This information is provided as an educational service and is not legal advice. Consult with an attorney for your specific circumstances. For a comprehensive evaluation of your immigration situation and options, you are invited to contact us: Badmus & Associates https://badmuslaw.com immigration@badmuslaw.com 214-494-8033 Principal office in Dallas, Texas Immigration services offered nationwide. #badmuslaw #immigrationlawyerusa #uscis #immigrationlaw #usvisa

1. Immigration Primer for Physician Recruiters
Presented by Ann Massey Badmus

2. ?
Ask questions at any time
? Use your Q&A section at the
right of your screen to type and
send your questions.
? For confidentiality, ask questions
in a general manner – no
personal details

3. • Helped thousands of clients gain
legal immigration status in the
U.S. since 1993
• Selected as Best Lawyers in Dallas
for immigration by D Magazine
• Selected to Best Lawyers list for
immigration nationwide by Best
Lawyers magazine
• Selected to Best Law Firms list for
Dallas-Fort Worth by US News &
World Report
• NAPR Vendor Member
About Badmus & Associates

4. Legal Notice
The content provided in this presentation is
informational purposes only and not intended
as legal advice and should not be relied upon
as such. For assistance with your own matter,
consult with one of our immigration attorneys or
another qualified professional.

5. Webinar Agenda
Avoiding Discrimination
Claims
Placing J-1 Physicians
Placing H-1B Physicians
Special Cases
Questions & Answers

6. Physician Immigration Overview

7. Avoiding Discrimination Claims in Hiring
Anti-Discrimination Laws
Federal law prohibits discrimination in hiring, including, but not
limited to:
 Unequal treatment because of citizenship or immigration status
 Unequal treatment because of nationality, which includes place of
birth, appearance, accent and language
 Asking for specific documents from employee, such as “Green Card”
or “work card”
 Having a citizen-only hiring policy

8. Avoiding Discrimination Claims in Hiring
Steer clear of the following language in job postings
and recruitment discussions:
• "Only U.S. Citizens”
• "Citizenship Required”
• "Only U.S. Citizens or Green Card Holders”
• "H-1Bs Only”
• "Must have a U.S. Passport”
• "Must have a green card"

9. Employment Eligibility Questions You Can Ask
Best Practice Questions
1. Are you currently authorized to work in the United States?
Yes – stop inquiry
No – may ask about current immigration status but do not
inquire about basis of current employment authorization
2. Will you now or in the future require sponsorship for employment
visa status (e.g., H-1B status)?
Alternative Question if employer has consistent hiring policy limited to
persons protected as to citizenship status
Are you a U.S. citizen, permanent resident alien, temporary resident
alien, applicant for temporary resident status, refugee or asylee?
Yes – stop inquiry
No - can eliminate applicant from consideration

10. Placing J-1 Physicians

11. 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”).

12. Placing J-1 Physicians
Waivers of the Two-Year Foreign
Residency Requirement (“J-1 Waivers”)
Interested
Government Agency
(IGA)
Hardship
Persecution

13. Placing J-1 Physicians
Typical 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)
Southeast Crescent Regional
Commission (SCRC)

14. 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
• http://datawarehouse.hrsa.gov/GeoAdvisor/Shortag
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

15. 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
• Three-year contract and
proof of recruitment
required
• Includes hospitalists
No limit on number of
waivers per year but
physician cannot have
completed residency more
than one year before
waiver start date

16. Appalachian Regional Commission (ARC)
Covers
Appalachian
region
www.arc.gov
Three-year
contract and
extensive
recruitment
required
HPSA required
and can sponsor
primary care and
specialists
No limit on
number of
waivers per year

17. J-1 Waivers – Delta Regional Authority (DRA)
Federal agency
covering eight
state region
• http://www.dra.gov/
for list of eight states
Three-year
contract required
and no non-
compete clause
HPSA or MUA
work location
and recruitment
required 45 days
minimum before
application
Primary care or
specialty and no
limit on number
of waivers per
year

18. Southeast Crescent Regional Commission (SCRC)
Federal agency
covering six state
region
• https://scrc.gov/pr
ograms/ for
covered states
and counties
Three-year
contract required
and no non-
compete clause
HPSA or MUA
work location
and recruitment
required 45 days
minimum before
application
Primary care or
specialty and no
limit on number
of waivers per
year

19. J-1 Waiver Obligations You Must Know
Physician must work in H-1B status for minimum of three years
Physician must be 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

20. 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

21. Placing J-1 Physicians – Strategic Plan
Start job search
immediately after
2nd year of
residency or one
year before
completion of
fellowship
Finalize
employment by
early Fall of 3rd
year of residency
or final year of
fellowship
Match with
employers
located in
HPSA/MUA who
agree to a three-
year contract and
no non-compete
clause
Refer physician
or employer to
immigration
attorney early in
process

22. Placing H-1B Physicians

23. 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

24. 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 register
for “lottery” in March

25. Recruiting H-1B Physicians
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

26. Placing H-1B Physicians
H-1B Facts to Know
• 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 in most cases
• Concurrent H-1B petitions (including part-time hours)
are permitted – “moonlighting”
– This could be a tool to work around the cap-exempt issue for private
employers
• Cap exempt employment part-time and
• Private practice employment full-time

27. Placing H-1B Physicians
Locums or Temporary Employment
• Physician must be an employee of sponsoring
employer; however, independent contractor
arrangement is possible if physician forms corporation
or LLC, i.e., “entrepreneurial H-1B”
• Physician’s corporate entity enters into agreement with
locums agency, hospital, or private practice to provide
services as independent contractor
• Physician’s corporate entity applies for physician’s H-1B
and pays salary from contract proceeds paid to
corporate entity

28. Placing H-1B Physicians – Strategic Plan
Start job search
immediately
after 2nd year of
residency or
one year before
completion of
fellowship
(prefer cap-
exempt
employers)
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 to
register for H-!B
in March
Apply early for
medical license
Refer physician
or employer to
immigration
attorney early in
process

29. Physicians with Employment Authorization Document (EAD)
Issued with
pending green
card
applications,
TPS, asylum,
or other
Limited period
of
authorization
– must renew
before
expiration
Can work for
any employer
If underlying
basis denied,
no longer
authorized to
work

30. Green Card – Top Benefit to Attract IMG Physicians
Labor Certification
• Employer
sponsorship
required
• Employer must
pay part of
attorney fee and
other costs
• Portability if same
or similar
occupation
National Interest
Waiver
• Self-sponsored
• Five years of
service in HPSA or
MUA
• Self-employment
permitted

32. 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 for your candidate’s
specific situation.

33. Need more information and advice?
Contact Ann Badmus
Badmus & Associates
Contact me at:
Tel. 214-494-8033
ann.badmus@badmuslaw.com
www.physicianimmigration.com