A foreign-trained doctor has five main routes to work in the United States: J-1 for training, H-1B for employed clinical work, TN for Canadians and Mexicans in teaching or research, O-1 for extraordinary ability, and an employment-based green card. Every route starts with the same base: ECFMG certification, USMLE, and a state license. The visa depends on your training stage, your citizenship and your employer. ConnectedMedics lists healthcare vacancies worldwide, so you can find roles in the US, filter by specialty and see which employers hire international clinicians.
TL;DR
- No visa replaces ECFMG certification, the USMLE steps and a state medical license. The visa only lets you work once these are in place.
- J-1 is the most common route for residency and fellowship. H-1B is the main route for employed clinical work and requires an employer to file the petition.
- TN covers only Canadian and Mexican citizens, and only teaching or research. O-1 and the physician National Interest Waiver green card suit narrower profiles.
- New H-1B petitions for workers abroad filed after September 20, 2025 carry a $100,000 payment unless an exception applies. Employers pay it, not you.
Table of Contents
- What every route has in common
- The five routes at a glance
- J-1: the common route into residency and fellowship
- H-1B: the main route for employed physicians
- TN: Canadian and Mexican physicians in teaching or research
- O-1: extraordinary ability
- Green cards: the physician National Interest Waiver
- How to choose your route
- Find US roles on ConnectedMedics
- Our perspective
- FAQ
- Sources
What every route has in common
There is no national medical license in the US. Foreign medical graduates must complete ECFMG certification and an accredited residency in the U.S. or Canada, apply for a state license, and obtain a visa that permits clinical training to enter graduate medical education.
In practice, you work through this order:
- Verify your medical degree with ECFMG and pass the USMLE steps.
- Secure a residency or fellowship position, or an employer offer if you already completed training.
- Get the employer or program to sponsor the right visa class.
- Apply for the license or training license from the medical board of the state where you will work.
Each residency or fellowship program decides which visa classes it will accept. Some programs allow J-1 sponsorship through ECFMG only, so check this before you rank programs, not after the match.
English proficiency also matters. Institutions that sponsor H-1B for clinicians commonly require an ECFMG-acceptable English exam alongside the USMLE. Our IELTS guide for doctors covers the score targets.
The five routes at a glance
| Visa | Who it fits | Sponsor | Typical limits |
|---|---|---|---|
| J-1 | Residents and fellows in clinical training | ECFMG | Up to 7 years; two-year home residency requirement unless waived |
| H-1B | Residents and physicians in employed clinical roles | Employer or program | Up to 3 years, extendable to 6; tied to the worksite in the petition |
| TN | Canadian and Mexican citizens | Employer | Teaching or research only |
| O-1 | Physicians with extraordinary ability | U.S. employer or agent | Validity of the petition |
| EB-2 NIW green card | Physicians serving underserved areas | Self-petition with agency statement | Five years of qualifying clinical work |
J-1: the common route into residency and fellowship
The J-1 is the most common route for clinical graduate medical education, with a maximum of seven years, and ECFMG sponsors it. It carries a two-year home residency requirement that you must fulfill unless you obtain a waiver such as Conrad 30.
What this means for planning:
- You train on J-1, then either return home for two years or secure a waiver.
- Conrad 30 waivers are tied to service in underserved areas. Our Conrad 30 explainer walks through how the program works.
- If you want to stay in the US after training, ask programs early how they handle waiver support and H-1B sponsorship.
Where it goes wrong: applicants treat J-1 as a formality and discover the home residency requirement only in their final year. Build the waiver timeline into your career plan from the first year.
H-1B: the main route for employed physicians
H-1B is the route most searches about physician visas are after, and the one with the most moving parts. The position must qualify as a specialty occupation, and the physician must meet a qualifying degree, license or equivalent-experience criterion. The employer submits a Labor Condition Application certified by the Department of Labor with Form I-129. You cannot file it yourself.
What a physician needs to qualify
For clinical roles with direct patient contact, sponsoring institutions commonly ask for these items:
- A medical degree from a recognized school, or a full and unrestricted foreign license.
- Passing USMLE Steps 1, 2 and 3, or the accepted equivalents.
- ECFMG certification for international medical graduates, as university immigration offices spell out.
- A state license or the authorization the state requires for the place where you will practice or train.
Step 3 is the item that most often decides between H-1B and J-1 for new graduates. Programs that require applicants to have passed it before H-1B filing leave many residents with J-1 as the practical option.
Duration and worksite
Admission is generally up to three years, extendable for up to three more, six in total. Residents in H-1B status may be granted time in one-year increments only, and moonlighting is not permitted, according to MUSC's physician guidance.
H-1B employees can work only at worksites included in the petition. If you plan to split time between hospitals or add a locum assignment, the employer's immigration counsel must cover those sites in the filing.
The $100,000 payment
This is the question that changed the market. The $100,000 payment is made to USCIS in addition to existing employer fees, which range from $960 to $7,380 for initial petitions depending on the firm. USCIS has clarified that it applies to new petitions filed after September 20, 2025 for H-1B workers abroad. Existing H-1B visas, renewals and changes of status inside the US are generally not subject to it.
What that means for you:
- A physician already in the US in a status that converts to H-1B without leaving the country is generally outside the payment.
- A physician abroad needing a new petition falls inside it unless an exception applies. Where it applies, the filing must include proof of payment or evidence of an exception.
- You are not the one paying. Under the rules on employer-side H-1B costs, mandatory fees cannot be shifted to the employee.
Rules and exceptions can change, so confirm the current position on the USCIS H-1B page before you negotiate. Our H-1B for doctors guide covers requirements, cap exemptions and fees in more detail.
Changing employers
H-1B portability lets physicians change employers by filing a new petition and starting work on filing rather than waiting for approval. Plan the license in the new state first, since the state board often sets the real timeline.
TN: Canadian and Mexican physicians in teaching or research
TN has one catch for doctors. Canadian and Mexican citizens may obtain TN status as physicians for teaching or research only. Status is granted in increments of up to three years and may be renewed while the stay remains temporary. The same source notes that physicians on TN cannot be primarily engaged in clinical patient care, though incidental patient care is permissible.
So TN suits a Canadian clinician-scientist taking a faculty or research post. It does not suit a Canadian physician who wants a full clinical load in a community hospital. That doctor looks at H-1B.
If a TN holder later pursues a green card, an immigration medical exam is part of adjustment of status. Details on the I-693 medical exam for TN holders explain what that exam involves.
O-1: extraordinary ability
The O-1 is for people with extraordinary ability in the sciences, arts, education, business or athletics, recognized nationally or internationally. A U.S. employer, U.S. agent or a foreign employer through a U.S. agent files Form I-129 for you. Admission covers the petition validity plus up to 10 days before and after.
For physicians, the O-1 fits a narrow group: researchers with major publications, leading clinician-scientists and specialists with national recognition. A strong residency application alone is not that profile. Build the evidence file with an immigration attorney before you assume it is open to you.
Green cards: the physician National Interest Waiver
The EB-2 category covers people of exceptional ability and members of professions holding advanced degrees. A job offer and labor certification are generally required, but the requirement can be waived in the national interest. The physician NIW criteria include:
- Full-time clinical practice for five years in a designated underserved area (an HPSA, MHPSA, MUA or VA facility).
- A statement from a federal agency or a state department of health.
This route rewards doctors who plan their first positions around underserved-area service. It pairs naturally with Conrad 30 and with H-1B jobs in shortage areas. Our US physician shortage overview shows where demand is concentrated.
How to choose your route
Start from your stage and citizenship, not from the visa name.
- Still in training or just matched: J-1 or H-1B, depending on what the program sponsors and whether Step 3 is done.
- Finished training, seeking an employed role: H-1B, with an employer willing to file and pay the required fees.
- Canadian or Mexican citizen in a faculty or research job: TN.
- Nationally recognized researcher or specialist: O-1, built with counsel.
- Long-term US plan: NIW or another employment-based green card, planned around underserved-area service.
Then check licensing. The state medical board decides when you can practice, so read the rules for your target state early. If you may practice in several states, the Interstate Medical Licensure Compact checklist shows how the compact speeds additional licenses for eligible physicians. For comparing international registration steps, our guide on medical registration across borders helps.
The job search is the hardest part for many visa-seeking doctors, because only some employers sponsor. Our job search checklist for doctors and the piece on why doctors struggle to find relevant jobs lay out how to narrow the field. For pay benchmarks when you negotiate, see US physician compensation trends.
Find US roles on ConnectedMedics
ConnectedMedics is a healthcare-only network with verified member profiles and a global jobs board. It carries over 22,000 active healthcare vacancies with specialty-specific filters, so you search by your specialty instead of scrolling through generic listings. Our platform also offers peer discussion forums and curated research summaries. Work permits are available online.
Employers use the same platform to post roles and reach verified clinicians. The Free plan, the Growth plan at £99 per month, Enterprise and Premium Employer options are on the employer plans page. Doctors can start from the ConnectedMedics home page.
Our perspective
Foreign-trained doctors rarely lack qualifications. They lack a clear view of which employers hire internationally and which visa each employer files.
That is why we built ConnectedMedics for healthcare only. Verified profiles mean employers see credentials that were checked. A jobs board with specialty filters means a nephrologist sees nephrology roles. Our network spans 190+ countries, so a doctor abroad can see US demand and talk to peers who made the move.
Our advice: set up your profile with your exam status, license progress and visa needs stated plainly, then follow roles in your specialty. Employers filtering for clinicians who already fit their pipeline can then find you.
David
FAQ
How can foreign doctors work in the USA?
They complete ECFMG certification and the USMLE, secure a U.S. residency or employer position, and obtain a state license. The employer or program then sponsors a visa, usually J-1 for training or H-1B for employed practice. Which one is open to you depends on your stage, citizenship and the program's policy.
Can a doctor on a TN visa see patients?
TN physician status covers teaching or research only. Direct clinical care is allowed only when incidental to those duties. Full clinical practice generally needs another status such as H-1B.
How long is an H-1B valid for a physician?
Initial admission is generally up to three years, extendable by up to three more for a six-year total, according to USCIS. Residents may receive status in one-year increments, depending on the institution.
Who pays the $100,000 H-1B payment?
The payment sits on the employer side, in addition to existing petition fees. It applies to new petitions filed after September 20, 2025 for workers abroad, with renewals and in-country changes generally outside it. Check USCIS for the current rules and exceptions.
Sources
- Practicing medicine in the U.S. as an international medical graduate (AMA)
- H-1B Specialty Occupations (USCIS)
- New H-1B Fee and Other Recent H-1B Developments (Congress.gov CRS)
- H-1B Visa for Physicians (MUSC Center for Global Health)
- Sponsoring H-1B Employment (University of Hawaii)
- H-1B Eligibility Requirements (UAMS Immigration Services)
- Doctor, Doctor: Reforming Physician Immigration Policy (Georgetown Immigration Law Journal)
- TN, Canadian or Mexican (Loyola University Chicago)
- O-1 Visa (USCIS)
- Green Card Through a Physician National Interest Waiver (USCIS)
- How Much Does It Cost to Sponsor a Work Visa? (Lighthouse)
- H-1B Specialty-Occupation Visa (CGMIMM)
- I-693 medical exam for TN visa holders adjusting status