1. 9.5 Immigration Rules You Need to Know
To Hire IMG Physicians Fast
THE WEBINAR WILL BEGIN IN A FEW MOMENTS
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2. 9.5 Immigration Rules You Need to Know
To Hire IMG Physicians Fast
Presented by Badmus Law Firm

3. Ask Questions Anytime
 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.

4. Featured Speakers
Ann Massey Badmus
Attorney
Angela M. Lopez
Attorney

5. Webinar Agenda
Hiring J-1
Physicians Fast
Question & Answer
Hiring H-1B
Physicians Fast

6. International Medical Graduate (IMG) Stats

7. International Medical Graduate (IMG) Stats (cont.)

8. International Medical Graduate (IMG) Stats (cont.)

9. Hiring J-1 Physicians Fast

10. 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
Rule 1.0

11. Hiring J-1 Physicians
Waivers of the Two-Year Foreign Residency
Requirement (“J-1 Waivers”)
• Interested Government Agency (IGA) – any
government agency is eligible
• Hardship – extreme hardship to U.S. citizen/LPR
spouse or children
• Persecution – likelihood of harm to physician
because of politics, religion, etc.

12. Hiring 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)

13. Hiring J-1 Physicians
Conrad 30 State Program
• Administered by each state health agency
• Health Professional Shortage Area (HPSA) or
Medically Underserved Area (MUA) –
– http://datawarehouse.hrsa.gov/GeoAdvisor/Shor
- Health Resources and Service Administration
website to determine HPSA or MUA designation
• Flex 10 slots available for facilities not located in
HPSA/MUA but serve HPSA/MUA population

14. Hiring J-1 Physicians
Conrad 30 State Program (cont.)
Flex 10
• 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
Rule 2.0

15. Hiring J-1 Physicians
Conrad 30 State Program (cont.)
• 30 slots per fiscal year – October 1 to September 30 –
varying deadlines!
• Recruitment efforts must be current – usually within six
months; some states have very specific requirements
• Sliding fee scale and patient payor mix data required for all
programs
Rule 3.0

16. Hiring J-1 Physicians
Conrad 30 State Program (cont.)
Contract Requirements
– 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
states, e.g. Georgia)
– Termination with cause only (some states)
– Location of work must be specified
Rule 4.0

17. Hiring J-1 Physicians
U.S. Department of Health and
Human Services (DHHS)
• Federal agency covers entire United States
– http://www.globalhealth.gov/exchangevisitorprogram/index.html#waiver
• Clinical care – primary care in HPSA with 7 score, public
health center, rural health clinic, or tribal medical facility,
three year contract required – contract requirements
similar to Conrad 30 program
• No limit on number of waivers per year
• Credentials verification required (1-4 months)

18. Hiring J-1 Physicians
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. Hiring J-1 Physicians
Timeline for J-1 Waiver Process
• Employer and Physician apply to IGA (1 month)
• IGA issues recommendation to Department of
State (DOS) (1 to 4 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 – 5 to 13 months

20. Hiring J-1 Physicians
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. Hiring H-1B Physicians
H-1B Physicians Defined
 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. Hiring H-1B Physicians
H-1B Numerical Limitation (“Cap”)
 Limit of 65,000 new H-1B visas per fiscal year
 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
Rule 5.0

24. Hiring H-1B Physicians
H-1B Cap
Who is subject to the cap?
– First time H-1B employees (physician)
– Employees who already hold H-1B status but
were employed by cap-exempt employers
– Previous H-1B employees who left U.S. for one
year or more
H-1B physicians are subject to the cap

25. Hiring H-1B Physicians
Cap Gap Challenge
July 1 to October 1
- Can Physician Legally Remain in U.S.?
- Can Physician Work?
- Does the Employment Qualify for Cap
Exemption?

26. Hiring H-1B Physicians
H-1B Cap Exemptions
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 51% of work week
Cap-exempt employees
• Physicians who receive J-1 visas sponsored by government
agencies, e.g. Conrad 30, ARC, DRA, DHHS waivers
Rule 6.0

27. Hiring H-1B Physicians
Credential and Licensing Requirements
• ECFMG certification and Steps 1, 2 and 3 of USMLE or Flex
I & II or NBME I, II & III
– Exception – Physicians of national or international renown
• Licensing in the state of intended employment
– Temporary licenses - one year of H-1B employment
permitted
– Must be issued before H-1B petition filed
• M.D. or foreign equivalent, e.g. MBBS
Rule 7.0

28. Hiring H-1B Physicians
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 (DOL) wage data for prevailing wage
– Salary must be guaranteed at prevailing wage or
actual wage – productivity bonuses okay after
minimum guarantee
• Employer must pay ACWIA fee of $750 (25 or fewer
employees) or $1500 (greater than 25 employees)
unless exempt

29. Hiring H-1B Physicians
Employer Obligations for H-1B
(cont.)
• Physician must be on payroll within 30 to 60 days
from H-1B approval date, regardless of pending
hospital privileges
• Physician must be an employee of sponsoring
employer, not independent contractor
• Employer must control physician’s employment
• Employer must keep specific documentation as
required by DOL
• Physician must work at specified locations

30. Hiring H-1B Physicians
H-1B Portability
• 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
• Concurrent H-1B petitions are permitted –
“moonlighting”
• Extenuating circumstances required for former J-1
physicians completing a J-1 waiver
Rule 8.0

31. Hiring H-1B Physicians
H-1B Visas are Temporary
• H-1B status can be valid up to 3 years initially, renewable
for 3 more years.
• 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
– Recapture time spent outside U.S. during H-1B visa (vacations,
leaves of absence, etc.)
• Physician is eligible for another 6 years after 1 year outside
U.S. but subject to H-1B cap
Rule 9.0

32. Hiring H-1B Physicians
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
 Ensure salary and benefits are within prevailing wage
requirement for location and that covers the H-1B term
 Contact immigration attorney early in process

33. Green Card – Top Benefit to Attract IMG Physicians
Green Cards Through Employment
• Labor Certification
– Employer sponsorship required
– Employer must pay part of attorney fee and other
costs
– Portability if same or similar occupation
– Can take 1.5 to 6+ years for physician to receive
green card
• National Interest Waiver
– Self-sponsored
– Five years of service in HPSA or MUA
Rule 9.5

34. Question and Answer
Session

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 for your
candidate’s specific situation.

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37. Thank You!
Badmus Law Firm
11325 Pegasus Street
Suite S-215
Dallas, Texas 75238
469-916-7900 Telephone
469-916-7901 Facsimile
www.physicianimmigration.com
immigration@badmuslaw.com