About Statements of Need
Statements of Need (SoNs), also known as Certificates of No Objection, are issued by Te Whatu Ora - Health New Zealand (Te Whatu Ora) to allow medical practitioners to obtain a J-1 visa to train in the United States. The SoN is one of many United States requirements which must be met before a J-1 visa can be obtained.
These statements certify that:
- the training that the named practitioner is intending to undertake is in an area for which there is a need in Aotearoa New Zealand; and
- the practitioner has given an undertaking to the New Zealand government that they intend to return to Aotearoa New Zealand at the conclusion of the training and intends to practise in the specialty for which the training is sought.
The Educational Commission for Foreign Medical Graduates (ECFMG) is the agency authorised by the United States Information Agency to sponsor foreign national medical practitioners as exchange visitors in accredited programmes of graduate medical education or training in the United States. A practitioner’s stay in the United States is limited to the training necessary to meet certification requirements of an American specialty board.
The duration of stay is limited to a maximum of seven years (unless an “exceptional need” for the (sub)specialty in question can de demonstrated, see below for more information).
The requirements for a SoN are set out in the United States Public Law 94-484. That law requires that each Exchange Visitor applicant provide a statement of need from the government of the country of their citizenship or most recent legal permanent residence. The statement must provide written assurance, satisfactory to the Secretary of the United States Department of Health and Human Services, that there is a need in that country for persons with the skills the alien practitioner seeks to acquire.
How to get a Statement of Need
Te Whatu Ora process applications for Statements of Need, which must be approved by Te Whatu Ora or Te Aka Whai Ora - Māori Health Authority staff under the Director-General of Health’s delegated authority.
Requests for a Statement of Need and supporting information can be submitted to Te Whatu Ora at the following contact email address:
Applications will be assessed and processed as fast as is practicable, however it is strongly recommended that applicant’s contact Te Whatu Ora as soon as possible after accepting a training position.
If approved, Te Whatu Ora will issue the SoN, signed by an appropriate delegated signatory, to ECFMG via email, and will also supply the applicant with an emailed copy.
Information you need to support your application
Each applicant must provide:
- a signed statement that they intend to return to Aotearoa New Zealand at the conclusion of the training and intend to practise in the specialty for which the training is sought
- a copy of their relevant passport page (or other evidence of NZ citizenship/permanent residency)
- an ECFMG number, which ECFMG will provide (sometimes known as the USMLE number). The format of this number will typically be 8 digits (e.g., 0-123-456-7).
- details of the study that he or she is intending to undertake (a course prescription, or, perhaps, the letter of offer from the training agency). The ECFMG requires that both specialty and (if applicable) subspecialty be specifically identified.
- their ethnicit(ies) (optional)
Te Whatu Ora recommends that applicants seek certainty from ECFMG on the required specific required wording of specialty and subspecialty.
Te Whatu Ora will then seek internal (and, if required external) advice/evidence that there is a ‘need’ in Aotearoa New Zealand for the training to be undertaken.
The evidence required of a ‘need’ in New Zealand
Before Te Whatu Ora provides a Statement of Need, confirmation is often sought from the Health Workforce Analytics and Intelligence Team, or other relevant bodies and in some cases the relevant New Zealand medical college that the training that practitioner is intending to undertake is in an area for which there is a need in Aotearoa New Zealand.
Where doubt exists on need, the relevant college is considered to be the body best able to determine that the skill is one for which there is a need in Aotearoa New Zealand. This sometimes requires dialogue with the applicant to clarify the nature of the training.
For this reason (and others), applicants are asked for details of the training that they are intending to undertake. Advice is occasionally sought from elsewhere as to whether there is a need for practitioners with certain skills – for example, from the head of the hospital department in which the practitioner works.
How long a Statement of Need lasts
It is strongly recommended that NZ citizens and permanent residents who have previously trained in the United States carefully plan their career to avoid exceeding the seven-year limit.
Statements of Need do not specify duration. As a rule, Te Whatu Ora has details of the course of training, including its duration, but the duration is left to the ECFMG to administer. Te Whatu Ora is most likely to consider the issue where an applicant files an application for a second, further, Statement. These are usually for a more specific specialty.
ECFMG’s maximum duration of sponsorship of foreign national medical practitioners is limited to a maximum of seven years, unless an “Exceptional Need” for the training in question can be demonstrated by Te Whatu Ora and the Ministry of Health.
Should an applicant seek a Statement of Need for training in excess of seven years (total duration), ECFMG requires a “Letter of Exceptional Need” to be issued by the Director-General of Health, the Minister of Health, or the New Zealand Ambassador to the United States. Such letters are held to a very high evidential standard.
Te Whatu Ora cannot guarantee that “Letters of Exceptional Need” will be issued, due to the high evidentiary standard applied.
Assurance to return to New Zealand
The assurances given to the New Zealand Government are sought by Te Whatu Ora for the purpose of preparing a Statement. Te Whatu Ora takes no further responsibility for the ongoing relationship between the ECFMG and the practitioner.
However, while Te Whatu Ora has no enforcement powers, it does undertake periodic audits to satisfy itself that practitioners have returned to work in Aotearoa New Zealand.
While not common, it is possible that a practitioner might wish to ‘switch countries’ during the tenure of a visa. In such cases, Te Whatu Ora would expect to receive a request from the practitioner, setting out the circumstances.
It is very likely that the ECFMG would decline to act on a new Statement from another country, until Te Whatu Ora had considered and agreed to cancel the original Statement of Need.
Example of a Statement of Need
TE WHATU ORA OR TE AKA WHAI ORA LETTERHEAD
TO WHOM IT MAY CONCERN
Name of Applicant for Visa: [insert full name]
ECFMG No: [0 – 123 – 456 – 7]
There currently exists in New Zealand a need for qualified medical practitioners in the specialty of [insert specialty] and the subspecialty of [insert subspecialty].
Dr [insert name] has filed a written assurance with the Government of New Zealand that (s)he will return to New Zealand upon completion of her/his training in the United States and intends to enter the practice of medicine in the specialty for which training is being sought.
Dr [insert name] is currently registered with the Medical Council of New Zealand in a general scope of practice. On her/his return to New Zealand (s)he may be required to have her/his overseas qualification assessed for vocational specialist registration.
[insert name][insert role]
Te Whatu Ora Health New Zealand or
Te Aka Whai Ora Māori Health Authority
Dated: [insert MMM-YYYY]
This Statement of Need has been issued on original, coloured Te Whatu Ora / Te Aka Whai Ora Māori Health Authority letterhead and has been signed in blue ink. Te Whatu Ora / Te Aka Whai Ora Māori Health Authority gives no undertaking as to the validity of this Statement if it is submitted as a photocopy or as otherwise reproduced.
Where an applicant is not registered with the Medical Council of New Zealand, the Statement is issued with a paragraph along the lines of:
Dr [insert name] is not registered with the Medical Council of New Zealand. To practise medicine in New Zealand on her/his return (s)he will be required to obtain registration either by sitting the Medical Council’s clinical examination or by having her/his overseas specialist qualification assessed for registration.
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