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9 Immigration Rules, Tips, and Tools to Hire IMG Physicians Fast

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This educational session is designed to take the mystery out of complex immigration rules and provide you with the necessary knowledge, strategies, and training to successfully hire and retain international medical graduates. Learn the the right way to hire H-1B and J-1 physicians FAST so you don’t waste precious time and resources, the legal pitfalls to avoid that can derail your recruitment and cost you time and money, and the little-known tips and tools that will help you eliminate immigration barriers so you can hire the physicians you need. PDF handout

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9 Immigration Rules, Tips, and Tools to Hire IMG Physicians Fast

  1. 1. 9 Immigration Rules, Tips & ToolsTo Hire IMG Physicians Fast Presented by Cowles & Thompson Immigration Practice Group Ask Questions at Any Time Go to your Question and Answer panel at the bottom of the page. Type and send your question. We will answer questions during the Q&A session at the end of the presentation. Webinar Agenda Immigration Rules, Tips & Tools for Hiring •J-1 Physicians •H-1B Physicians •E-3 Physicians Question & Answer
  2. 2. International Medical Graduate (IMG) Stats 9 Immigration Rules, Tips & Tools Physician Immigration Overview
  3. 3. Hiring J-1 Physicians Two Year Foreign Residency Requirement for J-1 Physicians After residency or fellowship training is completed, all J-1 physicians must return to home country for two years or obtain a waiverof this requirement before he or she can be employed in H-1B status or adjust to permanent residence (“green card”). Home Country -Country of last citizenship or permanent residence (even if dual citizenship retained) before J-1 visa 1.0 Waiver of Home Residency Rule Waivers of the Two-Year Foreign Residency Requirement (“J-1 Waivers”) Interested Government Agency (IGA) –State or Federal Agencies Hardship –extreme hardship to U.S. citizen/LPR spouse or children Persecution – likelihood of harm to physician because of politics, religion, etc.
  4. 4. Interested Government Agencies (IGA) Conrad 30 State Program Department of Veterans Affairs (VA) United States Department of Health and Human Services (HHS) Appalachian Regional Commission (ARC) Delta Regional Authority (DRA) HPSA/MUA Database All IGAs require location in or service to underserved areas –Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) First step -check Health Resources and Service Administration website to determine HPSA or MUA designation http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx 2.0 J-1 Waivers –Conrad 30 State Program •Varying deadlines and opening dates •Evaluation process differ •Unused slots do not rollover •10 FLEX slots available for non-underserved locations 30 slots per fiscal year –October 1 to September 30 •Must be current –usually within six months. •Some states have very specific requirements. •Start early and recruit consistently! Recruitment efforts •Priority usually given to primary care •Hospitalists may be considered specialists •Some states may restrict number of specialists slots Primary care or specialty, depending upon state
  5. 5. Conrad 30 State Program (cont.) FLEX 10 Slots •Check state program requirements •Determine surrounding HPSA/MUA locations and gather patient data •Provide evidence of sufficient number of patients for at least one additional physician 3.0 J-1 Waivers –Appalachian Regional Commission (ARC) Covers Appalachian regionwww.arc.gov and not limit on number of waivers per year Extensive recruitment required, including notices to medical schools HPSA and primary outpatient care only (no hospitalist) $250,000 liquidated damages clause required J-1 Waivers -U.S. Department of Health and Human Services (DHHS) Federal agency covers entire United States •http://www.globalhealth.gov/exchangevisitorprogram/index.html#waiver Clinical care waiver •Primary care only in HPSA with 7 score •Public health center, rural health clinic, or tribal medical facility qualifies No limit on number of waivers per year but physician cannot have completed residency more than one year before waiver start date
  6. 6. J-1 Waivers –Delta Regional Authority (DRA) Federal agency covering eight state region •http://www.dra.gov/ for list of eight states $250,000 liquidated damages in contract Recruitment required 60 days minimum before application, including notices to medical schools Primary care or specialty and no limit on number of waivers per year Contract Requirements for J-1 Waivers Three year term required (minimum) Agree to start employment within 90 days of USCIS waiver approval Non-compete clauses generally prohibited Employment only –no independent contractor agreements Liquidated damages permitted (required in some instances, e.g. Georgia, ARC, DRA) All work locations (addresses) must be included in contract 4.0 J-1 Waiver Employer Obligations •Annual or semi-annual reporting and notifications to state or federal sponsoring agency •Apply for H-1B and pay salary that meets the prevailing wage; income guarantees possible •Employ physician only at agreed locations and/or underserved areas
  7. 7. Timeline for the J-1 Waiver to H-1B Process Employer and Physician apply to IGA IGA issues recommendation to Department of State (DOS) (1 to 3 months) DOS issues recommendation to USCIS (1 to 2 months) USCIS issues final waiver approval I-612 (1 to 3 months) H-1B petition filed and approved (1 to 4 months) Total time –4 to 12 months Six Steps for Hiring J-1 Physicians Fast Contact immigration attorney early in the process to help develop recruitment plan Start search for candidates in their 2ndyear of residency or one year before completion of fellowship Execute employment agreement by early Fall of 3rdyear of residency or final year of fellowship Document current recruitment efforts, including advertising, recruiters, referrals, etc. Verify IGA program waiver requirements with attorney and gather data to support waiver application Plan to present the waiver application on October 1 or first day for acceptance of applications Hiring H-1B Physicians Fast
  8. 8. H-1B Physicians IMG Physicians who completed residency or fellowship with H-1B visa (no J-1) J-1 Physicians who returned to home country for two years after residency or fellowship completed J-1 Physicians who obtained hardship or persecution waiver and seek employment H-1B Physicians and the H-1B Cap Limit of 65,000 new H-1B visas per fiscal year (except Free Trade Act (FTA) nationals) 20,000 per fiscal year for persons who hold US Master’s degrees or higher Fiscal year runs from October 1 to September 30 Employers may apply for H-1B on April 1 with a start date of October 1 In 2014, over 170,000 new H-1B petitions filed the first week of April 5.0 H-1B Numerical Limitations “H-1B Cap” Who is subject to the cap? –First time H-1B beneficiaries (employee) –Beneficiaries who already hold H-1B status but were employed by cap-exempt employers –Physicians who maxed out the 6 year H-1B limit, left the U.S. for one year, and wish to return
  9. 9. Avoiding the H-1B Cap Cap-exempt employers •Universities and non-profit petitioners affiliated with post-secondary educational institutions •Government research organizations and non- profit petitioners affiliated with government research institutions •For-profit employers who place physician at a non- profit, university-affiliated facility for at least 50% of work week Cap-exempt beneficiaries •Physicians who are beneficiaries of J-1 IGA waivers only (does not include hardship waivers or persecution waivers) Avoiding the H-1B Cap Concurrent H-1B Strategy For profit employer offers part- time employment to the provider (ranges from 5 to 60 hours/week) The start date of the H-1B must be a date before the physician’s cap-exempt H-1B expires. Concurrent H-1B petition is filed and approved before current cap-exempt employment ends. 6.0 Employer Obligations for H-1B •Employer must pay minimum of prevailing wage or actual wage, whichever is higher, for the term of the H-1B –http://www.flcdatacenter.com/-Department of Labor wage data for prevailing wage –data often missing so prevailing wage request might be required and can delay the H-1B process –Salary must be guaranteed at prevailing wage or actual wage – productivity bonuses okay after minimum guarantee –Contracts must offer same benefits and can have same requirements as other physicians but cannot recover H-1B costs or other green card costs •Employer must pay ACWIA fee of $750 (25 or fewer employees) or $1500 (greater than 25 employees) unless exempt •Payment of attorneys fees are “safe harbor” from DOL complaints
  10. 10. Employer Obligations for H-1B (continued) •Physician must be on payroll within 30 to 60 days from H-1B approval date, regardless of pending hospital privileges or other credentialing issues •Physician must be an employee of sponsoring employer; however, independent contractor arrangement is possible if physician forms corporation or LLC (self-employment) •Employer must pay return transportation costs for physician if employment is terminated H-1B Facts to Know •H-1B status can be valid up to 3 years initially, renewable for 3 more years. Physician is eligible for another 6 years after 1 year outside U.S. •6 year maximum stay with some exceptions - –1 year extensions available after 6thyear if green card application pending for at least one year –3 year extension available if green card application is on hold because of limited availability of green cards •If new H-1B, physician cannot work until visa is approved •Dependent spouses (H-4) cannot work -2014 proposed rule may grant employment authorization to some H-4 spouses 7.0 H-1B Facts to Know (continued) •If employee is already in H-1B status and changing employers, new employer must file H-1B petition •May start new employment upon filing of new H-1B petition –need not wait for final approval •Extenuating circumstances required for former J-1 physicians completing a J-1 waiver
  11. 11. Six Steps for Hiring New H-1B Physicians Fast Finalize employment by early Fall of 3rdyear of residency or final year of fellowship Determine whether cap- exempt employer or employment If competing for non- exempt H- 1B, have contract in place by February so that H-1B petition can be filed on April 1 Encourage early application for medical license and credentials and prevailing wage Ensure salary and benefits are within prevailing wage requirement for location and that covers the H- 1B term Contact immigration attorney early in process 8.0 E-3 Visas for Australian Physicians •Visa category for citizens of Australia for professional positions in the U.S. –10,500 per year available •Requires certified LCA •Physician must be licensed in U.S. •2-year validity; renewable indefinitely •Dependent spouses can work 9.0
  12. 12. THE IMMIGRATION PRESCRIPTION Step by step, this book will show you how international medical graduates can legally practice medicine in the United States. You will learn:  The various ways to waive the two-year foreign residency requirement for the J-1 visas  The best paths to permanent residence (green card) and citizenship  Your responsibilities as a legal immigrant  How to get and maintain legal immigration status for family members  And more…! For your free copy, email abadmus@cowlesthompson.com For immigration updates, visit www.physicianimmigration.com Legal Notice Facts of individual situations differ. The information provided here is general in nature and should not be relied upon for specific situations. Consult with an experienced immigration attorney to get the right diagnosis and prescription for your specific situation.

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