Proposed ICE Change Will Severely Impact Health Care Delivery During COVID-19 Pandemic and Beyond, Leading Health Care Organizations Say

Five of the nation’s leading organizations in medical education and health care oppose a proposed Immigration and Customs Enforcement (ICE) rule change that will impact more than 12,000 foreign national physicians training in the United States in J-1 visa status. This change will severely hinder health care delivery during the COVID-19 pandemic and into the future.

Earlier this year, ECFMG®|FAIMER® was joined by the Accreditation Council for Graduate Medical Education (ACGME), American Hospital Association (AHA), American Medical Association (AMA), and Association of American Medical Colleges (AAMC) in opposition to this rule change that has the potential to stress an already strained health care system further as it battles COVID-19 amidst a growing physician shortage. Collectively these organizations asked that ICE exclude J-1 physicians from the rule change.

“If implemented, this will affect thousands of physicians who already have been thoroughly vetted and are serving in nearly 750 teaching hospitals across the nation,” said ECFMG|FAIMER President and CEO William W. Pinsky, MD. “It is a misguided policy for J-1 physicians and will have the unintended consequence of disrupting patient care, especially in underserved areas.”

The proposed change was published in the Federal Register on September 25, opening a 30-day public comment period. In light of this development, the organizations now are working to renew their objection and to urge members of the medical education and health care communities, and policymakers to ask ICE to exclude J-1 physicians from the proposed rule change. ECFMG|FAIMER and allied organizations are calling on the health care community to mobilize in response to ensure ICE reevaluates the proposed rule change and ensures a strong frontline health policy. More information is available at www.ecfmg.org/protect-ds-for-J1s.

The proposed rule change will alter the process used by F, I, and J visa holders to extend their period of authorized stay in the United States. Specifically, it will eliminate “duration of status” as an authorized period of stay, replacing it with a specific end date and the additional requirement to apply through the U.S. government each year to extend this end date. The five organizations agree that the proposed change is redundant for J-1 physicians and will not accomplish its stated goal of reducing visa overstay rates, since J-1 physicians already are monitored closely.

For nearly 50 years, ECFMG|FAIMER has been designated by the Department of State (DOS) as the sole J-1 visa sponsor for physicians in U.S. training programs. In this role, ECFMG|FAIMER already coordinates closely with DOS and with U.S. teaching hospitals to monitor J-1 physicians carefully throughout the academic year. Additionally, under the current process, J-1 physicians are required to apply annually to ECFMG|FAIMER to extend their visa sponsorship. This required annual renewal process already ensures a careful review by ECFMG|FAIMER in order to assure DOS that these physicians are compliant with J-1 visa requirements and progressing through their training programs as planned. When ECFMG|FAIMER completes this annual review and renews a J-1 physician’s visa sponsorship for an additional year of training, the physician’s authorized period of stay is extended for the “duration of status” of the renewed ECFMG|FAIMER visa sponsorship.

If the change is implemented, the physicians’ authorized period of stay would not be extended after the annual ECFMG|FAIMER review and renewal of J-1 visa sponsorship. Instead, J-1 physicians would be required to apply for an extension of stay, after and in addition to renewing their sponsorship annually with ECFMG|FAIMER, either through a U.S. Citizenship and Immigration Service (USCIS) Service Center in the United States or through a consulate abroad. Currently, the published processing time at USCIS’ five Service Centers ranges from five to 19 months. Based on current USCIS processing times, thousands of J-1 physicians will be unable to continue their training programs and provide patient care. Similarly, annual travel abroad to extend visa status during residency and fellowship would be problematic due to its likelihood to disrupt training and, in effect, patient care.

Detailed Information on Pathways Application Process Now Available

On August 20, ECFMG|FAIMER published additional information on the new requirements for ECFMG Certification for the 2021 Match. The new information includes detailed instructions for applying to the pathways, which will allow qualified IMGs who have not passed Step 2 CS to meet the requirements for ECFMG Certification and the 2021 Match. Information on required documentation, application timing, fees, and a limited exceptions process also is available.

Potential applicants can use this information to preview the on-line application process and to prepare for the launch of the on-line pathways application at the end of August.

ECFMG|FAIMER Supports Coalition Recommendations for Fellowship Applicants in 2020-2021

On June 16, the Coalition for Physician Accountability, of which ECFMG|FAIMER is a member, released its report titled Recommendations for Away Rotations and Interviews for Graduate Medical Education Fellowship Applicants During the 2020-2021 Academic Year. The report builds on the Coalition’s work to address aspects of the transition from medical school to residency during COVID-19 (Coronavirus).

ECFMG|FAIMER supports the Coalition’s recommendations for the sub-specialty community, which address away rotations, in-person interviews, and general communications. More information is available in the full report.

The Coalition exemplifies the collaboration required to create the best solutions for all stakeholders impacted by the pandemic. ECFMG|FAIMER looks forward to continuing to join with Coalition members and other partners to find those solutions.

ERAS 2021 Program Information for IMGs Now Available

Information for international medical students/graduates (IMGs) on the Electronic Residency Application Service® (ERAS®) 2021 application season is now available. If you plan to apply for U.S. residency positions* that begin in July 2021, visit the ERAS Support Services section of the ECFMG website for important information. Most U.S. residency programs participate in ERAS. If you apply to participating programs, you must use ERAS to do so.

At the ERAS Support Services section of the ECFMG website, you will be able to:

  • See an overview of the Application Process and Timeline.
  • View instructions on how to obtain an ERAS Token, which will enable you to register at the MyERAS website of the Association of American Medical Colleges (AAMC) and work on your residency applications.
  • Find instructions for submitting your supporting documents, such as letters of recommendation and transcripts.

ERAS Support Services will transmit your supporting documents to your ERAS application. All supporting documents must be submitted electronically. For more details, please refer to the “Upload Your Documents Now” e-mail that will be sent to you via the MyERAS Message Center after you have registered at MyERAS.

Residency Tokens for the ERAS 2021 application season will be available through ECFMG’s On-line Applicant Status and Information System (OASIS) beginning June 23, 2020. You can use a 2021 Token to register with AAMC’s MyERAS beginning June 23, 2020.

*IMPORTANT NOTE: In order to be eligible to participate in the National Resident Matching Program® Main Residency Match®, which will be held in March 2021, IMGs must have a passing performance on the exams required for ECFMG Certification (Step 1 CK, Step 2 CK, and Step 2 CS). The United States Medical Licensing Examination® (USMLE®) program has suspended Step 2 CS exams for 12-18 months. ECFMG|FAIMER has published preliminary information on how qualified IMGs who have not passed Step 2 CS can meet the Requirements for ECFMG Certification. You can learn more on the ECFMG website at https://www.ecfmg.org/certification-requirements-2021-match/.

(posted June 9, 2020; updated June 19, 2020)

ECFMG|FAIMER Responds to Suspension of USMLE Step 2 CS Testing, Commits to Uninterrupted Pathway for IMGs to ECFMG Certification

The May 26 announcement by the United States Medical Licensing Examination® (USMLE®) program that it will suspend Step 2 Clinical Skills (CS) testing for an additional 12-18 months creates a major disruption to the education and assessment of all medical students and graduates who seek to train and practice in the United States. The impact of the USMLE program’s decision is significant and immediate for international medical students and graduates (IMGs) who have relied on Step 2 CS to meet the clinical skills requirement for ECFMG® Certification, to participate in the National Resident Matching Program (“the Match”), and to enter U.S. programs of graduate medical education (GME).

ECFMG|FAIMER is committed to the continued smooth operation of its certification program and the ability of qualified IMGs to pursue and participate in U.S. GME without interruption. We are engaged in the following activities in response to the suspension of Step 2 CS testing.

  • Identifying alternatives to Step 2 CS that can be available now to allow IMGs to meet the clinical skills requirement for ECFMG Certification and providing an update on these alternatives in the very immediate future;
  • Collaborating with organizations involved in the recruitment and training of medical school graduates in the United States to mitigate disruptions; and
  • Advocating forcefully for the interests of IMGs as plans develop for the continued training of physicians during the COVID-19 (Coronavirus) pandemic.

This commitment underscores the vital importance of ECFMG Certification, which has served the U.S. medical education and regulatory communities, IMGs, and the public for almost 70 years. ECFMG’s program of certification provides assurance that the IMGs who enter U.S. GME are ready to do so and ensures an adequate and qualified pool of IMG applicants—trainees who will join the next generation of physicians.

ECFMG Certification also provides the pathway for the best and brightest physicians from around the world to train in the United States. Across our nation, IMGs fill gaps in training and practice that otherwise would remain empty, thereby ensuring a sufficient number of physicians to care for our population. IMGs also bring important international perspectives and much-needed diversity to our physician workforce.

We are committed to ECFMG Certification as a core component of our mission to promote quality medical education and health care. We will continue to support and advocate for IMGs because we know that our nation’s ability to provide accessible, quality health care depends on the continued contributions of IMGs in both U.S. training and practice.

We recognize that many IMGs have questions and concerns, and we are mindful of the need to provide you with effective and prompt answers and solutions in support of your educational plans.

Please stay well and monitor the ECFMG website for updates in the coming weeks.

ECFMG|FAIMER Supports Recommendations for Medical School Graduates Entering PGY-1 Residency Positions in Coming Months

On May 18, the Coalition for Physician Accountability, of which ECFMG®|FAIMER® is a member, released the final report of its work group on Learner Transitions from Medical Schools to Residency Programs in 2020. The report provides important and timely recommendations to mitigate the effects of pandemic-related disruption in the transition from undergraduate medical education to graduate medical education (GME) for more than 30,000 medical school graduates who will begin first-year (PGY-1) residency positions in the United States in the coming months.

ECFMG|FAIMER was represented on the work group, which considered the entire population of incoming PGY-1 residents, including more than 7,000 international medical graduates (IMGs), and the institutions and programs where they will train. The recommendations acknowledge that the pandemic may present elevated risks to the well-being of all PGY-1 residents and that IMGs may face unique challenges.

ECFMG|FAIMER strongly endorses the report’s recommendations, which include:

  • Accommodation of delayed arrival at residency programs due to reasons that include international travel, health concerns, visa issues, or licensure delays
  • Orientation to infection protection, including the provision of personal protective equipment and training in its use
  • Augmented relocation assistance in the form of referrals for services such as health care, housing, legal assistance, transportation, and child care
  • Augmented assessment and monitoring of resident well-being throughout the academic year
  • Enhanced cultural and community support for IMGs, in recognition of their increased risk for social isolation and other unique circumstances

For complete information, please read the final report.

As the J-1 visa sponsor for all foreign national physicians in U.S. GME, ECFMG|FAIMER is committed to the well-being of these physicians as they train in the United States. We welcome the Coalition’s coordinated and collaborative approach to protect all learners, as well as the broader health care workforce, patients, and the public.

ECFMG|FAIMER Endorses Recommendations and Resources for Medical Students, Trainees, and Physicians during COVID-19

On May 11, the Coalition for Physician Accountability, of which ECFMG®|FAIMER® is a member, released final reports from two work groups that examined critical issues facing medical students, residents, medical educators, and medical regulators during the COVID-19 (Coronavirus) pandemic.

ECFMG|FAIMER membership on the work groups represented the unique needs and perspectives of international medical students/graduates (IMGs). ECFMG|FAIMER plays key roles in the transition of IMGs from undergraduate medical education to U.S. graduate medical education (GME)—certifying the readiness of IMGs to enter U.S. GME; serving as the designated “Dean’s Office” for IMGs using the Electronic Residency Application Service® (ERAS®) to apply to U.S. GME programs; and sponsoring foreign national physicians for the J-1 visa to participate in such programs. ECFMG|FAIMER also is a leading expert on the medical credentials issued to physicians by medical schools and other institutions around the world. These credentials are a core component of establishing the qualifications of physicians.

ECFMG|FAIMER strongly endorses the work groups’ recommendations.

  • Medical Students in the Class of 2021: Moving Across Institutions for Post Graduate Training

The current health care crisis presents new challenges for medical students/graduates, trainees, and U.S. GME programs. This work group considered three major issues in preparation for the 2020-2021 residency cycle during the COVID-19 pandemic: away rotations, in-person interviews for residency, and the ERAS timeline. The recommendations, detailed in the following documents, will provide a consistent approach to disruptions caused by the COVID-19 pandemic, greatly reducing unnecessary confusion, stress, and inequity among students, and promoting a more successful residency selection process for all.

  • Maintaining Quality and Safety Standards Amid COVID-19

The pandemic has created a public health emergency that is rapidly altering the provision of health care services across the country. Physicians and other clinicians have responded with offers to provide care outside of their previously licensed jurisdiction and beyond their typical scope of practice. This work group has developed the following guidance and resources for the deployment of physicians, physicians in training (interns, residents, and fellows), and retired or inactive physicians, to ensure the safe delivery of quality clinical care during this unprecedented emergency.

The Coalition work groups exemplify the collaboration required to create the best solutions for all stakeholders impacted by the pandemic. ECFMG|FAIMER looks forward to continuing to join with Coalition members and other partners to find those solutions.

A Message to Applicants—ECFMG|FAIMER is Open and Processing Your Applications

We are pleased to confirm that ECFMG|FAIMER programs and services continue to operate. Our staff members are working to process your applications and service requests, and our representatives are answering phone and e-mail inquiries as quickly as possible.

Physicians who use our programs and services should continue to submit applications and other service requests as they would normally. This will help ensure sufficient processing time and your readiness for next steps, as they become available, in pursuing ECFMG Certification, J-1 visa sponsorship (if applicable), and U.S. graduate medical education (GME).

ECFMG Certification

ECFMG continues to process Applications for ECFMG Certification and applications for the United States Medical Licensing Examination® (USMLE®) step components required for Certification, and to verify medical education credentials.

  • USMLE Step 1 and Step 2 Clinical Knowledge (CK): Prometric test centers around the world are open or are beginning to reopen. We are aware that Prometric has provided inaccurate information about the status of some of its test centers, causing confusion and additional difficulties for some examinees. The leadership of the USMLE program and ECFMG are in daily contact with Prometric to ensure an immediate resolution to this situation. More >>
  • USMLE Step 2 Clinical Skills (CS): Work is underway to formalize a plan to resume USMLE Step 2 CS testing, and applicants with canceled testing appointments are receiving regular e-mail updates.
  • We continue to verify medical education credentials with international medical schools, although there are some pockets of service disruptions. To support institutions that are working remotely, ECFMG is leveraging electronic communications to stay connected, facilitate the verification process, and minimize disruption of services for our applicants.
  • Applicants seeking an ECFMG Certificate to begin U.S. GME programs in summer 2020 should expect their certificate to be issued in time to start their programs. ECFMG has been in contact with medical schools to ensure that individuals who meet ECFMG Certification requirements will be issued an ECFMG Certificate.

ECFMG Exchange Visitor (J-1 Visa) Sponsorship

ECFMG is actively processing applications for J-1 visa sponsorship for participation in U.S. GME programs that begin in summer 2020.

  • U.S. embassies and consulates worldwide have resumed processing of applications and visa appointments for medical professionals, including the J-1 Visa. More >>
  • The U.S. Department of State has provided additional flexibility regarding the Statement of Need letter for J-1 Visa sponsorship. More >>
  • President Trump’s Presidential Proclamation issued on April 22, 2020 does not affect physicians or their dependents who are on or applying for J-1 Visa sponsorship. More >>
  • Applicants who experience challenges during the application process should contact the Exchange Visitor Sponsorship Department at EVSP-support@ecfmg.org or +215-823-2121 for assistance.

U.S. Department of State Indicates Additional Flexibility Regarding Statement of Need Letter for J-1 Visa Sponsorship

The U.S. Department of State (DOS) has indicated additional temporary flexibilities around the issuance of the home country Statement of Need (SON) for physicians seeking J-1 visa sponsorship during the COVID-19 (Coronavirus) pandemic. ECFMG sought and received temporary authorization to accept SONs issued by foreign embassies in the United States, if authorized by the respective country. In addition, SONs may now be signed electronically. The SON is a regulatory requirement for all J-1 physicians and, previously, only paper SONs signed and sealed directly by the home country’s Ministry of Health were acceptable per DOS regulation. Also, the SON letter is waived for those entering fellowship training if ECFMG has a letter on file for the related specialty. These developments mark additional positive steps toward reducing the challenges faced by the thousands of foreign national physicians who are applying for J-1 visa sponsorship to participate in U.S. programs of graduate medical education beginning July 1.

For more information on the impacts of the COVID-19 pandemic on ECFMG|FAIMER programs and what we are doing in response, please visit our COVID-19 (Coronavirus) web page.

New Trump Administration Executive Order on Immigration Does Not Impact Non-immigrant Visa Processing, Including J-1s

President Trump issued a new Executive Order (EO) on April 22, 2020 temporarily suspending the issuance of immigrant visas. Non-immigrant visa classifications, such as the J-1, are not included in the EO and are, therefore, exempt from the provisions of the order.

As previously reported, the U.S. Department of State has advised that physicians and other health care workers are deemed to be mission critical to fighting and mitigating the impacts of COVID-19 (Coronavirus). Potential J-1 applicants who have been issued Form DS-2019 by ECFMG are encouraged to review the website of their nearest embassy or consulate and request a visa appointment.

For more information on the impacts of the COVID-19 pandemic on ECFMG|FAIMER programs and what we are doing in response, please visit our COVID-19 (Coronavirus) web page.