International Clinicians: Keys to Immigration

1
International Clinicians/IMGsKeys to Immigration
Presented by Immigration Attorney Carl
Shusterman to AMN Workforce Summit November 7-8,
2013
2
Internationally Born Medical GraduatesAn
Essential Resource

• IMGs make up 25 of the physician workforce
  (includes US IMGs)

Are most represented in Are most represented in
Nephrology 45
Internal Medicine 37
Psychiatry 32
Oncology 30
Pulmonology 30
Anesthesiology 28
Pediatrics 28
Gastroenterology 28
Source AMA Physician Master File
3
IMGs by Country (Top Ten)
Country Percent Total
India 20 47,581
Philippines 8.7 20,861
Mexico 5.8 19,929
Pakistan 4.8 11,330
Dominican Republic 3.3 7,892
Former USSR 2.5 6,039
Grenada 2.4 5,708
Egypt 2.2 5,202
South Korea 2.1 4,982
Italy 2.1 4,978
IMGs in U.S. come from 127 countries
Source AMA Physician Master File
4
IMGs Heaviest Concentration by State as a Percent
of All Active Physicians
1. New Jersey 39
2. New York 38
3. Florida 35
4. Illinois 33
15. Texas 25
All United States 25
Source AMA Physician Master File
5
IMGs Number of Potential Candidates Coming Out
of Residencies

• Total graduating residents per year 25,000
• Number of IMGs approximately 7,000

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Visa Options For Residents Fellows

• J Status (training visa)
• H-1B Status (employment visa)
• Permanent Residence and Other Options

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Consequences of J Status for IMGs

• 2-Year Home Residency Requirement
• Must return to Country of Nationality or Last
  Residence for 2 years before obtaining H or L
  visa or Green Card

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How to Obtain a J Waiver

• Persecution
• Exceptional Hardship
• To USC/LPR Spouse
• To USC/LPR Child (under 21 unmarried)
• Interested Governmental Agency (IGA)

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J Waivers Interested Governmental Agencies

• Federal Agencies
• ARC
• VA
• HHS
• DRA
• Conrad State Programs

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Conrad 30

• Primary care and/or specialists
• All 50 states participate
• Some have 10 flex spots the physician does
  not have to practice in an underserved area, as
  long as he/she sees patients from underserved
  areas
• Some states run out of spots, some do not
• Check with Mr. Shustermans office

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Medical Residency/Fellowshipon H-1B Status

• Passage of USMLE, Parts I, II III
• Acceptance to Residency Program
• H-1B Petition

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H1B Visa

• No 2-year rule doctor does not have to practice
  in an underserved area

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But there is a cap!

• 85,000 H1Bs per year
• April 1st is filing date
• Physicians who receive J waivers are exempt from
  cap
• So are doctors who work at academic institutions,
  government or non-profit research institutes

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Permanent ResidenceEmployment Options

• PERM
• National Interest Waiver
• The Law (1999)
• The Regulations (2000)
• The Lawsuit (2005)

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What about Canadian Physicians?

• They are not considered IMGs
• LMCC accepted in almost all states for licensure
• Can qualify for H-1B if they have a U.S. exam
  (USMLE, FLEX, NBME)
• But dont need a U.S. exam for a green card

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Immigration Reform Bill in Congress

• Would make the Conrad 30 program permanent
• Would make J status dual intent
• Would exempt spouse/children from 2-year rule
• Would make it easier for H-1B MDs to change jobs
• Would eliminate per-country quotas
• Would provide a faster route for green cards to
  physicians and their families

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Finding IMG Resources Online http//shusterman.com

• We Link to
• Governmental Sites
• Conrad 30 Programs
• HPSA/MUA List
• ECFMG/USMLE
• Job Opportunities

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How to Keep Current

• Physicians
• Immigration Guide
• Social Media

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