SERIES: TO GRE OR NOT TO GRE: THE VISA ISSUES

The previous post on the GRE Route to Residency dealt with how a visa-needing IMG could strategize and pre-plan for using the GRE option to leverage Residency Dreams, which brings the next natural question to the fore - is that option right for you ?

This article is a start of a series of discussions and analysis about the pros and cons of this GRE to Residency Route to help give IMGs a decision-support on whether the GRE route is sensible for them. I am not attempting to bias anyone for or against this decision, but merely shall be placing facts that can affect a decision. Priorities will differ from IMG to IMG and so shall the decision.

In Medicine, when the exact reasons behind a disease are not known, it is shoved off in the category of 'multifactorial'. Likewise, the answer to the questions - "Is the GRE route to a residency necessary" or "is the GRE route right for me" must begin with..."It Depends..." ;-)



Visa Issue I: Since CS Visas (Visitor's visa for CS) are now easier (though not always a guarantee), some people may find themselves more inclined to instinctively scrap the GRE route as unnecessary and an overkill. But lets analyze this further - before getting a residency, an IMG candidate based outside the US will need to be in the US for at least three reasons - Step 2 CS, Step 3 CCS (If H1 needed) and then again the Interviews. I said 'at least' because in addition some folks may secure observerships / externships and may need to step on the American soil again. Other reason could be being around the post-match scramble. Unless you lucky to get a multiple-entry visitors or a long term CS Visa and you are able to coordinate all of aforementioned activties in a single visit, I perceive the constant visa hassle and the repeated flights to the US as a headache and a financial strain. The F1 visa gives you that long term presence in the US to complete all of those at your own pace and convinience. Well, that was the first issue.

Visa Issue II: The second issue that has begun to gain prominence as a bother to program directors, atleast for the H1b visas, is the visa approval delays due to first-time-rejected-second-time-accepted scenario, unavailable dates, etc. in home countries. I know of atleast 3 incidences where an IMG joined a residency late because the visa stamping got delayed. People on F1 visas don't need to go back to their home countries before starting residencies. They they are allowed to stay on in the USA during the summer (May to mid-August) without taking any classes. They can then begin work on H1-status after getting the paper work done. The eventual visa stamping can then be done after 6 months either in their home countries or Canada/Mexico/Bahamas. etc. This way has a lesser chance of rejection since the IMG can show his 6-months of residency-pay stubs as solid proof of work. An IMG on a visitor's visa must always head back to his country and have the appropriate visa stamped before flying back to begin residency.
(Though technically it is possible to 'change status' from B1 / B2 to a J1 or H1b within in the US itself, it is not considered a good thing to do. Coz', eventually you will need to get out of the USA and will need to have the new visa type stamped to get back - and visa officers around the globe seem to have a particular distaste for people who came to the US on a visitors visa, i.e. with no intention of staying on and yet got their status changed. )

Visa Issue III: The final Visa issue I shall touch on is that of the F1-Student Visa itself. As I mentioned earlier, USMLE Step 1 and Step 2 CK Studies will be most effective in the comfort of your home countries - For a Masters/PhD student who needs to work and cook besides study/research, availability of sustained prep times for USMLE Steps are often a luxury [it's too expensive to eat out each day on a student budget and yeah - maids are not cheap either ;-)]
The visa issue is - it safe to take USMLE Steps and then apply for the Student Visa ?

Again, let me begin with "it depends" - The trend of visa-rejects and approvals are often cyclical and can be gauged from other people's experiences on forums and friends. Use that information. Second, an admission to a well-known University is less likely to be rejected. Third, Scholarships / assistantships from the University granting you an admit makes visa approval more likely, besides strong homeland finances. If you still must feel pressed to not risk a student visa and rather take USMLE Steps after a visa approval, then to make the best of your situation, you should aim to finish studying and revising for the first step before you land here .....sort of attempting a damage control :-) A medical school junior of mine was either lucky or smart enough to have the Step 1 taken days before flying to US AFTER the student visa was approved :-)