Visa Options for Physicians

The pressures of the COVID-19 pandemic are mounting worldwide, with the United States currently at the epicenter of the public health crisis. The anticipated surge in patients infected with the novel coronavirus is increasing on a daily basis and will continue for the near future. As a result, the United States is experiencing an urgent need for physicians to combat the acceleration of the virus and meet current patient demands.

If you are a physician that has been working to treat or mitigate the effects of COVID-19, now is the time to apply for a U.S. visa on an expedited basis.

The majority of foreign physicians enter the United States to participate in U.S. Graduate Medical Education programs (GME) or to receive training at accredited U.S. schools of medicine. GME refers to any type of formal medical education, usually hospital-sponsored or hospital-based training pursued after receipt of a medical degree. Foreign physicians who seek entry into GME or training must obtain an appropriate visa that permits clinical training activities.

There are several visa options available to physicians for this purpose including: The J-1 Exchange Visitor Program, H-1B Temporary Worker Visa, E-3 Australian Temporary Worker, O-1 Visa for Aliens of Extraordinary Ability, TN Visa for Canadian or Mexican Physicians, or National Interest Waiver.

Each of these visas is discussed in turn.

The most common visa category available to physicians who wish to participate in GME is the J-1 Exchange Visitor Program, administered by the Educational Commission on Foreign Medical Graduates (ECFMG) a government entity which has exclusive authority to sponsor J-1 physicians in clinical training programs. The ECFMG is responsible for issuing Form DS-2019, Certificate of Eligibility for Exchange Visitor Status, which authorizes participation in a clinical training program.

Please note that the J-1 visa has a two-year home country physical presence requirement which means that upon completion of their medical training in the United States, J-1 visa holders must return to their home country for a period of two years to transmit the knowledge they gained in the United States. The two-year home country physical presence requirement means that an individual must complete the two-year period before being eligible to apply for a change of status to other U.S. visa types such as the H visa or to apply for permanent residency. This two-year residence requirement does not need to be continuous but must be “meaningful.” Brief or casual periods spent in one’s home country will not count toward the two-year home residence requirement.

J-1 visa holders cannot apply for a change of status or for permanent residence until the two-year residence requirement is met or a waiver is approved.

For information on seeking a waiver of the two-year residence requirement see below.

The J-1 visa applicant must meet the following requirements in order to receive a visa and participate in a clinical training program:

• Have adequate prior education and training to participate satisfactorily in the program for which they are coming to the United States;
• Be able to adapt to the educational and cultural environment in which they will be receiving their education and training;
• Have the background, needs and experiences suitable to the program;
• Have competency in oral and written English;
• Have passed either Parts I and II of the National Board of Medical Examiners Examination, the Foreign Medical Graduate Examination, Step I and Step II, or the Visa Qualifying Examination (VQE) prepared by the National Board of Medical Examiners, administered by the Educational Commission for Foreign Medical Graduates;
• Provide a statement of need from the government of the country of their nationality or last legal permanent residence (typically the Ministry of Health in one’s country). Providing written assurance to the Secretary of Health and Human Services that there is a need in that country for persons with the skills the alien physician seeks to acquire and the alien physician has filed a written assurance with the government of this country that he/she will return upon completion of the training; and
• An agreement or contract from a U.S. accredited medical school, an affiliated hospital or a scientific institution to provide the accredited graduate medical education, signed by the alien physician and the official responsible for the training.

Much of the application process itself requires close coordination between the applicant and the Training Program Liaison (TPL) at the teaching hospital where the clinical training will take place. Training Program Liaisons (TPLs) must obtain the necessary documentation from the applicant and submit an online application on their behalf visa the EVNet website.

The J-1 visa program can last either seven years in progressive training or the period of time that is required to complete your training. J-1 visa holders can obtain an extension if they can demonstrate an “exceptional need” to continue their training and thereafter bring their skills to their home country. J-1 visa holders must also demonstrate their commitment to depart the United States after the conclusion of their training when applying for an extension.

Additionally, J-1 visa holders can apply for an extension, for the purpose of Board Examination directly with the ECFMG, providing evidence of exam registration, adequate financial resources, and proof of health insurance for the duration of their stay. Such extensions are typically issued for a period of six months.

As stated above, J-1 visa holders must abide by the two-year home residence requirement unless they have received a waiver. There are several different types of waiver available including a no objection waiver, persecution waiver, exceptional hardship waiver, and Conrad 30 waiver as discussed below.

A J-1 visa holder can apply for a waiver of the two-year home residence requirement if any of the following circumstances are true:

• The waiver applicant can demonstrate that he or she came to the United States to observe, consult, teach, or consult research, and the individual’s home country does not object to the sponsored training or work in the U.S.—also known as a “no objection” waiver
• The waiver applicant can demonstrate that he or she will suffer from persecution (based on race, religion, or political opinion) in his or her home country or country of last legal permanent residence—also known as a “persecution waiver”
• Fulfillment of the residency requirement would bring proven exceptional hardship to the applicant's spouse and/or children who are U.S. citizens or permanent residents—also known as “exceptional hardship waiver”
• The applicant is sponsored by an Interested Governmental Agency (IGA) that is interested in the physician’s continued employment in the United States—also known as a “Conrad 30 Waiver”

The following governmental agencies have sponsored waivers for international medical graduates under Conrad 30:

• The Department of Health and Human Services
• The Department of Veterans Affairs
• The Appalachian Regional Commission
• The Department of Agriculture
• The Department of Housing and Urban Development
• State departments of public health may sponsor up to 30 J-1 physicians per year for waivers to provide care in underserved communities.

Once an international medical graduate receives a J-1 waiver and a state medical license, he or she may obtain a new work authorized status for U.S. employment, which in most cases will be an H-1B visa or an immigrant visa.

The Conrad 30 waiver allows J-1 medical doctors to apply for a waiver of the two-year foreign residence requirement upon completion of the J-1 exchange visitor program to allow for work in medically underserved areas. In order to apply for a Conrad 30 waiver, the J-1 medical doctor must obtain sponsorship of a state health department and complete the U.S. Department of State (DOS) Form DS-3035, J-1 Visa Waiver Review Application. Thereafter, the state public health department that agreed to sponsor the J-1 medical doctor for a waiver must then send the waiver application to the DOS Waiver Review Division (DOS-WRD) for a recommendation. DOS-WRD will then notify USCIS electronically of its recommendation and USCIS will be responsible for making a final determination on whether to approve the waiver application. Upon a favorable recommendation by DOS-WRD, USCIS will generally grant the waiver as long as there are no underlying concerns.

Eligibility for the Conrad 30 waiver varies from state to state, but the following program requirements generally apply to all J-1 medical doctors.

The J-1 medical doctor must:

• Agree to be employed full-time in H-1B nonimmigrant status at a health care facility located in an area designated by U.S. Department of Health and Human Services (HHS) as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP).
• Obtain a contract from the health care facility located in an area designated by HHS as a HPSA, MUA, or MUP
• Obtain a “no objection” letter from his or her home country if the home government funded his or her exchange program
• Agree to begin employment at the health care facility within 90 days of receipt of the waiver, not the date his or her J-1 visa expires

Applicants should review their state’s public health department website for specific requirements.

For more information about the J-1 visa click here.

The second most common visa sought by physician employers is the H-1B non-immigrant visa for professionals. The H-1B visa is a very sought after, lottery-based visa that allows employers to petition to hire highly skilled professionals to work in specialty occupation. To be eligible for the H-1B visa, a worker must demonstrate that they have a “body of highly specialized knowledge,” meaning that they have the academic qualifications and/or experience necessary to fulfill the job duties.

Only a limited number of visas are issued for the H-1B visa program every fiscal year—65,000 for professionals with a bachelor’s degree and 20,000 for professionals with a master’s degree and above. This makes the H-1B application process difficult, because an applicant must first be selected in order to apply for the visa.

In addition, employers can only register for a chance at selection once every fiscal year (mid-March).

Below are some key requirements that you must meet to qualify for the H-1B Temporary Worker:

• You must have an employer-employee relationship with the petitioning U.S. employer (job offer/contract)
• Your job must qualify as a specialty occupation by meeting one of the following criteria:
  1. A bachelor’s or higher degree, or its equivalent is normally the minimum requirement for the particular position;
  2. The degree requirement is common for the position in the industry, or the job is so complex or unique that it can only be performed by someone with at least a bachelor’s degree in a field related to the position;
  3. The employer normally requires a degree or its equivalent for the position; or
  4. The nature of the specific duties is so specialized and complex that the knowledge required to perform the duties is usually associated with the attainment of a bachelor’s or higher degree.
• Your job must be in a specialty occupation related to your field of study.
• The petitioning employer must submit evidence that a labor condition application (LCA) has been certified by the U.S. Department of Labor.
• You must be paid at least the actual or prevailing wage for your occupation, whichever is higher.
• An H-1B visa number must be available at the time of filing the petition, unless the petition is exempt from numerical limits.

The H-1B visa is issued for a three-year period but may be extended for another three years. In addition, physicians may bring their spouse and children to live with them in the United States. Dependent spouses however are not allowed to work on an H-2 dependent spouse visa. For more information about the H-1B visa click here.

The E-3 specialty occupation visa is identical to the H-1B visa, except that this visa is only for Australian nationals.

Just like with H-1B, these applicants must provide evidence of a legitimate job offer, evidence of their qualifications (academic equivalence to U.S. bachelor’s degree or relevant work experience), and evidence that they have a body of highly specialized knowledge and will be working in a specialty occupation using their knowledge or skills.

The E-3 is issued for an initial maximum period of 2 years. Extensions of stay can be granted in two-year increments, generally with no limit on the number of extensions that can be sought.

For more information about the E-3 visa click here.

A fourth but less common option for physicians is the O-1 visa for aliens of extraordinary ability who have received national and/or international acclaim in their field.

In order to qualify for this visa type, you must demonstrate that you are exceptionally distinguished in your field (by way of awards, honors, distinctions, titles, membership in distinguished board or associations, evidence of continuous recognition, etc.)

Only physicians that can demonstrate a high level of expertise in their field will qualify. Physicians fall under the O-1A category as individuals with an extraordinary ability in the sciences.

To qualify for an O-1 visa, the applicant must demonstrate extraordinary ability by sustained national or international acclaim and must be coming temporarily to the United States to continue work in the area of extraordinary ability.

Extraordinary ability in the sciences means a level of expertise indicating that the person is one of the small percentage who has risen to the very top of the field of endeavor.

Evidence that establishes expertise includes evidence that the applicant has received a major, internationally recognized award, such as a Nobel Prize, or evidence of at least (3) three of the following:

• Receipt of nationally or internationally recognized prizes or awards for excellence in the field of endeavor
• Membership in associations in the field for which classification is sought which require outstanding achievements, as judged by recognized national or international experts in the field
• Published material in professional or major trade publications, newspapers or other major media about the beneficiary and the beneficiary’s work in the field for which classification is sought
• Original scientific, scholarly, or business-related contributions of major significance in the field
• Authorship of scholarly articles in professional journals or other major media in the field for which classification is sought
• A high salary or other remuneration for services as evidenced by contracts or other reliable evidence
• Participation on a panel, or individually, as a judge of the work of others in the same or in a field of specialization allied to that field for which classification is sought
• Employment in a critical or essential capacity for organizations and establishments that have a distinguished reputation

The O-1A visa is good for an initial period of up to three years which can be extended in increments of up to 1 year.

For more information about the O-1A visa click here.

A fifth option for Mexican and Canadian Physicians is the TN Visa which allows professionals from Mexico and Canada to work in the United States under the North American Free Trade Agreement (NAFTA).

One of the conditions of the TN visa program requires the TN visa applicant to fill a position in the United States that requires a NAFTA professional. Physicians are included in the NAFTA list of professionals eligible to participate in the program.

To be eligible:

• TN applicants must be Citizens of Canada or Mexico;
• TN applicants must apply to work in a profession that is on the NAFTA list;
• TN position must fill an approved position in the U.S. that requires a NAFTA professional;
• Mexican or Canadian applicants must work in a prearranged full-time or part-time job, for a U.S. employer (see documentation required). Self-employment is not permitted;
• Professional Canadian or Mexican citizens must have the qualifications required for the position.

Additionally, applicants must demonstrate that they are properly classifiable as NAFTA Professionals for TN visa, under U.S. law by:

• Education Requirement - The applicant's employer must submit proof that the applicant meets the minimum education requirements or has the alternative credentials set forth in NAFTA agreement, chapter 16 appendix 1603.d.1. Evidence of professional qualifications may be in the form of degrees, certificates, diplomas, professional licenses, or membership in a professional organization. Degrees, diplomas, or certificates received from an educational institution outside the United States, Canada, or Mexico must be accompanied by an evaluation by a reliable credential’s evaluation service specializing in evaluating foreign documentation.
• Work Experience Requirement - Documents proving the applicant's experience should be in the form of letters from former employers. If the applicant was self-employed, business records should be submitted proving that self-employment.
• Licensure Requirement - Licensure to practice a given profession in the United States is a post-entry requirement subject to enforcement by the appropriate state or other sub-federal authority.

Canadians do not need a visa for admission to work as NAFTA professionals. Canadians can simply request admission to work in TN status at a U.S. port of entry by providing supporting documentation including request for admission under TN status, employment letter, proof of professional qualifications, proof of ability to meet licensure requirements, and proof of Canadian citizenship. Canadians however may choose to obtain a visa at their closest U.S. Embassy or Consulate. Non-Canadian dependents such as spouses and children for example are required to obtain a visa in order to be admitted.

Mexican citizens on the other hand must apply for a TN visa at a U.S. Embassy or Consulate and provide all supporting documents at their interview.

The TN visa is issued for an initial period of up to three years. Extensions may also be requested in time increments of one year. There is no limit on the number of years a TN visa holder can remain in the United States.

For more information about the TN visa click here.

The last option for physicians to live and work in the United States is not in the form of a visa, but rather is a self-petition for a green card called a National Interest Waiver. Essentially, the applicant is asking the government to “waive” the labor certification requirement by demonstrating that granting the applicant’s petition would be in the national interest of the United States.

To be eligible:

• You must agree to work full-time in a clinical practice. For most physician NIW cases, the required period of service is 5 years (time spent in other visa classifications such as O-1, H-1B count toward this five-year period)
• You must work in a primary care (such as a general practitioner, family practice petitioner, general internist, pediatrician, obstetrician/gynecologist, or psychiatrist) or be a specialty physician
• You must serve either in a Health Professional Shortage Area (HPSA), Mental Health Professional Area (MHPSA – for psychiatrists only), a Medically Underserved Area (MUA), or a Veterans Affairs facility, or for specialists in a Physician Scarcity Area (PSA)—area in the public interest and
• You must obtain a statement from a federal agency or a state department of health that has knowledge of your qualifications as a physician and that states your work is in the public interest (This statement is known as an attestation)

We hope that these immigration options were of interest to you. We invite you to contact our office at 619.819.9204 to discuss more details regarding your individual case or by email at jacob@h1b.biz.