. This will allow you to file your visa application with the US embassy in Islamabad immediately, saving four five days. While you are waiting for the couriered documents to arrive, your passport is being processed for the interview date.

Note: This article has been derived from "Roadmap to Residency" authored by AKU graduates, with permission from few of the authors. Name of the original author, has purposely not been mentioned on request of one of the authors, for privacy reasons. If you are the original author of this article and want your name to be mentioned or wish this article to be modified/ removed from this website, please contact us and we would be more than happy to entertain your request. We fully respect your privacy, acknowledge your efforts put in authoring this article and appreciate your hard work involved in it.