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

2. J-1 Waivers
Purpose:
Bring physicians into medically underserved communities
Ensure that low income populations are served
Keep physicians in the community to permanently address shortages

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

4. J-1 Waivers Primary Care/Specialists
Programs favor primary care and Federal programs are generally limited to primary care
Specialists permitted under Conrad 30
May require additional documentation
May be accepted only after primary care applications are accepted

5. J-1 Waivers Generally for all IGA programs Conrad 30 – State Program
Worksite(s) in Federally designated medically underserved areas – HPSA/MUA
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
Multiple sites - if one is not in HPSA/MUA – need FLEX

6. 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
Service to low income
Compliance with prevailing wage obligation
Start within 90 days of receipt of waiver

7. J-1 Waivers Applications require:
6 or more 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

8. J-1 Waivers Procedures: Physician obtains Waiver case number from DOS
Employer/physician submit waiver application to the State 30 administrator*
State recommends waiver and sends to DOS
DOS recommends waiver and sends to USCIS
USCIS approves waiver
* Delaware requires advance employer application

9. 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

10. Extenuating Circumstances
H-1Bs with J-1 waiver may transfer to new employer if extenuating circumstances
Extenuating defined on case-by-case basis
Not “counted” again
Direct filing with USCIS possible
Obtaining State approval bolsters transfer request.
Must complete full 3 years of service before change to other status

11. IMG H-1B Residents No two year home residence requirement
Employer 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

12. Beyond Waivers/H-1B Permanent Residence a/k/a “Green Card”
Request may arise during contract negotiations
Why?
Long wait for visas – India/China
Ability for spouse to obtain work authorization
Currently H-4s not permitted to work
Security

13. Visa Bulletin – Sept. 2016
/law-and-policy/bulletin.html
Employment-based
All
China – Mainland
India
Mexico
Philippines
1st C
Jan 01, 2010
2nd
Feb 01, 2014
Feb 22, 2005
Feb 01,
2014

14. Green Card Process Establish basis
Employment/Family
Application to register permanent residence
Physicians must complete 3 year J-1 service obligation before filing unless National Interest Waiver
Spouse and children are derivative beneficiaries
Interim travel and work benefits

15. 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

16. 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 if 3 year obligation not completed if visa available
Must complete 5 years to obtain green card

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

18. 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 – 3 year contract/no non-compete, little flexibility in work sites
Swift execution of requirements

19. 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

20. Taylor & Ryan, LLC Mary E. Ryan Taylor & Ryan, LLC
1777 Reisterstown Road, Ste. 265
Baltimore, MD 21208