Exchange visitor program: Foreign medical graduates; pursuit of graduate medical education or training in U.S.; program administration issues; policy statement,

[Federal Register: June 30, 1999 (Volume 64, Number 125)]

[Rules and Regulations]

[Page 34982-34983]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr30jn99-7]

UNITED STATES INFORMATION AGENCY

22 CFR Part 514

Exchange Visitor Program

AGENCY: United States Information Agency.

ACTION: Statement of policy.

SUMMARY: The Agency hereby announces its police regarding various program administration issues arising from the pursuit of graduate medical education or training in the United States by foreign medical graduates under the aegis of the Exchange Visitor Program.

EFFECTIVE DATE: This policy statement is effective June 30, 1999.

FOR FURTHER INFORMATION CONTACT: Stanley S. Colvin, Assistant General Counsel, United States Information Agency, 301 4th Street, S.W., Washington, DC 20547; telephone, (202) 619-6531.

SUPPLEMENTARY INFORMATION: Since enactment of the Health Care Professions Act, Pub. L. 94-484, USIA has been responsible for the administration and oversight of exchange programs whereby foreign medical graduates enter the United States to pursue graduate medical eduation or training opportunities at U.S. medical training facilities, most of whom enter the United States to pursue clinical-based medical speciality training. In addition to reviewing the credentials of foreign medical graduates, and pursuant to a long-standing agreement, the Educational Commission for Foreign Medical Graduates (ECFMG) is responsible for the day to day administration of these exchange programs. ECFMG administration of these programs is conducted in conformance with the program and policy guidance of the USIA, which in turn is developed in consultation with the Secretary of Health and Human

[[Page 34983]]

Services. Periodically, program administration issues arise and USIA provides appropriate guidance to the ECFMG on how to address such issues. Recently, five specific questions regarding eligibility for program participation have presented themselves.

A foreign medical graduate seeking to pursue graduate medical education must apply for a residency program in one of the recognized speciality or subspeciality fields of medicine. These residency programs are conducted by the various teaching hospitals and medical facilities located throughout the United States. Because such residency programs require the performance of clinical care of patients, the individual states require that the foreign medical graduate be licensed to practice medicine in the particular state. The question of state licensure comes up at both the beginning of a program of graduate medical education as an eligibility criteria and at the end of a program when the foreign medical graduate seeks a waiver of the statutorily-imposed two-year home country physical presence requirement. Because the question of who may practice medicine in any jurisdiction is a unique question of local determination, USIA imposes no regulatory requirement regarding state licensure.

A recurring question regarding eligibility for program participation arises from the statutory requirement that the foreign medical graduate present a statement of need from his or her country of nationality or last legal permanent residence. This statement of need is submitted in a prescribed format and provides assurances to the United States Government that the graduate medical education that the foreign medical graduate will pursue is of use to his or her country of nationality or last legal permanent residence. The foreign medical graduate seeking to pursue graduate medical education does not have a choice regarding which country will submit the statement of need. Such determination is self-executing and fact based. Does the foreign medical graduate reside in his or her country of nationality? If so, the statement of need is submitted from that country. If the foreign medical graduate does not reside in his or her home country, then the statement of need is submitted by his or her country of last legal permanent residence. If the foreign medical graduate cannot submit the appropriate statutorily-mandated statement of need, the foreign medical graduate is ineligible for program participation.

An additional area of program administration that has generated substantial interest is the eligibility of foreign medical graduates to continue in J-visa status following the completion of their graduate medical education. This eligibility question arises for those foreign medical graduates who have completed their program and who have also received a waiver of the two-year home country physical presence requirement. These participants are required to adjust their non- immigrant status from the J-visa to the work based H-visa. In doing so, many participants have been delayed in their receipt of the H-visa because of the yearly numerical limitation governing the initial issuance of H-visas. To accommodate these participants, USIA has adopted a policy that participants who have received an IGA or State 20 based waiver and who are sitting for speciality board examinations may continue in J-visa status. These participants are not authorized to work while in this extension period and the extension is limited to the end of the month in which the Board examination is given but not to exceed six months.

Two employment related or work authorization questions arises from the desire of many participants and medical facilities to have the foreign medical graduate participate in residency training as a ``chief'' resident or work outside of the residency program. First, the number of years of eligibility for program participation and thereby work authorization is totally dependent upon the period of time established by the American Council for Graduate Medical Education as published in the American Medical Association; Graduate Medical Education Directory. It appears that many residency programs have attempted to add an additional year of residency training and thereby have the services of the foreign medical graduate for the additional year. Given the requirement that the USIA administer this activity on a national basis and in conjunction with criteria established by the Secretary of Health and Human Services, USIA will not authorize program participation for this additional year unless such additional year is set forth as a requirement in the American Medical Association; Graduate Medical Education Directory. Further, a foreign medical graduate is not authorized to ``moonlight'' and is without work authorization to do so. A foreign medical graduate may receive compensation from the medical training facility for work activities that are an integral part of his or her residency program. The foreign medical graduate is not authorized to work at other medical facilities or emergency rooms at night or on weekends. Such outside employment is a violation of the foreign medical graduate's program status and would subject the foreign medical graduate to termination of his or her program.

Finally, USIA has examined the eligibility of foreign medical graduates who have entered the United States not as alien physicians seeking to pursue graduate medical education or training, but as research scholars holding a J-visa. The Exchange Visitor Program is premised upon the idea that foreign nationals will enter the United States for a specific program purpose such as training or research and then return to their home country to share their impressions and experiences with their countrymen. This premise, which lies at the heart of the Agency's mission, obligates the Agency to administer the program in the manner most likely to achieve this exchange objective. Accordingly, the Agency has informed the ECFMG that individuals who have participated in the Exchange Visitor Program as a research scholar or professor participant during the twelve month period preceding their proposed commencement of a program of graduate medical education are ineligible for sponsorship.

Dated: June 25, 1999. Les Jin, General Counsel.

[FR Doc. 99-16757Filed6-29-99; 8:45 am]

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