Physicians

PHYSICIANS

J-1 Visa Waivers for Physicians

If sponsored by ECFMG, all J-1 resident and/or fellow physicians are required to return to their home country after completing medical training – this is known as the 212(e) home residency requirement. To avoid this requirement, J-1 physicians can apply for a J-1 visa waiver. Most waivers require the location of the practice to be in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), Medically Underserved Population (MUP) or Mental HPSA (MHPSA) – this designation only applies for psychiatrists. Applicants are encouraged to plan and prepare to apply for a waiver 8-10 months in advance, if possible.

J-1 Waiver Options:

The work site must be designated HPSA, MHPSA, MUA, or MUP location. Conrad 30 waivers are available to primary care and specialist physicians. If the work location is not designated, some states offer a FLEX 10 waiver. Every state has different requirements for a FLEX 10 waiver application, but the general idea is to establish that the employer treats patients who are located in underserved areas thereby justifying a waiver for the J-1 physician. There are 30 spots available per year, per state including the FLEX10.

HHS waiver are for primary care physicians (IM, FP, PEDS, PSYCH, OBGYN) and hospitalists who are their completing primary care residency. In some situations, a specialist may be able to apply if the fellowship is one year and the residency was completed in primary care. The work location must be designated as HPSA and must have a HPSA score of 7 or above. There is no annual limit of spots granted per year. Note: HPSA minimum score requirement only applies to HHS J-1 waiver applications.

J-1 waiver employment locations include certain locations in Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and all of Florida. Specialists and primary care applicants are eligible to apply. The work site must be designated HPSA, MHPSA, MUA, or MUP location. There is no annual limit of spots granted per year.

J-1 waiver employment locations include certain locations in Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia. Specialists and primary care applicants are eligible to apply, and the work location must be designated as HPSA and each state within the ARC has their own guidelines. There is no annual limit of spots granted per year.

J-1 waiver employment locations include certain locations in Alabama, Arkansas, Illinois, Mississippi, Missouri, Kentucky, Louisiana and Tennessee. Specialists and primary care physicians are eligible. There is no annual limit of spots granted per year.

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Hardship and/or Persecution waivers can be sought at any time during the IMG’s J-1 tenure and the IMG may be able to apply under both categories at the same time. An IMG can apply for a waiver listed in Section A-F above and a hardship and/or persecution waiver.

Obtaining a J-1 waiver does not give the IMG work authorization, the IMG will need work authorization, physician will need an H-1B visa.

J-1 Waiver Process

THE PROCESS

CHANGING EMPLOYERS

    1. Submit J-1 waiver application and submit U.S. Department of State (DOS) application;
    2. Upon the recommendation of approval, the interested government agency or state agency will forward their recommendation for approval to DOS automatically;
    3. DOS will review the packet and will send a recommendation for approval automatically to USCIS.
    4. Upon J-1 waiver approval from USCIS, the 212(e) home residency requirement is lifted.

    After obtaining the J-1 visa waiver from the USCIS, the employer is required to apply for an H-1B visa on behalf of the physician (IMG) so that the physician has work authorization. Physicians who obtain J-1 waiver are always considered H-1B cap-exempt for the entire duration of their stay on an H-1B visa. This means the H-1B filing will NOT be subject to the annual quota limitations.

    All H-1B fees (attorney and filing) must be paid by the employer as per USCIS regulations. Upon H- 1B approval, the IMG is required to work for a minimum of 3 years with the initial employer and in accordance with the J-1 waiver application that was submitted.

  • Changing Employers During the J-1 Waiver Period (Extenuating Circumstances):

    After being granted a J-1 waiver and the physician begins working on an H-1B visa to complete the three-year requirement, the physician encounters situations and circumstances that leaves them wanting to change employers. There are circumstances that may necessitate a change of employer, these are known as “extenuating circumstances”. Extenuating circumstances examples include, but are not limited to:

    • Being paid less than what is documented;
    • Malpractice risks, including staffing requirements;
    • Insufficient patient base or too many patients creating an unsafe medical environment;
    • Physician termination;
    • Compliance with waiver requirements;
    • Personal circumstances such as marriage, birth/adoption of a child, illness, disability, other personal reasons that require a relocation;
    • Discrimination or other behavior which leads to an unsafe workplace.

    It should be noted that USCIS has not provided specific guidance on what constitutes an extenuating circumstance and what does not. Please contact our office to discuss the potential of filing an H-1B change of employer petition.

    If our office is able to determine that a physician is experiencing an extenuating circumstance that necessitates an H-1B change of employer application, the new work site must also be located in an underserved area. All H-1B change of employer petitions are under the purview of USCIS.

    Post J-1 Waiver Employment: Physicians who are completing the three-year J-1 waiver requirement are able to file an extension to stay with their current employer or are able to move to any employer who is willing to sponsor their H-1B visa (no underserved area requirement). J-1 waiver recipient physicians are exempt from the H- 1B cap for their entire duration on an H-1B visa.

GREEN CARDS FOR PHYSICIANS

EB-2 Physicians National Interest Waiver

  • Requires a 5-year commitment to work in an underserved area (includes the 3 years J-1
  • waiver requirement on H-1B but does not include J-1 residency or fellowship on a J-1 visa);
  • Physician can self-sponsor, no requirement for employer to pay for costs of application;
  • Can apply immediately after starting on a H-1B;
  • Physician can work for initial 3 years and then complete work with another employer provided the new work location is also located in an underserved area;
  • Skip the entire PERM labor certification process
  • Premium Processing through USICS available

EB-2 Link

O-1A FOr Physicians

O-1A Criteria

IMPORTANT NOTES

  • The O-1 visa evidentiary criteria are focused on outstanding achievements recorded in one’s professional field, there is no need to work in a designated shortage area. The requirements are as follows:
    • The IMG must have a job offer.
    • Letters of Recommendation. Quality over quantity is key, 5 – 8 letters will suffice but it is the strength of the letter that matters.
    • IMG applicants only need to meet three out of eight criteria below. Having around four to five (even if not as strong) is preferable. Remember, the IMG must be able to document everything.
    1. Receipt of recognized awards or prizes for excellence at the national or global level.
    2. Membership in an organization in your field which requires outstanding achievements to enter.
    3. Published materials in professional journals or other major media about the IMG or their work in the field.
    4. Original scholarly contributions of major significance in the field.
    5. Authorship of scholarly articles in the field that are published in professional journals or other major media.
    6. Proof that the IMG has judged other people’s work in the medical field, either individually or as a member of a panel.
    7. A large salary or other compensation indicative of the IMG’s achievements.
    8. Evidence showing that the IMG has been employed in and have performed well in a critical or essential capacity in a well-established organization.
    9. Catchall Provision: If the IMG cannot establish all three of the above requirements, the IMG can submit other evidence such as patents, previous work in organizations, ownership of an organization that relates to the IMG’s field or work.

  • For IMGs applying for an O-1A visa, the following criteria is usually the most applicable:

    1. Membership in an organization in your field that requires outstanding. achievements to enter.
    2. Published materials in professional journals or other major media about the IMG or their work in the field.
    3. Authorship of scholarly articles in the field that are published in professional journals or other major media.
    4. Proof that the IMG has judged other people’s work in the medical field, either individually or as a member of a panel.
     

    Important Notes about O-1A visas in relation to J-1 visas:

    • The IMG will still be subject to the 212(e) requirement and therefore the IMG will need to obtain a waiver at some point in the future if they wish to pursue a green card.
    • IMG is not permitted to change from a J-1 to an O-1 within the U.S.
    • Once the O-1A is approved by USCIS, the IMG must depart the country and obtain a visa stamp at a U.S. consulate abroad to reenter under O-1A status.
    • O-1A visas may be valid for an initial period of three years and may be extended indefinitely.
    • There is no requirement to work in an underserved area and any employer is eligible to hire an O-1A candidate.
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