Resident & Fellow Appointments Policy

This policy describes eligibility criteria, sponsored Visa statuses, application, recruitment and selection related to resident/fellow appointments (including transfers) to ACGME— (Accreditation Council for Graduate Medical Education) accredited residency/fellowship training programs sponsored by University at Buffalo Graduate Medical Education (UBGME). This policy also addresses Visa statuses, applications and licensure for employees of University Dental Resident Services (UDRS).

Accredited programs must select residents/fellows from a pool of applicants who meet the eligibility requirements established by the accrediting body (e.g., ACGME, CODA), New York State (NYS) regulations, the University at Buffalo and affiliated hospitals, and the individual program. UB GME monitors each of its ACGME-accredited programs for compliance with applicable requirements and regulations. 

 J-1 visas are generally accepted for all medical resident/fellow training programs sponsored by the University at Buffalo.

• J-1 FICA Exemption — According to the Internal Revenue Service (IRS) — Resident Aliens and Nonresident Aliens are taxed differently; it’s important for you to determine your tax status. Refer to the IRS website: https://www.irs.gov/taxtopics/tc851 for help in determining your status. Nonresident aliens may be exempt from FICA tax withholdings. Resident aliens are not exempt and subject to FICA tax withholdings.
  • Nonresident Aliens — You’re considered a nonresident alien for any period that you’re neither a U.S. citizen nor a resident alien for tax purposes.
  • Resident Aliens — You’re considered a resident alien for a calendar year if you meet the green card test or the substantial presence test for the year.
    • Green Card Test — You’re considered to have met the green card test, and are therefore a resident alien, if at any time during the calendar year you were a lawful permanent resident of the United States according to the immigration laws, and this status hasn’t been revoked or administratively or judicially determined to have been abandoned.
    • Substantial Presence Test — You satisfy the substantial presence test, and are therefore treated as a resident alien for a calendar year, if you have been physically present in the United States on at least:
      • 31 days during the current year, and
      • 183 days during the 3-year period that includes the current year and the 2 years immediately preceding the current year. To satisfy the 183-day requirement, count:
    • All of the days you were present in the current year
    • One-third of the days you were present in the first year before the current year, and
    • One-sixth of the days you were present in the second year before the current year.
      

H-1B visa holders may be accepted for medical foundational residency training programs and all medical fellowship training programs sponsored by the University at Buffalo. Approved medical foundational residency programs will have a combined, limited number cap of 10 H-1B visas, based on institutional resources, and may be offered to exceptional medical residency candidates with approval of the DIO.

H-1B visas are subject to USCIS regulations, laws and approvals. A medical resident or fellow may apply for an H-1B visa if they meet the below requirements:

1. Has passed USMLE steps 1, 2 and 3.

        a. If Step 3 is not completed prior to the anticipated start date, program must approve delay with training until H-1B visa is approved by USCIS. If delay not approved by program, resident/fellow must pursue a J-1 Visa

2. The training program submits a letter of support for filing the H-1B visa. The program director must fully support the H-1B Filing. If the program does not allow H-1B visas due to the possibility of delayed start dates, the resident/fellow must pursue a J-1 Visa.

Approved foundational residency programs, for the combined, limited number cap of 10 H-1B Visas, as referenced above are:

1. Internal Medicine SUNY
2. Internal Medicine Catholic Health
3. Internal Medicine & Pediatrics Combined
4. Family Medicine SUNY
5. Family Medicine Catholic Health
6. Pediatrics
7. Obstetrics & Gynecology Catholic Health

A resident or fellow may convert from a J-1 to an H-1B Visa if:

1. Tied to a J-1 Waiver and allowed by immigration status.
2. The spouse of the resident or fellow is a recipient of a J-1 Waiver
3. The resident/fellow is a Canadian citizen who is unable to obtain a Statement of Need and plans on living in Canada and working in the United States. This is subject to changes in USCIS regulations, laws and approvals.
4. The resident/fellow has received a letter of support from the program director supporting the filing of an H-1B Visa and they are joining a fellowship program or one of the approved foundational residency programs; as listed above.

Other Visas: T/N Visas are suitable for dental residents participating in the UB Dental residency training program. F-1, STEM, OPT or extensions are not considered for medical or dental residency training programs. If matched on F-1 OPT, the resident is obligated to change category to J-1 as soon as possible prior to training program start date.

All University at Buffalo- (UB) sponsored residency and fellowship programs must utilize the ERAS (Electronic Residency Application Service) or ADEA PASS (American Dental Education Association Postdoctoral Application Support Service) application whenever possible.

Throughout the year and during the post-Match period in particular, program directors must exercise due diligence when selecting residency/fellowship candidates. This includes compliance with all requirements, regulations, policies.

The following steps are recommended as part of the program director’s routine when selecting residency/fellowship candidates:

• Scrutinize the CV for gaps in training, short training stints, or serial experiences without program completion. Ask the candidate for explanations and verify the information by contacting prior programs directly.
• Investigate whether international medical graduates have satisfied the NYS Department of Education (NYS DOE) 12-week rule. If more than 12 weeks of medical school curriculum have been spent outside of the country in which the medical school is located, the school must appear on the list of approved schools issued by the NYS DOE.
• Search by name for physicians who may have had prior professional difficulties on the NYS Office of Professional Medical Conduct website.
• Check NRMP Match History to ensure applicant does not have a binding contract with another program or a previous match violation.

Prior to selection, all prospective residents/fellows must be interviewed by the program director and/or their designee(s). Programs must adhere to UB Graduate Medical Education Committee (GMEC) decisions regarding interview format (i.e., remote vs. in-person). The ACGME requires that, “An applicant invited to interview for a resident/fellow position must be informed, in writing or by electronic means, of the terms, conditions and benefits of appointment to the ACGME-accredited program, either in effect at the time of the interview or that will be in effect at the time of the applicant’s eventual appointments.” Information provided must include:

• stipends, benefits, professional liability coverage and disability insurance accessible to residents/fellows;
• institutional policy(ies) for vacation and leaves of absence, including medical, parental and caregiver leaves of absence; and,
• health insurance accessible to residents/fellows and their eligible dependents.

Applicants may be provided with a hard copy of these documents, or instructed to access them via the GME website at the time that the invitation to interview is extended.

Selection

UB residency programs should participate in the National Resident Matching Program (NRMP) for first year U.S. Graduates (entering their initial residency program). Programs and Program Leaders must adhere to all policies as outlined in the NRMP’s Match Participation Agreements. For example, Program Directors and Administrators must not share passwords, and Program Directors must adhere to all NRMP deadlines. 

Programs must select from among eligible applicants on the basis of residency/fellowship program-related criteria such as preparedness, ability, aptitude, academic credentials, communication skills and personal qualities such as motivation and integrity. Holistic review of applicants is recommended to foster equity and diversity.    

Programs must not discriminate with regard to sex, sexual orientation, gender identity, race, age, religion, color, national origin, disability, or any other applicable legally protected status.

Although a medical license is not generally required in New York State for residents/fellows in accredited medical training programs, individual programs may require licensure. Dental residents are mandated by New York State to obtain a license or limited permit.

Acceptance of a non-US citizen is contingent upon application and approval for and receipt of an appropriate visa, and to the visa considerations outlined above.  

The Employment Onboarding Policy outlines the procedures for resident/fellow employment.

Prior to accepting a resident/fellow who is transferring from another program, the program must obtain verification of previous educational experiences and a summative, competency-based performance evaluation. Milestones evaluations must be obtained by the program upon matriculation.

Solicitation of applications from individual trainees currently under contract with another training program is inappropriate.

If a program director is approached about a career change by a resident/fellow enrolled in another training program, the program director should encourage the resident/fellow to also notify their program office and UB GME early in the planning stage.

The Outside The Match procedure describes the procedure required by UB GME for accepting medical residency/fellowship candidates outside The Match, including transfers.

ACGME Institutional Requirements effective 7/1/2022 (applicable to UMRS employees (e.g. residents/fellows in ACGME-accredited programs)):

• Resident/Fellow Appointments (IV.B.- IV.B.2.c).(2))
  • The Sponsoring Institution must have written policies and procedures for resident/fellow recruitment, selection, eligibility and appointment consistent with ACGME Institutional and Common Program Requirements, and Recognition Requirements (if applicable), and must monitor each of its ACGME-accredited programs for compliance. (Core)
  • An applicant must meet one of the following qualifications to be eligible for appointment to an ACGME-accredited program: (Core)
    • graduation from a medical school in the United States or Canada, accredited by the Liaison Committee on Medical Education (LCME); or, (Core)
    • graduation from a college of osteopathic medicine in the United States, accredited by the American Osteopathic Association (AOA); or, (Core)
    • graduation from a medical school outside of the United States or Canada, and meeting one of the following additional qualifications: (Core)
    • holds a currently-valid certificate from the Educational Commission for Foreign Medical Graduates prior to appointment; or, (Core)
    • holds a full and unrestricted license to practice medicine in a United States licensing jurisdiction in his or her current ACGME specialty-/subspecialty program. (Core)

ACGME Common Program Requirements (Residency) effective 7/1/2022 (applicable to UMRS employees (i.e., residents/fellows in ACGME-accredited programs)):

• Resident Appointments (III.-III.A.4.b), III.C.)
  • Eligibility Requirements
    • An applicant must meet one of the following qualifications to be eligible for appointment to an ACGME-accredited program: (Core)
      • graduation from a medical school in the United States or Canada, accredited by the Liaison Committee on Medical Education (LCME) or graduation from a college of osteopathic medicine in the United States, accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation (AOACOCA); or, (Core)
      • graduation from a medical school outside of the United States or Canada, and meeting one of the following additional qualifications: (Core)
        • holding a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) prior to appointment; or, (Core)
        • holding a full and unrestricted license to practice medicine in the United States licensing jurisdiction in which the ACGME-accredited program is located. (Core)
      • All prerequisite post-graduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGME-accredited residency programs, AOA- approved residency programs, Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada, or in residency programs with ACGME International (ACGME-I) Advanced Specialty Accreditation. (Core)
      • Residency programs must receive verification of each resident’s level of competency in the required clinical field using ACGME, CanMEDS, or ACGME-I Milestones evaluations from the prior training program upon matriculation. (Core) [The Review Committee may further specify prerequisite postgraduate clinical education]
      • A physician who has completed a residency program that was not accredited by ACGME, AOA, RCPSC, CFPC, or ACGME-I (with Advanced Specialty Accreditation) may enter an ACGME-accredited residency program in the same specialty at the PGY-1 level and, at the discretion of the program director of the ACGME-accredited program and with approval by the GMEC, may be advanced to the PGY-2 level based on ACGME Milestones evaluations at the ACGME- accredited program. This provision applies only to entry into residency in those specialties for which an initial clinical year is not required for entry. (Core)
      • Resident Eligibility Exception                       The Review Committee for ______ will allow the following exception to the resident eligibility requirements: (Core)[Note: A Review Committee may permit the eligibility exception if the specialty requires completion of a prerequisite residency program prior to admission. If the specialty-specific Program Requirements define multiple program formats, the Review Committee may permit the exception only for the format(s) that require completion of a prerequisite residency program prior to admission. If this language is not applicable, this section will not appear in the specialty- specific requirements.]
        • An ACGME-accredited residency program may accept an exceptionally qualified international graduate applicant who does not satisfy the eligibility requirements listed in III.A.1.- III.A.3., but who does meet all of the following additional qualifications and conditions: (Core)
          • evaluation by the program director and residency selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of this training; and, (Core)
          • review and approval of the applicant’s exceptional qualifications by the GMEC; and, (Core)
          • verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification. (Core)
        • Applicants accepted through this exception must have an evaluation of their performance by the Clinical Competency Committee within 12 weeks of matriculation. (Core)

o   Resident Transfers

The program must obtain verification of previous educational experiences and a summative competency-based performance evaluation prior to acceptance of a transferring resident, and Milestones evaluations upon matriculation. (Core)

[The Review Committee may further specify]

Established:  1994
Reviewed by GMEC: 09/94; 11/01; 04/05; 05/05; 03/08; 01/10; 05/11; 02/13; 10/13; 06/15; 03/17; 05/18; 02/19; 10/19; 07/20; 06/22; 10/22