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Immigration Prescription for Physicians 2014


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Webinar produced especially for foreign graduate residents, fellows, and physicians as well as medical employers and recruiters.

Provides an in-depth overview of the special immigration rules and options for physicians to practice medicine in the United States.

Takes the mystery out of complex immigration rules and regulations and provide you with the knowledge, tips, and tools to successfully navigate the immigration maze for physicians and medical employers.

Published in: Law, Health & Medicine, Career
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Immigration Prescription for Physicians 2014

  1. 1. Immigration Prescription for Physicians 2014 Presented by Cowles & Thompson
  2. 2. Webinar Agenda J-1 Physicians and Waivers H-1B Visa Fundamentals for Physicians Permanent Residence (Green Card) Questions & Answers
  3. 3. Physician Immigration Overview
  4. 4. 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 waiver of this requirement before he or she can be employed in H-1B status or adjust to permanent residence (“green card”).
  5. 5. Waiver of Home Residency Rule
  6. 6. Interested Government Agency (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)
  7. 7. J-1 Waivers – Conrad 30 State Program • Varying deadlines and opening dates • Evaluation process differ • Unused slots do not rollover • Proof of recruitment required 30 slots per fiscal year – October 1 to September 30 • eDesignationAdvisor.aspx - HPSA or MUA designation website • 10 FLEX slots available for non-underserved areas Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) • Some states require four or more years • Non-compete not allowed • Agree to start date within 90 days of waiver Three year minimum contract required • 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
  8. 8. J-1 Waivers – Appalachian Regional Commission (ARC) Covers Appalachian region Three year contract and extensive recruitment required HPSA and primary outpatient care only (no hospitalist) $250,000 liquidated damages clause required No limit on number of waivers per year
  9. 9. J-1 Waivers - U.S. Department of Health and Human Services (DHHS) Federal agency covers entire United States • http://www.globalhealth.g ov/exchangevisitorprogr am/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 • Three year contract and proof of recruitment required No limit on number of waivers per year but physician cannot have completed residency more than one year before waiver start date
  10. 10. J-1 Waivers – Delta Regional Authority (DRA) Federal agency covering eight state region • for list of eight states Three year contract required and $250,000 liquidated damages required HPSA or MUA work location and recruitment required 60 days minimum before application Primary care or specialty and no limit on number of waiversyear
  11. 11. J-1 Waivers – Department of Veteran Affairs (VA) Primary care or specialty 1 year contract minimum but 3 years work required by USCIS No limit on number of waivers per year Direct application by VA to Department of State
  12. 12. J-1 Waiver Obligations You Must Know Physician must work in H-1B status for minimum of three years Physician must be a an employee, not independent contractor, of sponsoring employer Employer and physician must submit periodic reports to state or federal health agency Physician cannot change employer unless extenuating circumstances, e.g. termination by employer . Personal reasons usually not valid for change of employer Physician cannot become a permanent resident until waiver service is completed
  13. 13. 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
  14. 14. Strategic Planning for J-1 Physicians Start job search immediately after 2nd year of residency or one year before completion of fellowship Target employers located in HPSA/MUA or FLEX locations Sign contract by early Fall of 3rd year of residency or final year of fellowship Meet with qualified immigration attorney
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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)
  19. 19. 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 – - Department of Labor wage data for prevailing wage – 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
  20. 20. 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
  21. 21. 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 6th year 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
  22. 22. Strategic Planning for H-1B Physicians Start job search immediately after 2nd year of residency or one year before completion of fellowship Target cap- exempt employers and apply early for medical license Finalize employment by early Fall of 3rd year of residency or final year of fellowship If competing for cap-subject H-1B, have contract in place by February so that H-1B petition can be filed on April 1 Meet with qualified immigration attorney
  23. 23. Lawful Permanent Residence (Green Card) PERM Labor Cert National Interest Waiver EB-1 Relative Petition
  24. 24. PERM Labor Certification Employer must show no available and qualified U.S. citizen or permanent resident physician through local recruitment Employer must show ability to pay prevailing wage Physician must be qualified at the time of filing of labor certification Physicians are EB-2 category
  25. 25. National Interest Waiver • Two types – General – physician’s research work is in national interest – Physician – 5 years medical care in HPSA or MUA – specialties accepted • Self-sponsored and self-employment possible • Physicians are EB-2 category
  26. 26. EB-1A Extraordinary Ability Basic Requirements • Must show sustained national or international acclaim in applicant’s field of endeavor • Overall evidence must show applicant has “risen to the top of the field” • Must show prospective contribution to the United States • Can be self-sponsored but must show prospective employment in the U.S.
  27. 27. EB-1A Extraordinary Ability Must Meet 3 of 8 Criteria • National or internationally recognized prizes or awards • Membership in organizations requiring outstanding accomplishments • Published materials in major or professional media about applicant’s work • Judging the work of others, individually or on a panel • Original contributions of major significance to the field
  28. 28. EB-1A Extraordinary Ability Must Meet 3 of 8 Criteria (cont) • Authorship of scholarly articles • High salary or compensation as compared to others in the field • Performance in a leading or critical role for distinguished organizations • Other comparable evidence
  29. 29. Relative Sponsorship Immediate relative USC spouse USC child over 21 Preference Relationship USC or LPR parent LPR spouse USC brother or sister
  30. 30. Timeline Immigrant Visa Number must be available . Visa backlog delays Physicians with IGA J-1 waivers cannot obtain permanent residence before completion of service Permanent Residence
  31. 31. 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.
  32. 32. 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 For immigration updates, visit