Download - Immigration Prescription for Physicians 2014
Immigration Prescription for Physicians 2014
Presented by Cowles & Thompson
Webinar AgendaJ-1 Physicians and
Waivers
H-1B Visa Fundamentals for Physicians
Permanent Residence (Green Card)
Questions & Answers
Physician Immigration Overview
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”).
Two-Year Home Residency Rule
Waiver of Home Residency Rule
Three Types ofJ-1 Waivers
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)
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/ShortageDesignationAdvisor.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
J-1 Waivers – Appalachian Regional Commission (ARC)
Covers Appalachian
regionwww.arc.gov
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
J-1 Waivers - U.S. Department of Health and Human Services (DHHS)
Federal agency covers entire United States• http://www.globalhealth.g
ov/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
• 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
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 $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
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
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
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
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
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
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
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)
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– 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
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 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
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
Lawful Permanent Residence (Green Card)
PERM Labor Cert
National
Interest
Waiver
EB-1
Relative
Petition
PERM Labor Certification
Employer must show no available and qualified U.S. citizen or permanent resident physician through local recruitmentEmployer must show ability to pay prevailing wagePhysician must be qualified at the time of filing of labor certificationPhysicians are EB-2 category
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
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.
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
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
Relative Sponsorship
Immediate relative USC spouse
USC child over 21
Preference Relationship USC or LPR parent
LPR spouseUSC brother or sister
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
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.
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 protected] immigration updates, visitwww.physicianimmigration.com