The Bottom Line
- J-1 (physicians) is commonly sponsored via ECFMG, but it carries the INA §212(e) two-year home-country physical presence requirement unless waived.
- H-1B is “dual intent” in practice (more straightforward long-term pathway), but fewer residency programs will sponsor it and the admin burden is higher.
- If you want a predictable US permanence runway, prioritise H-1B-sponsoring programs early; if you accept a waiver service commitment, J-1 can still be viable.
The non-negotiable constraint: §212(e)
If you train on a physician J-1, you are typically subject to the two-year home-country physical presence requirement (§212(e)). That means: after training, you must either (a) complete two aggregate years in your home country, or (b) secure a waiver before you can access certain US immigration benefits. For waivers, you’ll see Form DS-3035 (State Department) and, for hardship/persecution bases, Form I-612 (USCIS). Keep every DS-2019 you’ve ever been issued — you’ll need copies.
Common failure mode: choosing a visa without a “post-training plan”
The risk is not the visa itself — it’s drifting into PGY3 without clarity on how you’ll legally stay/work after graduation. Your job is to choose a visa + an exit route (home return, waiver job, or permanence pathway) on Day 1 of residency.