Becoming the Employer of Choice for International Medical Graduates PowerPoint Presentation

Becoming the Employer of Choice for International Medical Graduates

Mary E. Ryan

Purpose:

Bring

physicians into medically underserved communities Ensure that low income populations are servedKeep physicians in the community to permanently address shortages

J-1 Waivers

J-1 Two year home residence requirement Waiver of HRR

Interested

Government Agency (IGA) based on service in a medically underserved areaConrad State 30 programFederal Programs:

Delta Regional Authority

Appalachian Regional CommissionDepartment of Health and Human Services

IMG J-1

Residents

Programs favor primary care and Federal programs are generally limited to primary care

Specialists

permitted under Conrad 30May require additional documentationMay be accepted only after primary care applications are accepted

J-1 Waivers Primary Care/Specialists

Generally for all IGA programsWorksite(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 areasMay be considered only after waivers for

HPSA/MUA

Multiple sites - if one is not in HPSA/MUA – need FLEX

J-1 Waivers

3 year contractFull-time/ minimum 32 hours direct patient care

Address of worksites

No non-competeStatement re: compliance with J-1 policies by both parties to the contractService to low income

Compliance with prevailing wage obligation

Start within 90 days of receipt of waiver

J-1 Waivers

Applications require:6 or more

months of evidence of unsuccessful recruitment

Evidence of facility’s patient mix:Commercially insuredMedicaid/MedicareSliding FeePublic notice that all patients will be seen regardless of ability to pay

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 DOSDOS recommends waiver and sends to USCISUSCIS approves waiver

* Delaware requires advance employer application

J-1 Waivers

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 StateYearly confirmations of continued employmentChanges in practice site/contract must be reported to State and to USCIS

J-1 to H-1B

H-1Bs with J-1 waiver

may transfer

to new employer if extenuating circumstancesExtenuating defined on case-by-case basisNot “counted” againDirect filing with USCIS possible

Obtaining State approval bolsters transfer request.

Must complete full 3 years of service before change to other status

Extenuating Circumstances

No two year home residence requirementEmployer must

file H-1B to “transfer” physician

Finite number of H-1Bs available each year for cap-subject employersCap-exempt – non-profit organizations affiliated with an institution of higher educationSix year limitMay need to initiate permanent residence immediately

IMG H-1B

Residents

Permanent Residence a/k/a “Green Card”

Request may arise

during contract negotiationsWhy?Long wait for visas – India/ChinaAbility for spouse to obtain work authorizationCurrently H-4s not permitted to workSecurity

Beyond Waivers/H-1B

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

Visa Bulletin – Sept. 2016

Employment-based

All

China

– Mainland

India

Mexico

Philippines

1

st

C

Jan

01

, 2010

Jan

01

, 2010

C

C

2

nd

Feb

01, 2014

Jan

01

, 2010

Feb 22, 2005

Feb

01,

2014

Feb

01,

2014

Establish basis

Employment/Family

Application to register permanent residencePhysicians 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

Green Card Process

Employer must file labor certification with Department of LaborMust 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 certificationPhysician files application to register permanent residence3 year service obligation completedVisa available

Permanent Labor Certification/Immigrant Petition

Immigrant Petition with USCISMust 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 yearsMust obtain support letter from StateMay file application to register permanent residence even if 3 year obligation not completed if visa availableMust complete 5 years to obtain green card

Physician National Interest Waiver

TimingStrictures of immigration system

Cost of mistakes

Must plan for the future now Understanding the concerns of IMGs

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 sitesSwift execution of requirements

What you can do

IMG: International Medical GraduatesECFMG: Educational Commission on Foreign Medical GraduatesJ1 – Immigration status of IMGs sponsored by the ECFMG

H-1B – Immigration status of IMGs not sponsored by the ECFMG

J-2 – Spouse of J-1Conrad 30: State Administered J-1 Waiver programDOS – U.S. Department of StateUSCIS – U.S. Citizenship and Immigration Services

Important Terminology

Mary E. Ryan

Taylor & Ryan, LLC

1777 Reisterstown Road, Ste. 265Baltimore, MD

21208

mryan@taylor-ryan.com

410.412.3467

Taylor & Ryan, LLC