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Becoming the Employer of Choice for International Medical Graduates

Becoming the Employer of Choice for International Medical Graduates. Mary E. Ryan. Important Terminology . IMG: International Medical Graduates ECFMG: Educational Commission on Foreign Medical Graduates J1 – Immigration status of IMGs sponsored by the ECFMG

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Becoming the Employer of Choice for International Medical Graduates

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  1. Becoming the Employer of Choice for International Medical Graduates Mary E. Ryan

  2. Important Terminology • IMG: International Medical Graduates • ECFMG: Educational Commission on Foreign Medical Graduates • J1 – Immigration status of IMGs sponsored by the ECFMG • H-1B – Immigration status of IMGs not sponsored by the ECFMG • J-2 – Spouse of J-1 • Conrad 30: State Administered J-1 Waiver program • DOS – U.S. Department of State • USCIS – U.S. Citizenship and Immigration Services

  3. Physician Shortages *Total: Primary Care, Surgical and Medical Source: AAMC Center for Workforce Studies, June 2010 cited in AMA/IMGs in American medicine Contemporary Challenges and Opportunities, 1/2013 (IMG 2013)

  4. Percentages of IMGs in Residence IMG 2013: citing ECFMG (2102) 2011 Annual Report www.ecfmg.org

  5. Profiles of IMGs in the Workforce * Percentages exclude residents/fellows. IMG 2013 Citing Source: AAMC Center for Workforce Studies, June 2010

  6. Residency Positions in Primary Care (family medicine only) IMG 2013 citing National Resident Matching Program

  7. Additional Advantages • IMGs: • Are motivated applicants • Must be sponsored by an employer to remain in the U.S. • Need early decision • Ideally, close to a year in advance

  8. Understanding the concerns of IMGs • Timing • Strictures of immigration system • Cost of mistakes • Must plan for the future now

  9. What you can do • Create certainty by: • Having policies and procedures set up before you recruit IMGs that meet the requirements of waivers and beyond • Swift execution of requirements

  10. H-1B Residents • No two year home residence requirement • Must file H-1B to “transfer” physician • Finite number of H-1Bs available each year for cap-subject employers • Cap-exempt – non-profit organizations affiliated with an institution of higher education • Six year limit • May need to initiate permanent residence immediately

  11. J-1 Residents • Two year home residence requirement • Waiver of HRR • Hardship or Persecution • Interested Government Agency (IGA) based on service in a medically underserved area • Conrad State 30 program • Federal agencies: • Delta Regional Authority • Appalachian Regional Commission • Department of Health and Human Services

  12. J-2 Residents • Subject to spouse’s two year home residence requirement • Spouse must obtain waiver before J-2 can file to change status • Cannot change status in U.S. to H-1B

  13. J-1 Waivers • Purpose: • Bring physicians into medically underserved communities • Keep physicians in the community to permanently address shortages

  14. J-1 Waivers Primary Care/Specialists • Programs favor primary care • Specialists permitted • May require additional documentation • May be accepted only after primary care applications are accepted

  15. J-1 Waivers • Generally for all IGA programs • Worksite(s) in Federally designated medically underserved areas – HPSA/MUA http://www.hrsa.gov/shortage/find.html • Conrad 30 – State Program • State may permit up to 10 Flex spots • Prepare to show service to patients in underserved areas • May be considered only after waivers for HPSA/MUA

  16. J-1 Waivers • 3 year contract • Full-time/ minimum 32 hours direct patient care • Address of worksites • No non-compete • Statement re: compliance with J-1 policies by both parties to the contract • Compliance with prevailing wage obligation • Start within 90 days of receipt of waiver

  17. J-1 Waivers • Applications require: • 6 months of evidence of unsuccessful recruitment • Evidence of facility’s patient mix: • Commercially insured • Medicaid/Medicare • Sliding Fee • Public notice that all patients will be seen regardless of ability to pay

  18. J-1 Waivers • Procedures: • Physician obtains Waiver case number from DOS • Employer/physician submit waiver application to the State 30 administrator • October 1st • State recommends waiver and sends to DOS • DOS recommends waiver and sends to USCIS • USCIS approves waiver

  19. J-1 to H-1B • After approval* by USCIS, H-1B petition filed by employer with USCIS (* possible to file with DOS recommendation) • Upon approval of H petition and change of status, physician commences employment • Reports arrival to practice to the State • Yearly confirmations of continued employment • Changes in practice site/contract must be reported to State and to USCIS

  20. H-1Bto H-1B • H-1Bs completing J-1 service requirement may transfer obligation to new employer if extenuating circumstances • Extenuating define on case-by-case basis • Not “counted” again • Direct filing with USCIS • Obtaining State approval bolsters transfer request. • Must complete full 3 years of service

  21. Common Issues • Change of start date • Change of salary • Change of practice site • Performance

  22. Beyond Waivers/H-1B • Permanent Residence a/k/a “Green Card” • Request may arise in recruitment • Long wait for visas – India/China • Ability for spouse to obtain work authorization • Currently H-4s not permitted to work

  23. Visa Availability

  24. Visa Bulletin • http://travel.state.gov/content/visas/english/law-and-policy/bulletin.html

  25. Green Card Process • Establish basis • Employment/Family • Application to register permanent residence • Physicians must complete 3 year J-1 service obligation* • Spouse and children are derivative beneficiaries • Interim travel and work benefits

  26. Permanent Labor Certification/Immigrant Petition • Employer must file labor certification with Department of Labor • Must provide evidence of unavailability of U.S. workers • Specific recruitment procedures must be followed • Employer files immigrant petition with USCIS based on approval of labor certification • Physician files application to register permanent residence • 3 year service obligation completed • Visa available

  27. Physician National Interest Waiver • Immigrant Petition with USCIS • Must be based on 5 year contract for work in underserved area • Dated less than 6 months before filing • Typically amend J-1 service contract; add 2 years • Must obtain support letter from State • May file application to register permanent residence even 3 year obligation not completed if visa available • Must complete 5 years to obtain green card

  28. Guidance • “Immigration law is a mystery and a mastery of obfuscation...”-USCIS spokeswoman Karen Kraushaar

  29. Taylor & Ryan, LLC Mary E. Ryan Taylor & Ryan, LLC 1777 Reisterstown Road, Ste. 265 Baltimore, MD 21208 mryan@taylor-ryan.com 410.412.3467

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