To the Editor:

We read with much interest the article by Ashry et al. “The Implications of the Current Visa System for Foreign Medical Graduates During and After Graduate Medical Education Training” published on 8th May, 2019 in The Journal of General Internal Medicine.1 In this article, the authors discuss difficulties faced by the matched applicants who hold H1B and J1 visas in starting their residencies and in job search after training. The authors also note the effects of recent changes in the immigration policies on the international medical graduate (IMG) physicians’ job situation.

We would also like to point out that it is not only the VA hospital system which mandates 6 months of active unsuccessful physician search; most of the Conrad-30 programs require employers to make efforts to recruit a US citizen or permanent resident for the position prior to signing a contract with J1 IMGs.2 In order to fulfill the requirements of the J1 waiver, all J1 physicians have to work in a medically underserved area (MUA) for at least 3 years and this policy adds to their woes with fixed number of available positions for increasing physicians with J1 visa. The table 3 of the main article shows that it is easier for a J1 physician to transition to fellowship because a majority of fellowship program accept J1 candidates. However, this is not entirely true. Fellowship results are announced during the last week of November, far later than most Conrad-30 programs open and fill. If a J1 IMG does not match, there is a high likelihood that he/she might not be able to secure a job before the training year ends on June 30.3 This unpredictability about their career choices and plans can substantially increase anxiety among J1 IMGs. Since most residency/fellowship programs in the USA are only accepting J1 visas, the number of J1 IMGs is increasing which is making it more difficult for them to secure one of the fixed numbers of available jobs. All of these complexities and moving hurdles for J1 IMGs have made career planning cumbersome and filled with uncertainties.