US visa for Medical Professionals

For many years, the United States was a closed shop for most foreign-born physicians. Until they were declared unconstitutional, many state laws required foreign physicians to be U.S. citizens in order to obtain licenses.

From 1976 to 1991, federal immigration laws barred foreign-born physicians from obtaining temporary working ("H-1B") status in order to perform direct patient care. A physician in H-1B status was permitted only to teach or conduct research in the U.S. for a public or nonprofit private educational or research institution or agency.

However, in 1991, Congress amended the laws to allow foreign-born physicians to qualify for temporary visas to enter the U.S. in order to qualify for medical residencies and fellowships and to perform patient care.

This guide deals with H-1B visas for foreign doctors and physicians who would like to work in the US.

Before the Immigration Act of 1990, the only way for physicians to come to the US to engage in graduate medical training was to enter in J-1 status. But the 1990 Act dropped this requirement and for many years now physicians have been able to use the H-1B visa to join residency and fellowship programs.

Doctors who are seeking employment in the US should bear in mind that there are special licensing requirements, and because of this start planning before the completion of medical school. Getting an H-1B visa is not always easy and even getting H-1B status is not free from problems. With adequate preparation, however, and the help of workpermit.com, a foreign national physician should be able to get employment authorization in the US, especially in medically underserved areas or health professional shortage areas.

H-1B Visas and research

If you are a foreign medical graduate coming to the US to teach or perform research, and only a small amount of patient care is involved, you will have to show that you have received a medical education and are licensed in your home country. You must also show that you have received an appropriate license by the state where you will be working if patient care will be performed.

H-1B Visas and clinical practice

You can also use an H-1B if you wish to engage in a clinical practice or engage in graduate medical training. You generally must meet a number of requirements including the following:

• You must have a license or other authorization required by the state where you will practice;
• You must have an unrestricted license to practice medicine in your country or have graduated from a foreign or US medical school; and
• You must passed the appropriate examinations.

Licensing

As mentioned above, you must be properly licensed. All states require physicians to be licensed to practice medicine, including physicians working in residency or fellowship programs. Some states do not permit physicians to sit for USMLE Step 3 prior to engaging in graduate medical training and in such states the J-1 visa is the main option.

The H-1B requirements of the 1990 Act also require a physician to show that he or she possesses a state license "or other authorization" in order to perform patient care as well as a full and unrestricted license to practice in a foreign country or proof of graduation from a foreign medical school.

Note that some states will not issue a license without proof of the issuance of a visa. The Catch-22 can be avoided by getting a letter from the state licensing board documenting that the only thing standing in the way of issuing a license is the visa itself. Usually this letter will satisfy USCIS.

Examinations

As noted above, a physician needs to have passed one of the required medical examinations:

• Federation Licensing Examination (FLEX) parts I and II, or an "equivalent examination as determined by the Secretary of Health and Human Services";
• National Board of Medical Examiners (NBME), Parts I, II and III;
• or The United States Medical Licensing Examination (USMLE), Steps 1, 2 & 3

For many years, the USMLE has been the exclusive examination. Passage of earlier examinations is still recognized, but "mixing and matching" of examinations is not permitted for H-1B purposes. Note that the Licentiate Medical Certificate of Canada is NOT equivalent to the FLEX or USMLE for H-1B purposes.

• Physicians are also required to document competency in English and passage of the Test of English as a Foreign Language will suffice for this purpose.

Exceptions

Doctors who have graduated from US medical schools only need to show they have graduated from a US medical school and that they possess the appropriate state license. Also, most of the above requirements above are waived for doctors who are of national or international renown in their area of specialization and who have graduated from a foreign medical school.

Physicians who would like to enter the US in J-1 status to participate in graduate medical training are subject to strict requirements. They must have passed the Foreign Medical Graduate Examination in Medical Sciences, they should have good English, they are automatically subject to the two-year foreign residence requirement (to be scheduled later), and are subject to time limits on the duration of their program.

Physicians coming to the United States on exchange visitor programs for the purpose of observation, consultation, teaching, or research in which little or no patient care is involved are not subject to the above requirements.

A U.S. employer may obtain permanent residence ("green card") status for a foreign-born physician if the employer can demonstrate that he or she is unable to locate a U.S. physician to fill the position.

An employer may obtain permanent residence for a foreign-born physician utilizing the following three step process:

1. Application for alien labor certification from U.S. Labor Department (DOL)
2. Submission of visa petition to US Citizenship and Immigration Services
3. Application for permanent residence from US Citizenship and Immigration Services or U.S. Embassy or Consulate abroad

Step one: labor certification

Unless the physician in question is a "person of extraordinary ability in the sciences" or his employment is clearly in the "national interest", his employer must undergo the labor certification process in order to obtain permanent residence on his behalf.

Although this procedure varies somewhat from state to state, an employer is usually required to place a job advertisement for a physician in an appropriate national journal. The ad must describe both the employment offered in terms of the job duties and the salary and the qualifications required to perform the job. The offered salary may not be less than the prevailing wage. The name of the employer need not be mentioned in the ad.

After reviewing the resumes received and interviewing any applicants who profess to be qualified for the position, the employer must demonstrate to the Labor Department that there are no U.S. physicians ready, able and qualified to perform the job.

In contrast to the requirements for obtaining H-1B status, an employer need not require that an applicant for permanent residence have passed the FLEX exam for foreign physicians, or even that he has obtained a medical license in the state of intended employment.

There is an exception to the labor certification requirement for physicians whose employment would be in the "national interest". Generally, physicians who intend to practice in medically underserved areas for a minimum of five years may petition the US Citizenship and Immigration Services to bypass the labor certification requirement. Even physicians who are independent practitioners rather than "employees" are eligible to apply for national interest waivers. However, US Citizenship and Immigration Services regulations restrict which physicians are eligible for national interests waivers, and how they qualify to do so.

Step two: visa petition

Once the Labor Department has approved the alien labor certification, the employer must submit a petition to INS to classify the physician under the appropriate category for permanent residence. Most physicians qualify under the employment- based second category as professionals holding advanced degrees.

The employer must demonstrate that they have the financial ability to guarantee the physician's salary. They must also establish that the employment is full-time with no definite termination date. Documents evidencing the physician's education and prior experience must be attached to the petition.

Step three: application for permanent residence

If the physician's priority date is "current" (There are numerical backlogs which govern the length of time that a physician with an approved visa petition must wait to file an application for a green card. However, presently, there is no backlog for physicians.), the physician and his family may apply for permanent residence either at the US Citizenship and Immigration Services office having jurisdiction over his place of residence in the U.S. at the same time that the visa petition is submitted. Alternatively, once the visa petition is approved, they may apply for permanent residence at a U.S. Embassy or Consulate in the physician's home country. When the application is made to US Citizenship and Immigration Services, it is known as an application for "adjustment of status." When it is made abroad, it is called an application for an "immigrant visa".

Simultaneously with the submission of the application for adjustment of status, US Citizenship and Immigration Services offices permit applications for employment authorization and "advance parole" (which is a travel document) to be filed on behalf of the physician, his spouse and children.

All applicants for permanent residence must show that they are not "excludable" from the U.S. Grounds for excludability may include certain criminal convictions, immigration fraud, subversive activities and infection with certain dangerous contagious diseases.