J1 visas for Residency applicants are a cultural exchange program - they were never meant to train more physicians to practice in the US.

I believe we need to make a separate system for J1 visa applicants from the Main Match - and here are my reasons why.

Every year, thousands of applicants apply for residency. IMGs (both US citizens and non) must apply for certification deeming them eligible for residency.

Here's the number of applicants certified each year. Since 2005, it's been relatively stable at ~10K.

Over the same time course, the number of approved J1 visas has essentially doubled in 10 years.

And that should be fine - if more non-US citizens are applying, of course we need to issue more visas.

BUT

Of those that are certified, the makeup of citizenship has changed quite drastically over the same time course.

The majority of IMGs currently applying to residency are actually US citizens.

Okay, maybe this shouldn't matter. Because non-US IMGs work in underserved areas and help reduce the physician shortage, they are a great asset.

Except.. data shows that they actually don't stay and practice in these underserved areas, even if they completed residency there.

Some more data:

Here's a visual based on states

I also believe that shouldn't matter. They can practice in wherever they want. They can't be forced to stay somewhere.

But the thing is, they also can't be forced to stay in the US. After residency, it's required for them to go back to home country for minimum 2 yrs.

And this is where it doesn't make sense. Bringing IMGs on J1 visas is not helping reduce the physician shortage - it might inadvertently be contributing to it.

And those that apply for a J1 visa with the intention of practicing in the US have to figure out a waiver to stay.

This makes no sense at all - creating a backlog of doctors on J1 visa who need a green card and also losing trained doctors because the visa was never intended to be an immigration pathway.

And we already have thousands that go unmatched, because too many applicants to spots.

We obviously need to increase the number of residency spots. That goes without saying.

We also need a separate cultural exchange Match system - not a part of Main Match. It needs its own process that allows the program to continue with its original purpose.

Residency programs that participate in J1 cultural exchange already need to accept that they will host a minimum of 5 spots each year.

So why not make a set number of spots and create a Cultural Exchange Match? Set number of spots applicants apply to.

Another step should be to create a pathway to citizenship for those that are on J1 visa as long as they meet some criteria (yrs practice US, location, etc)

Because the way it's going it looks horrible for those doctors that can't get a green card after years of practicing in US.

So yes - increase the number of residency spots.

But also create a Cultural Exchange Match so we don't use arbitrary measures such as USMLE or country of education to assess applicants.

And keep Main Match for those that don't require a visa.

This way we increase the number of practicing physicians staying in the US while also continuing cultural exchange.

Those that stay in the US have a clear path to citizenship while those that return to their home country are serving J1s purpose.

Overall then, we won't have an obscene amount of applicants to spots - all applicants can be evaluated holistically.

And programs can't discriminate based on IMG or citizenship, or anything else that does not make sense.

We're all applying with clear intent.

@threadreaderapp unroll

#TrainMoreDoctors #TrainingShortage #PhysicianShortage

J1 visa requires applicants “do not have immigrant intent”

Hence it being a cultural exchange program... not an immigration visa.

https://www.stilt.com/blog/2019/02/j1-to-green-card/#J1_to_Green_Card_Process_Options