Many physicians decide to bypass the J1 visa and instead enter the United States with an H-1B visa to complete residency or fellowship training.  With the H-1B visa, the physician is not subject to the two-year foreign stay requirement that would attach if the physician used a J1 visa.  However, the H-1B physician is subject to the H-1B cap (the annual numerical limitation for issuing H-1B visas) if the physician was not counted toward the cap when the original H-1B visa was issued.  Most physicians coming to join a residency program are initially exempt from the H-1B cap.  Thus, when the physician changes jobs, the physician may be subject to the cap again.