LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter.transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refuse,es sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Medical training in the United States r. Richard Hu's article "Training in US beneficial but foreign trainees face many roadblocks" (Can Med Assoc J 1991; 144: 592-593) raised the issue of visa problems for Canadians wishing to stay in the United States after their medical training is complete. The J-1 (exchange visitor) visa provides a relatively easy path for entry into the United States for medical training and permits unrestricted participation in the complete residency program. Unfortunately, the 2-year foreign residence requirement after training is strictly adhered to. An H-1 (permanent resident) JANUARY 15, 1992
visa, which does not carry a foreign residence requirement, is more difficult to obtain and does not permit direct clinical care. When I was finishing my residency training at Bellevue Hospital in New York City I found that I was expected to return to Canada for 2 years before pursuing immigration to the United States. That I had been married to a US citizen for 3 years did not matter. My wife and I were contemplating moving to a town on the New York-Ontario border so that she could continue her medical practice. Immigration lawyers were pessimistic and made no pretence that they would be successful. Exemption from the foreign residence requirement is available for political refugees and for physicians sponsored by a US federal agency. I pursued the latter option through the US Veterans Administration, which recommended to the United States Information Agency after several months that I was in the "national interest" and that the foreign residence requirement be waived. The United States Information Agency endorsed the recommendation and sent it to the United States Immigration and Naturalization Service. At that point I was able to obtain permanent residence status by virtue of being married to a US citizen. The procedures needed to get approval from the Veterans Administration are getting more stringent and difficult to pursue. Nevertheless, since my success I have seen three other physicians obtain exemptions. Two simultaneously pursued labour certification (a process to ensure that no US citizen is available to take the job in question) to obtain perma-
nent residence status (both were unmarried), and one applied for an H-1 visa. State agencies are unable to petition on the physician's behalf. There are very few federal agencies other than the Veterans Administration that employ large numbers of physicians and that have a recruitment problem necessitating the extraordinary measures required to hire the holder of a J-1 visa. The armed forces is another possibility but a more restrictive one when it comes to lifestyle. The courts have not been helpful to those seeking a legal remedy. The 2-year foreign residence requirement takes precedence over any personal hardships (including moving a US spouse and children born in the United States). Applications for a waiver on the basis of personal hardship have been unsuccessful even after great expenditures of time and money. Until the US immigration laws concerning J-1 visas change, Canadians who wish to pursue postgraduate medical training in the United States need to be prepared to return to Canada. Leslie L. Citrome, MD, FRCPC Middletown Psychiatric Center Middletown, NY
Special Report on Quebec creates controversy s teachers at the Herzl
Family Practice Centre of the Sir Mortimer B. Davis-Jewish General Hospital, CAN MEDASSOCJ 1992; 146 (2)
99
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter.transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refuse,es sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Medical training in the United States r. Richard Hu's article "Training in US beneficial but foreign trainees face many roadblocks" (Can Med Assoc J 1991; 144: 592-593) raised the issue of visa problems for Canadians wishing to stay in the United States after their medical training is complete. The J-1 (exchange visitor) visa provides a relatively easy path for entry into the United States for medical training and permits unrestricted participation in the complete residency program. Unfortunately, the 2-year foreign residence requirement after training is strictly adhered to. An H-1 (permanent resident) JANUARY 15, 1992
visa, which does not carry a foreign residence requirement, is more difficult to obtain and does not permit direct clinical care. When I was finishing my residency training at Bellevue Hospital in New York City I found that I was expected to return to Canada for 2 years before pursuing immigration to the United States. That I had been married to a US citizen for 3 years did not matter. My wife and I were contemplating moving to a town on the New York-Ontario border so that she could continue her medical practice. Immigration lawyers were pessimistic and made no pretence that they would be successful. Exemption from the foreign residence requirement is available for political refugees and for physicians sponsored by a US federal agency. I pursued the latter option through the US Veterans Administration, which recommended to the United States Information Agency after several months that I was in the "national interest" and that the foreign residence requirement be waived. The United States Information Agency endorsed the recommendation and sent it to the United States Immigration and Naturalization Service. At that point I was able to obtain permanent residence status by virtue of being married to a US citizen. The procedures needed to get approval from the Veterans Administration are getting more stringent and difficult to pursue. Nevertheless, since my success I have seen three other physicians obtain exemptions. Two simultaneously pursued labour certification (a process to ensure that no US citizen is available to take the job in question) to obtain perma-
nent residence status (both were unmarried), and one applied for an H-1 visa. State agencies are unable to petition on the physician's behalf. There are very few federal agencies other than the Veterans Administration that employ large numbers of physicians and that have a recruitment problem necessitating the extraordinary measures required to hire the holder of a J-1 visa. The armed forces is another possibility but a more restrictive one when it comes to lifestyle. The courts have not been helpful to those seeking a legal remedy. The 2-year foreign residence requirement takes precedence over any personal hardships (including moving a US spouse and children born in the United States). Applications for a waiver on the basis of personal hardship have been unsuccessful even after great expenditures of time and money. Until the US immigration laws concerning J-1 visas change, Canadians who wish to pursue postgraduate medical training in the United States need to be prepared to return to Canada. Leslie L. Citrome, MD, FRCPC Middletown Psychiatric Center Middletown, NY
Special Report on Quebec creates controversy s teachers at the Herzl
Family Practice Centre of the Sir Mortimer B. Davis-Jewish General Hospital, CAN MEDASSOCJ 1992; 146 (2)
99
