[Federal Register Volume 64, Number 125 (Wednesday, June 30, 1999)]
[Rules and Regulations]
[Pages 34982-34983]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-16757]


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UNITED STATES INFORMATION AGENCY

22 CFR Part 514


Exchange Visitor Program

AGENCY: United States Information Agency.

ACTION: Statement of policy.

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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. 99-16757 Filed 6-29-99; 8:45 am]
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