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.

1. 9 Immigration Rules, Tips & Tools
To Hire IMG Physicians Fast
Presented by Cowles & Thompson
Immigration Practice Group

2. 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.

3. Webinar Agenda
Immigration Rules,
Tips & Tools for
Hiring
• J-1 Physicians
• H-1B Physicians
• E-3 Physicians
Question & Answer

4. International Medical Graduate (IMG) Stats

5. 9 Immigration Rules, Tips & Tools

6. Physician Immigration Overview

7. 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 waiver
of 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

8. Waiver of Home Residency Rule

9. 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.

10. 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)

11. 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/ShortageDesigna
tionAdvisor.aspx
2.0

12. 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.
Recruitment efforts • Start early and recruit consistently!
• 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

13. 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

14. J-1 Waivers – Appalachian Regional Commission (ARC)
Covers
Appalachian
region
www.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

15. 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
No limit on number of
waivers per year but
physician cannot have
completed residency more
than one year before waiver
start date

16. 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

17. 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

18. 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

19. 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

20. 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 2nd year
of residency
or one year
before
completion of
fellowship
Execute
employment
agreement
by early Fall
of 3rd year 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

21. Hiring H-1B Physicians Fast

22. 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

23. 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

24. 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

25. 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)

26. 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

27. 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

28. 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

29. 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
7.0

30. 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

31. Six Steps for Hiring New H-1B Physicians Fast
Finalize
employment
by early Fall
of 3rd year 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

32. 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

34. 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

35. 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.