{
 "standard": "data/img-visa.json — physician immigration registry. Every row distinguishes statute, regulation, agency guidance, proposed rule and litigation, and carries its own checked-at date. Nothing here is legal advice.",
 "asOf": "2026-09-01T21:00:00-07:00",
 "lawCheckedAt": "2026-09-01",
 "regulationCheckedAt": "2026-09-01",
 "litigationCheckedAt": "2026-09-01",
 "institutionalGuidanceCheckedAt": "2026-09-01",
 "disclaimer": "General educational information about published rules, not individualised immigration legal advice. Immigration consequences depend on facts this site does not know.",
 "comparison": [
  {
   "issue": "Sponsor",
   "j1": "ECFMG / Intealth — the sole J-1 sponsor for foreign-national physicians in U.S. clinical graduate medical education",
   "h1b": "The employer. Availability is institution- and often programme-specific."
  },
  {
   "issue": "Step 3",
   "j1": "Generally not required for J-1 sponsorship",
   "h1b": "Typically critical. For most foreign medical graduates providing patient care, Step 3 or the legally accepted equivalent, plus required state authorisation, is part of the physician-specific requirements."
  },
  {
   "issue": "INA §212(e) two-year home-country requirement",
   "j1": "Yes. Graduate medical education is an independent trigger, regardless of the Skills List.",
   "h1b": "No"
  },
  {
   "issue": "Dual intent",
   "j1": "Limited",
   "h1b": "Yes"
  },
  {
   "issue": "Numerical cap",
   "j1": "No H-1B cap applies",
   "h1b": "Cap-subject unless the employer and the work arrangement qualify for statutory exemption"
  },
  {
   "issue": "Availability in GME",
   "j1": "Broadly used across residency programmes",
   "h1b": "Programme-specific; many programmes sponsor J-1 only"
  },
  {
   "issue": "Moonlighting",
   "j1": "Prohibited outside the approved activity",
   "h1b": "Depends on separate authorisation and employer"
  },
  {
   "issue": "Duration",
   "j1": "Time normally required to complete training; generally seven years overall for the physician category",
   "h1b": "H-1B statutory rules"
  },
  {
   "issue": "Admission period (from 15 September 2026)",
   "j1": "Fixed-date admission. I-94 controls; generally program length or four years, whichever is shorter; longer training may need an Extension of Stay or another lawful admission mechanism",
   "h1b": "Petition validity governs; unaffected by the F/J/I fixed-admission rule"
  },
  {
   "issue": "After training",
   "j1": "Home return, or a physician-specific waiver — Conrad 30, interested government agency, persecution, or exceptional hardship where applicable",
   "h1b": "Employer-sponsored continuation and ordinary immigration pathways"
  }
 ],
 "capExemption": {
  "rule": "A hospital is not cap-exempt because it is a hospital. Exemption follows the employer’s legal character and the work arrangement, not the industry.",
  "categories": [
   {
    "category": "Institution of higher education",
    "basis": "Statute",
    "note": "The clearest category."
   },
   {
    "category": "Nonprofit entity related to or affiliated with an institution of higher education",
    "basis": "Statute and regulation",
    "note": "This is where most teaching hospitals are argued to fall, and where the analysis is genuinely fact-dependent."
   },
   {
    "category": "Nonprofit research organisation",
    "basis": "Statute",
    "note": "Organisational purpose controls."
   },
   {
    "category": "Governmental research organisation",
    "basis": "Statute",
    "note": ""
   },
   {
    "category": "Qualifying employment performed AT a qualifying organisation",
    "basis": "Regulation",
    "note": "Current USCIS rules recognise certain work performed at a qualifying organisation where the regulatory nexus requirements are met, even where the petitioner is not itself exempt."
   }
  ],
  "fieldRule": "Program records carry H1BCapExemptEvidence with values VERIFIED / LIKELY / NOT PUBLICLY STATED — never a guess, and never inferred from the employer being a hospital."
 },
 "policyWatch": [
  {
   "item": "$100,000 proclamation fee",
   "state": "NOT CURRENTLY ENFORCEABLE",
   "instrumentType": "PROCLAMATION · LITIGATION",
   "detail": "A 2025 proclamation imposed a $100,000 payment on certain new H-1B petitions for individuals outside the United States. A U.S. district court vacated the policy on 8 June 2026; the government appealed; the First Circuit declined the government’s stay request on 24 July 2026. On that record the requirement is not currently enforceable. Litigation continues.",
   "checkedAt": "2026-09-01"
  },
  {
   "item": "$103,265 cap-subject fee",
   "state": "PROPOSED — NOT IN FORCE",
   "instrumentType": "PROPOSED RULE",
   "detail": "DHS published a 2026 proposal for a $103,265 fee on H-1B cap-subject petitions, including advanced-degree-exemption petitions. Comments close 24 September 2026. If finalised as proposed, it would by its terms reach cap-subject petitions — which is precisely why cap-exempt status matters strategically.",
   "checkedAt": "2026-09-01"
  },
  {
   "item": "DHS fixed-period admission for F, J and I",
   "state": "FINAL RULE — EFFECTIVE 15 SEPTEMBER 2026",
   "instrumentType": "FINAL RULE",
   "detail": "Eliminates duration-of-status admission. Intealth states DHS did not exempt J-1 physicians. The I-94 becomes the controlling document; Intealth is moving toward multi-year DS-2019s; the seven-year physician training limit is unchanged.",
   "checkedAt": "2026-09-01"
  },
  {
   "item": "H-1B cap exemption",
   "state": "CONTINUING STATUTORY AND REGULATORY BASIS",
   "instrumentType": "STATUTE AND REGULATION",
   "detail": "Unaffected by the fee developments. The exemption categories continue to apply on their own terms.",
   "checkedAt": "2026-09-01"
  }
 ],
 "waivers": {
  "noObjection": "Foreign medical physicians who acquired J-1 status for U.S. graduate medical education generally cannot use the ordinary No Objection Statement waiver route. This is a frequent and costly misunderstanding.",
  "physicianRoutes": [
   "Conrad State 30",
   "Interested U.S. government agency",
   "Persecution",
   "Exceptional hardship where applicable"
  ],
  "conrad30": {
   "elements": [
    "Sponsorship by a designated state public-health department",
    "Generally full-time physician employment",
    "Service in or for an underserved area",
    "A three-year service commitment",
    "Employment generally beginning within 90 days after the waiver",
    "Up to 30 waiver requests per state annually",
    "Up to 10 flex slots under the current federal framework where applicable"
   ],
   "note": "State programmes differ substantially in windows, specialty priorities, employer requirements and documentation. A 50-state tracker is the correct form for this and is not yet built; nothing here should be read as any particular state’s rule."
  }
 }
}