Navigating Immigration:

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215.885.3600 215.885.0324 (fax)
www.goldhess.com wendy_at_goldblumhess.com
101 Greenwood Ave. Ste 380 Jenkintown,
Pennsylvania 19046

• Navigating Immigration
• Presented to
• The Pennsylvania Association of Community Health
  Centers Annual Conference

By Wendy Castor Hess, Esq. Karen M.
Pollins, Esq.
Lancaster, PA October 7, 2014
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What is an IMG?

• International Medical Graduate physician who
  obtained a medical degree abroad
• Includes U.S. citizens who chose to go to medical
  school abroad
• Includes foreign born physicians who obtained
  Lawful Permanent Resident status or U.S.
  Citizenship
• Our focus will be on IMGs who come to the U.S. to
  pursue training/employment on a nonimmigrant
  (temporary) visa

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Recruiting Foreign Physicians Providing
Immigration Sponsorship

• Great tool for recruiting and retaining qualified
  physicians!
• Be careful not to discriminate in recruitment
  process! Treat all applicants the same ask the
  same permissible questions
• Are you legally authorized to work for our
  health center in the U.S.?
• Will you require visa sponsorship?
• Type of visa sponsorship will depend on foreign
  physicians current and previously held visa
  status

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Two Arms of Employment-Based Immigration Law for
Physicians
Nonimmigrant
Immigrant
(temporary)
(green card)
Can lead to U.S. Citizenship
Professional
Training
EB-1
EB-2
EB-3
J
F
H-1B
O
Goldblum Hess 215.885.3600 215.885.0324
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• Nonimmigrant (Temporary)
• Options for IMG Physicians
• H-1Bs, J-1s, J-1 Waivers and O-1s

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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H-1B Temporary Worker

• Nonimmigrant visa classification for IMG trainees
  or practicing physicians to work for a specific
  employer
• Duration up to 6 years (with exceptions)
• H-1B cap (65,000 20,000 visas per fiscal year
  not enough to meet demand in recent years)
• Certain institutions exempt from cap (1)
  colleges/universities, (2) affiliated nonprofits
  and (3) nonprofit government/research
  organizations
• J-1 Waiver beneficiaries also exempt

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Requirements for H-1B Physicians

• Medical degree
• USMLEs Steps 1, 2 and 3
• ECFMG Certificate for English language fluency
  (not required for Canadian physicians) and
• Valid state medical license. Note Trainees with
  temporary licenses may be limited to H-1B status
  in 1-year increments (instead of the typical 3
  years)

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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H-1B Petition Process

• Obtain certified Labor Condition Application from
  U.S. Department of Labor
• File H-1B Petition with U.S. Citizenship
  Immigration Services detailing position and
  IMGs qualifications (degree, USMLEs, ECFMG
  certification, license, etc.)
• Processing Time
• 2 - 4 months via regular processing
• 15 days via Premium Processing

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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J-1 Exchange Visitor

• Nonimmigrant visa classification that permits
  IMGs to obtain post-graduate medical training
• Duration program length 30-day grace period
  (generally limited to 7 years)
• Pro No annual cap!
• Con Requires return and physical presence in
  home country or country of last residence for two
  years.

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Post-Training Options for J-1 Physicians

1. Go home satisfy two year home residence
   requirement
2. Obtain a waiver of J-1 two year home residence
   requirement
3. Obtain O-1 or other nonimmigrant visa status
   (defers, does not eliminate, two-year home
   residence requirement) or
4. Obtain Asylum/Withholding of Removal.

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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J-1 Physician Waiver Options

• Federal Interested Governmental Agency (IGA)
• State Department of Health Conrad 30 Program
• Exceptional Hardship
• Persecution.
• IMGs are ineligible for no objection
  waivers.

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Federal IGA Waivers

• Direct clinical employment by Interested
  Government Agency e.g. Department of Veterans
  Affairs (VA), Delta Regional Authority (DRA),
  Appalachian Regional Commission (ARC).
• Conducting outstanding research Department of
  Health Human Services (HHS)/NIH.

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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ARC J-1 Waiver

• Physician must have job offer at a HPSA facility
  in an ARC county that serves Medicare, Medicaid
  and indigent patients
• Limited to primary care
• Need support of state DOH/governor
• Physician must commit to working full-time (40
  hours) for 3 years
• Good faith recruitment effort in 6 months prior
  to waiver application submission
• Contract restrictions non-compete prohibited
  liquidated damages required

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Conrad State 30 J-1 Waiver Program

• 30 slots per state per year
• Physician needs job offer at a facility in a
  federally-designated underserved area (HPSA,
  MUA/P)
• Exception 10 of the 30 may be for physicians not
  located in federally-designated underserved
  areas, but who treat patients from such areas
  (FLEX)

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Federal Conrad 30 Requirements

• Must provide full-time (40 hours) clinical
  services (i.e. direct patient care)
• 3 year service term (fulfilled in H-1B status)
• Physician must agree to begin employment within
  90 days of USCIS approval

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Other State-Specific Considerations

• Primary care versus specialty care
• Application periods
• Contract restrictions (e.g. non-compete clauses)
• Filing fees
• Reporting requirements
• Number of slots utilized
• FLEX waiver policy

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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J-1 Clinical Waiver Process

• Register Physician submits Application to
  obtain case number with U.S. Department of State
  (DOS)
• Apply Employer submits J-1 Waiver Application
  to State Department of Health (DOH)
• DOH recommends waiver to DOS
• DOS recommends waiver to USCIS
• USCIS issues final waiver approval

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Exceptional Hardship J-1 Waiver

• Hardship to U.S. Citizen or Permanent Resident
  spouse or child
• Need to show hardship if physician returns for
  two years either with or without qualifying
  relative
• Process
• I-612 Application filed with USCIS
• Reviewed by DOS Waiver Review Division
• Processing time 4 - 8 months

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Persecution J-1 Waiver

• Persecution based on race, religion, or political
  opinion
• IMG may also be eligible for asylum
• Process
• I-612 Application filed with USCIS
• Reviewed by DOS Waiver Review Division
• Processing time 4 - 8 months

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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• Immigrant (Permanent
• or Green Card)
• Options for IMG Physicians NIWs and PERMs

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Green Card Process

• IMG physicians are usually in the
  Employment-Based, Second Preference (EB-2)
  category for advanced degree professionals
• Generally a 3-step process
• (1) Labor Certification (PERM) Application
  filed with U.S. Department of Labor
• (2) I-140 Immigrant Petition filed with U.S.
  Citizenship Immigration Services (USCIS)
• (3) I-485 Application to Adjust Status filed
  with USCIS (if priority date current)

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Introducing the Visa Bulletin
Employment-Based All Chargeability Areas Except Those Listed CHINA INDIA MEXICO PHILIPPINES
1st EB-1 Current Current Current Current Current
2nd EB-2 Current 15 FEB 05 01 JAN 00 Current Current
3rd EB-3 01 OCT 11 O1 APR 09 15 NOV 03 01 OCT 11 01 OCT 11
OTHER WORKER 01 OCT 11 22 JUL 05 15 NOV 03 01 OCT 11 01 OCT 11
Employment Based - October 2014 Visa Bulletin

• Messages
• Priority Date date Application / Petition is
  filed with government
• For those that require PERM, date PERM filed
• For those that do not require PERM, date I-140
  filed
• There is a backlog for 2ND PREFERENCE physicians
  born in India and China

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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Labor Certification - PERM

• Employer must place ads (i.e. test the labor
  market) to show that it was unable to recruit
  minimally qualified, willing and available U.S.
  workers for the position
• Must show that IMG physician will be paid the
  prevailing wage in the area of intended
  employment

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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National Interest Waiver (NIW)

• Waiver of labor certification requirement
• IMG physician must agree to work in a
  medically-underserved area (HPSA, MUA/P) for 5
  years
• State DOH supports the NIW and issues a letter
  certifying that the medical service is in the
  public interest
• Good option for IMGs who already have 3-year
  service obligation pursuant to J-1 waiver

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com
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CONCLUSION

• Although complex, immigration laws allow the
  recruitment of highly-qualified IMG physicians by
  U.S. employers!
• Keys for Success
• Careful screening and strategic planning
• Advance planning
• Open communication
• Participation by employer, IMG and legal counsel
  throughout process

Goldblum Hess 215.885.3600 215.885.0324
(fax) www.goldhess.com