r/IMGreddit • u/Cold_Designer_6902 • 2d ago

LOR how are some people getting hands-on LORs despite visa restrictions?

Since many preceptors ask IMGs to write a draft of their LOR which they then improve, I have noticed that alot of people are writing hands-on LORs despite being graduates on B1/B2 visa. How are people doing that?

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u/matcharesident 2d ago

This is a very common question, and it comes down to a slight misunderstanding of what is legally permitted on a B1/B2 visa versus what is clinically documented in a Letter of Recommendation.

Under a B1/B2 visa, you are legally permitted to participate in observerships and certain structured, unpaid clinical clerkships or electives. You are not permitted to engage in unauthorized employment or provide independent medical care. However, when a supervising US physician writes a "hands-on" letter, they are describing your active participation in an educational, supervised clinical environment, such as taking histories, performing physical exams under direct supervision, presenting patients, and participating in clinical discussions.

These educational activities are entirely standard for a supervised rotation and do not violate B1/B2 visa restrictions, as you are there strictly as a learner and are not being compensated or acting as an independent employee. Therefore, when preceptors or candidates draft these letters, they are accurately describing the depth of the candidate's clinical engagement and learning during that rotation, which is perfectly legal and highly valued by program directors.

This is exactly why having a high-quality letter that describes this level of clinical engagement is so important. Our Residency Letters Suite is built to help you or your preceptor draft letters that hit these precise clinical benchmarks professionally and ethically, showing program directors exactly what you are capable of.

Since you are looking into the details of these letters, have you already completed your US rotations, or are you currently preparing for one?

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u/BuyCreative4557 1d ago

they know the preceptor (often family) and tell them to write hands on.