Q: Can we switch 2 H1 from J1 and do the Waiver later as Indian citizen with Canadian PR? I read that Canadians can do it.

A: Section 212(e) of the Immigration and Nationality Act prohibits a person who came in J-1 status to the U.S. for graduate medical education from applying for a "nonimmigrant visa under section 1101(a)(15)(H)", which includes H-1B and H-4 visas. Canadian citizens (not Canadian permanent residents) are exempt from the requirement to apply for H-1B and H-4 visas pursuant to U.S. Department of State regulations at 22 CFR 41.2(a). Accordingly, Canadian citizens (not Canadian permanent residents), regardless of their country of birth, may apply for admission to the U.S. in H-1B or H-4 status without obtaining a J-1 Waiver waiving the prohibition of Section 212(e). See Atanackovic v. Duke, 399 F.Supp 3d 79 (W.D.N.Y. 2019).

A: Your situation touches on some complex visa regulations that affect many medical professionals. Let me help break this down for you.

The path you're describing - switching from J1 to H4 before completing the J1 home residency requirement - isn't permitted under U.S. immigration law. The two-year home residency requirement (212(e)) remains binding until it's either fulfilled or waived, regardless of having other visa options. While Canadian citizens may have some flexibility with waivers, this applies to Canadian citizens, not just permanent residents of Canada.

Your spouse would need to either complete the two-year home residency requirement or obtain a waiver before switching to H4 status. The timing here matters significantly - the fellowship position might need to be postponed until after receiving the waiver. Once your spouse receives the waiver, she could switch to H4 status and pursue the fellowship, assuming the institution accepts H4 visa holders for their program.

I recommend consulting with an immigration attorney who focuses on physician immigration cases, as they can review your specific circumstances and potentially identify additional options. Medical training programs often have unique visa considerations, and having professional guidance could help navigate this successfully while staying compliant with immigration requirements.