On March 17, medical students in Michigan and across the United States experienced an important milestone and discovered the next phase of their journeys in becoming future physicians on Match Day 2023. While the excitement and trepidation at receiving the envelope containing the contents of their immediate futures may have temporarily subsided, soon these aspiring physicians will begin to look toward the next step: full-fledged employment.
For physician recruiters and human resource specialists, this means that you may soon field complex visa-related questions from foreign medical resident job seekers. Foreign nationals engaging in U.S. graduate medical education programs are primarily in one of two visa statuses: J-1 or H-1B. Here is what you need to know about the impact these visas have on future employment as a physician in the U.S.:
J-1 Visa Holders
The majority of foreign national physicians complete their residencies with a J-1 visa sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). The J-1 program subjects visa holders to Section 212(e) of the Immigration and Nationality Act, also referred to as the “Two-year Home Country Physical Presence Requirement.” This means J-1 visa holders will not be able to obtain an H-1B temporary worker visa or permanent residency until they have satisfied the requirement by being physically present in their country of nationality or last legal permanent residence for an aggregate of at least two years after departing the U.S. at the end of their J-1 program.
Waivers of the Two-Year Home Country Physical Presence Requirement are often granted to allow foreign physicians trained in the U.S. to work full time for at least three years in designated health care professional shortage areas (HPSA). The U.S. Department of Health and Human Services (USDHHS) offers unlimited waivers to primary care practitioners in family medicine, internal medicine, obstetrics and gynecology, pediatrics and psychiatry. Physicians may work for any facility as long as it is located in a HPSA with a score of 07 or higher. These unlimited waivers may be issued year-round, but no longer than 12 months after completion of a medical residency.
For specialists, and also primary care physicians who do not qualify for the federal program, most states in the U.S. participate in the Conrad 30 program. In Michigan, 30 waivers are available in an application process that begins each September and ends in early November. Eligible work sites include HPSAs and medically underserved areas, as well as adjacent locations under certain circumstances.
The process for both the USDHHS and Conrad 30 waivers winds through several state and federal agencies. Thus, employers and applicants must allow several months for the paperwork to be processed. Moreover, once the J-1 waiver is granted, the prospective employer must petition for the foreign physician to switch to H-1B status. One piece of good news is that J-1 waiver physicians are exempt from the infamous H-1B quota lottery.
H-1B Visa Holders
Foreign national physicians might prefer to complete their clinical training in H-1B status in order to avoid the J-1 waiver Two-year Home Country Physical Presence Requirement and to also avoid the need to work in physician shortage areas. However, many residency programs prefer to sponsor J-1 visas, given the associated ease of visa processing and substantially reduced costs. If a foreign physician does complete graduate medical education in H-1B visa status, there are important points to consider. The H-1B visa classification contains a six-year work authorization limit. However, medical residency programs can range in duration from three years for some primary care programs, such as internal or family medicine, to seven years for advanced specialties like neurosurgery. Many other areas of medical expertise fall between that range. Thus, medical residents who complete their clinical training in H-1B status may find their U.S. work authorization substantially reduced before their first day of employment as a fully-trained physician. From a hiring employer’s perspective, a matter of critical importance is maintaining work authorization without any disruptions related to visa processing. In these situations, one potential solution is assisting the foreign physician in filing for U.S. permanent residency, i.e., a green card. In many situations, legal restrictions prohibit foreign physicians from filing for green cards without employer sponsorship. Employers often wait at least a year or more to negotiate participation in the green card process. However, with medical residents who complete their training in H-1B status, it may be necessary for employers to make green card processing part of the initial contract negotiations. To keep the process on track, when physician immigration issues come to the forefront, employers should consult an immigration attorney as soon as possible during employment negotiations.
For questions about the immigration process for foreign national physicians or for assistance with an immigration issue, contact Michael Wooley.