What are Statements of Need?
Statements of Need (SONs), also known as Certificates of No Objection, are issued by the Ministry of Health (the Ministry) to allow medical practitioners to obtain a J-1 visa to train in the United States. The SON is one of many requirements to be met before a J-1 visa can be issued.
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 New Zealand; and
- the practitioner has given an undertaking to the New Zealand government that she or he intends to return to 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 her/his nationality 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.
Who issues Statements of Need in New Zealand?
The Ministry issues Statements of Need, and are approved by Ministry staff under the Minister of Health’s delegated authority.
Requests for a Statement of Need and supporting information can be submitted to the Ministry at the contact details below. The Ministry recommends email submission.
Ministry of Health
PO Box 5013
Applications can take up to four weeks to process and ECFMG can also require the completed SON six weeks before the deadline. In addition, ECFMG will only accept original (posted) Ministry documents, and not copies or facsimiles. Applicants must, therefore, contact the Ministry early.
What information is required in support of an application?
Each applicant must provide:
- a signed statement that he or she intends to return to New Zealand at the conclusion of the training and intends to practise in the specialty for which the training is sought;
- a copy of their relevant passport page (or other evidence of citizenship/permanent residency)
- an ECFMG number, which ECFMG will provide (sometimes known as the USMLE number)
- 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 subspecialty be specifically identified.
In addition, the Ministry of Health will seek evidence that there is a ‘need’ in New Zealand for the training to be undertaken.
What evidence is required of a ‘need’ in New Zealand for the training to be undertaken?
Before the Ministry provides a Statement of Need confirmation is often sought from 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 New Zealand. 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 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 does a Statement of Need last?
Statements of Need do not specify duration. As a rule, the Ministry has details of the course of training, including its duration, but the duration is left to the ECFMG to administer. The Ministry 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 the Ministry.
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 Ministry. Such letters are held to a very high evidential standard, and require the authorisation of the Minister of Health, or the Ministers delegated authority.
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. The Ministry cannot guarantee that “Letters of Exceptional Need” will be issued, due to the high evidentiary standard applied.
Is the assurance to return to New Zealand enforced?
The assurances given to the New Zealand Government are sought by the Ministry of Health for the purpose of preparing a Statement. The Ministry takes no further responsibility for the ongoing relationship between the ECFMG and the practitioner. However, while the Ministry has no enforcement powers, it does undertake period audits to satisfy itself that practitioners have returned to work in 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, the Ministry of Health 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 the Ministry of Health had considered and agreed to cancel the original Statement of Need.
What does a Statement of Need look like?
MINISTRY OF HEALTH 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]
Ministry of Health
Dated: [insert MMM-YYYY]
This Statement of Need has been issued on original, coloured Ministry of Health letterhead and has been signed in blue ink. The Ministry of Health 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.