The reasons for the projected shortfall of physicians in the U.S. are many and very complex, ranging from pure patient demand, to politics, to health care and educational financial control.
It would require a textbook to cover it all. Instead, this short article will provide a quickstep guide to help organizations and candidates understand how to employ a non-U.S. citizen physician or a foreign physician to stay in the U.S. after they complete their graduate medical education (GME) training. Whether you are recruiting a foreign physician or if you are going through the process of staying in the U.S., it can be complex and daunting.
Why do we need to consider hiring every great physician we can find? Demand shortages expected to continue to worsen in rural markets, but it will be felt everywhere. Upwards of 130,000 more physicians needed by 2025, the U.S. medical school and GME program machine simply can’t meet demand fast enough. Of the 784,000 practicing physicians in the U.S., an estimated 15%, or 107,000, have successfully immigrated already.
The essentials you need to know about the process of the most common sponsorship for IMG candidates who complete GME in J-1 visa status are below.
- Majority of IMG physicians coming for GME are on a J-1 visa
- Required to return to home countries for 2 years, or apply for and receive a waiver.
- Waivers available to facilities in underserved areas, many Conrad 30 programs will accept up to 10 J-1 waiver applications from facilities that are outside geographic HPSA/MUAs, referred to as “FLEX” slots. Criteria for FLEX slots are state-specific, non-HPSA/MUA facilities may be able to sponsor by using a FLEX slot if the facility qualifies.
- Federal agencies like the U.S. Department of Health and Human Services and VA can sponsor primary care or general psychiatry in HPSA’s or mental health HPSA’s.
- Delta Regional Authority and Appalachian Regional Commission are examples of two separate programs that cover many states in the southeast.
- Limited waiver category for physicians demonstrating a U.S. citizen or permanent resident spouse or child would suffer “extreme hardship” if the physician required to fulfill home residency requirement.
- Once facility qualifies, employer submits request to the state health department or federal agency on behalf physician. Physician cannot file on own behalf. If agency recommends waiver, it forwards to the U.S. Department of State’s J-1 Waiver Review Office. Within 1 to 2 months, Department of State sends recommendation to U.S. Citizenship and Immigration Services (USCIS), which has final authority to grant waiver.
- Once approved, employer files immigration petition with USCIS changing physician’s visa status from J-1 to H-1B to authorize employment.
- H-1B responsibilities of employer includes meeting prevailing wage rate for similarly employed physicians in geographic area, maintain documents defining conditions of employment and employment verification.
- Department of Labor policy considers all fees associated with H-1B sponsorship including legal and filing fees to be part of the employer’s business expense, must be paid by employer. Fees vary based on corporate structure, company size, and exemptions.
- H-1B status valid for initial period of three years, renewable for additional three years.
- Physician must complete 3-year federal J-1 waiver service obligation with sponsoring employer, unless rare “extenuating” circumstances. If physician cannot demonstrate extenuating circumstances and chooses to leave the employment, they will be re-subject to 2-year home residency requirement.
The most common route to a J-1 waiver is through the Conrad 30 program for physicians who agree to work full time for 3 years in a federally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA). Departments of Health in every state are able to grant 30 waiver slots each fiscal year via their own application process and eligibility criteria.
Remember getting employment authorized will be a two-step process: first, approval of the J-1 waiver. Second, filing the H-1B petition to authorize the physician’s employment. Keeping these parameters in mind, you are well on your way to considering IMG applicants as viable candidates for your facility or finding a new practice in the U.S. Your immigration attorney can assist you in determining whether or not your facility will qualify for one of the state or federal waiver programs.
Niels K. Andersen
, President & CEO, of KontactIntelligence & VeritasHealthCare
A published industry writer, Niels’ work has appeared in New England Journal of Medicine’s Recruiting Physicians Today, the Association of Staff Physician Recruiters publications, and others.
, Attorney at Law, Law offices of Dayna Kelly
A graduate of the University of North Carolina School of Law. She is an active member of the N.C. State Bar, the North Carolina Bar Association, the American Immigration Lawyer’s Association, and the International Medical Graduate Taskforce. Heather focuses exclusively on employment, family based immigration, and has a special interest in adoption. The reasons for the projected shortfall of physicians in the U.S. are many and very complex.