Statements of need

Statements of Need (SoNs),  are issued by Health New Zealand Te Whatu Ora (Health NZ) to allow medical practitioners to obtain a J-1 visa to train in the United States of America. 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 Department of State 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 time typically required to complete a program, as defined by 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 be 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 overseas practitioner seeks to acquire.

Health NZ process applications for Statements of Need, which must be approved by Health NZ staff under the Director-General of Health’s delegated authority.

Requests for a Statement of Need and supporting information can be submitted to Health NZ at the following contact email address:

hwcontracts@tewhatuora.govt.nz

Applications will be assessed and processed as fast as is practicable, however it is strongly recommended that applicant’s contact Health NZ as soon as possible after accepting a training position.

If approved, Health NZ will issue the SoN, signed by an appropriate delegated signatory, to ECFMG via email, and will also supply the applicant with an emailed copy.

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 the applicant 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.

Health NZ recommends that applicants seek certainty from ECFMG on the required specific required wording of specialty and subspecialty, as if the wording does not exactly match, the Statement of Need may be declined, requiring correction and re-issue.

Health NZ 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.

Before Health NZ  issues 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 or Australasian 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.

Statements of Need do not specify duration. As a rule, Health NZ has details of the course of training, including its duration, but the duration is left to the ECFMG to administer. Health NZ is most likely to consider the issue where an applicant files an application for a second, further, Statement of Need. These are usually for a more specific specialty or more advanced training program.

A practitioner’s stay in the United States is limited to the time typically required to complete a program(s), as defined by an American specialty board.

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 Health NZ 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.

Health NZ cannot guarantee that “Letters of Exceptional Need” will be issued, due to the high evidentiary standard applied.

The assurances given to the New Zealand Government are sought by Health NZ for the purpose of preparing a Statement. Health NZ takes no further responsibility for the ongoing relationship between the ECFMG and the practitioner.

However, while Health NZ 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, Health NZ 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 Health NZ had considered and agreed to cancel the original Statement of Need.

HEALTH NZ 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]

[insert department]
Health New Zealand Te Whatu Ora

Dated: [insert MMM-YYYY]

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.

If you have any questions, email us at  hwcontracts@tewhatuora.govt.nz.