Welcome to the Berardi Immigration Law Health Care Resource Center

Foreign health care workers play a major role in the health care industry in the United States. Berardi Immigration Law represents many reputable health care organizations, as well as physicians, nurses, researchers, and other health care workers. Our attorneys evaluate each client’s options and tailor a customized immigration approach. There are a variety of visa options available, depending on the client’s situation and circumstances.

NONIMMIGRANT VISA OPTIONS

Our firm considers the following visas for foreign health care workers:

H-1B specialty occupation visas, and analyzing for cap-exempt filing opportunities

The H-1B category is designated for temporary professionals to work in the U.S. in a “specialty occupation.” This is generally defined as a position that requires at least a Bachelor’s degree or the equivalent. Many foreign nationals who come to work as physicians in the United States do so pursuant to H1B status. Candidates must usually be counted against the H-1B cap before the individual is eligible to work in H1B status, unless the institution is:

  • an accredited, nonprofit institution of higher education;
  • a nonprofit entity that is related to or affiliated with a qualifying institution of higher education; or
  • a nonprofit research organization or a governmental research organization. 

J-1 visas and J-1 waivers

The Exchange Visitor (J) non-immigrant visa category is for individuals approved to participate in work-and study-based exchange visitor programs. Many international medical graduates (IMGs) pursuing graduate medical studies opt to use this visa. IMGs in the United States on J-1 visas are subject to a two year residency requirement. This requirement holds that a J-1 visa holder must be present in their home country or country or permanent residency for two years prior to applying for another non-immigrant visa category (H1-B) or permanent residency in the United States. Waivers can be applied for in order to bypass this requirement. There are five circumstances which make a J-1 visa holder eligible for a waiver:

  • the visa holder receives a no objection statement from the host government;
  • an interested U.S. Government agency requests a waiver on the visa holder’s behalf;
  • the visa holder would be persecuted upon return to the country of residence;
  • the residency requirement would cause exceptional hardship to a U.S. citizen or a permanent resident spouse or child; or,
  • a designated State health agency or its equivalent requests a waiver.

O-1A visas for individuals with extraordinary ability in science

The O-1A visa is for individuals with an extraordinary ability in the sciences, education, business, or athletics. “Extraordinary Ability” 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.  This is a category to consider for well-published researchers, accomplished clinical physicians, and other highly-skilled and achieved health care professionals. The O-1 category is also an exception to the J-1 two-year home residency requirement.

TN category for Canadians and Mexicans in the health care industry

The TN Visa category was created under the North American Free Trade Agreement (NAFTA), which created special economic and trade relationships for the U.S., Canada, and Mexico. Canadians and Mexicans may be eligible to work in the U.S. as a nonimmigrant NAFTA professional if they meet certain conditions. Generally, each profession listed under this category requires the applicant to possess a Bachelor’s degree as an entry-level requirement. In some professions, an alternative to a Bachelor’s degree is listed, such as related experience or special licensing.

USCIS considers the following medical professionals for the TN category: dentist; dietitian; medical laboratory technologist; medical technologist; nutritionist; occupational therapist; pharmacist; physician; physiotherapist; physical therapist; psychologist; recreational therapist; registered nurse; and veterinarian. It is important to note that only physicians in research or teaching roles are eligible for the TN visa.

E-2 Investor Visas, where appropriate

The E-2 Treaty Investor visa exists for citizens of countries that maintain a treaty of commerce and navigation with the United States. It enables an individual to be admitted to the U.S. when investing a substantial amount of capital in a U.S. business. This classification can be utilized by foreign nationals of treaty countries in the medical profession to establish and open their own practice in the States.

GREEN CARD APPLICATIONS

Our attorneys are also adept at analyzing green card options for health care professionals. U.S. immigration law provides foreign nationals with a variety of ways to become lawful permanent residents through employment in the United States:

PERM Labor Certifications

Labor certification is the standard route for obtaining an employment-based green card. U.S. employers must demonstrate that there are no minimally qualified U.S. workers for a given position. The Department of Labor (DOL) must certify this application in order for an employer to be able to apply for a green card for a foreign employee.

Applications are processed under a program called Program Electronic Review Management (PERM). Labor certification applications under PERM require a full-time employee, a permanent job offer, reasonable job requirements, and pay of the prevailing wage or higher for the job’s occupational classification.

EB-1 extraordinary ability applications

EB-1 visas are available to foreign nationals that can demonstrate exceptional abilities in their field. This category is of primary preference. EB-1A and EB-1B visas are most relevant to those in the medical field. EB-1A visas are for those who can demonstrate extraordinary ability in designated fields, including the sciences. A major asset of the EB-1A category is that applicants may self-petition and do not need an offer of employment to apply. EB-1B visas are designated for outstanding researchers and professors.

While a major benefit of these categories is their relatively broad nature, USCIS sets out stringent guidelines and evidentiary criteria that must be met.

EB-2 National Interest Waivers

EB-2 visas are of secondary preference after the EB-1 category. Generally this category requires an offer of employment and PERM Labor Certification; however, some individuals may qualify for a National Interest Waiver (NIW). The NIW allows an EB-2 visa without an offer of employment or PERM Labor Certification. To obtain an NIW, an applicant bears the burden of demonstrating that the United States would gain a greater benefit from waiving the EB-2 requirements than enforcing them.

Although the jobs that qualify for a national interest waiver are not defined by statute, national interest waivers are usually granted to those who have exceptional ability and whose employment in the United States would greatly benefit the nation. Physicians meet a specific set of criteria:

  • an applicant must be a J-1 physician in pediatrics, internal medicine, obstetrics, psychiatry, or family medicine;
  • an applicant must sign an agreement to work for at least 5 years in one of the above practices;
  • an applicant must to work in one of the following areas:
    • Health Professional Shortage Area
    • Mental Health Professional Area
    • Medically Underserved Area
    • Veterans Affair facility; and,
  • an applicant must have a statement from a government agency or the state department of health stating that the applicant’s qualifications demonstrate the benefit to the public interest.

Schedule A Green Card Applications

Schedule A green cards provide an accelerated option for professional nurses and physical therapists looking to reside permanently in the United States. Currently, this application applies only to these two professions. To qualify for this accelerated processing, a professional nurse must have either passed the Commission on Graduates in Foreign Nursing Schools (CGFNS) examination or must hold a full and unrestricted license to practice professional nursing in the state of intended employment. A physical therapist must possess all the qualifications necessary to take the physical therapist licensing examination in the state in which he or she proposes to practice physical therapy. The major benefit of this option is a green card can be obtained without going through the entire labor certification process, which cuts down the processing time significantly.

Berardi Immigration Law represents numerous clients in the medical field and provides an individualized approach for each client. If you study or work in the medical field and are considering immigration to the United States, please contact our office to schedule a consultation with one of our attorneys today!

Immigrant Physicians: Supporting the U.S. Healthcare Industry

Immigrants play a crucial role in the U.S. healthcare industry. In fact, around a quarter of physicians in the U.S. are international medical graduates (IMGs). This group of more than 6,000 IMGs makes essential contributions to the industry when coming to the U.S. to participate in medical residency programs. These physicians enter the U.S. under a J-1 non-immigrant visa. A J-1 visa is a non-permanent visa category for individuals approved to participate in work and study-based exchange visitor programs. Subsequently, IMGs have two choices if they wish to continue to work in the U.S. Their first option is to return to their country and work for two years, then apply for a different visa to return, such as on an H-1B. Their second option is to apply for a federal or state 30 “interested government agency” (IGA) waiver. This waiver allows IMGs to continue working in the U.S. so long as they commit to practicing in an underserved area for three years. These underserved areas are often rural. According to the American Association of Medical College (AAMC), this waiver program has allowed 15,000 foreign doctors to serve in underserved areas. Without these IMGs, underserved medical areas would likely face an […]
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Educational Commission for Foreign Medical Graduates Certification: What Is It, Who Needs It and How to Get It

The Educational Commission for Foreign Medical Graduates (ECFMG) is an organization that assesses the readiness of international medical graduates to enter residency or fellowship programs in the U.S. These programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). International medical graduates make up a significant portion of the U.S. physician workforce and provide significant and necessary contributions to the industry. Certification by ECFMG is the standard regarding the evaluation of qualifications of international physicians before they can enter U.S. graduate medical education. An international medical graduate is defined as a physician who received a basic medical degree outside of the U.S. or Canada. It is based on the location of medical school, rather than citizenship. This certification is also necessary for international medical graduates taking Step 3 of the United States Medical Licensing Exam (USMLE) and to obtain an unrestricted license to practice medicine in the U.S. In order to obtain ECFMG Certification, physicians must demonstrate certain criteria. First, physicians must complete the Application for ECFMG Certification. Second, physicians must show passing performance on USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 Clinical Skills. Lastly, physicians must have primary-source verification of medical education credentials. The […]
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H-1B Cap Exemptions

H-1B visas are a popular category for foreign medical professionals who wish to work in the US. The H-1B nonimmigrant visa is a category for temporary workers who wish to work in a specialty occupation in the United States. In order to qualify to apply for an H-1B visa, an individual in the medical field must meet several qualifications. First, it is generally necessary to have a bachelor’s or higher degree or its equivalent. Second, an applicant must hold an unrestricted license, registration or certification which gives authorization to fully practice the specialty occupation and be engaged in that specialty in the state of intended employment. Lastly, an applicant must have education, training or progressively responsible experience in the specialty that is equivalent to the completion of such a degree and have recognition of expertise in the specialty through progressively responsible positions directly related to the specialty. It is also necessary that the intended employment meet specific criteria to qualify under the H-1B program. One challenging aspect of the H-1B category is that it is subject to an annual numerical limit cap. However, there are certain circumstances under which applicants are exempt from this cap. Some employers are cap-exempt under […]
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Schedule A Nurses and Physical Therapists: A Fast Track to an Employment-based Green Card

Foreign nationals looking to obtain a green card to immigrate to the U.S. who work as either nurses or physical therapists may qualify for a special form of expedited processing. As a result of significant shortages of U.S. workers, the Department of Labor (DOL) established nurses and physical therapists as Schedule A shortage occupations. Schedule A is a list of pre-certified occupations that the DOL has determined that there are not sufficient U.S. workers who are able, willing, qualified and available. This allows foreign nationals to skip the lengthy labor certification process which tests the job market and start working in the U.S. sooner. In order to take advantage of the Schedule A classification, workers in these occupations must have a full-time job offer from an employer. Both nurses and physical therapists must provide proof of licensing or certification qualifications. Employers are responsible for completing the Immigrant Petition for Alien Worker as well as a completed, but uncertified Program Electronic Review Management (PERM) labor certification petition. Furthermore, parties must comply with DOL rules throughout the process.  Process Overview Step One: Prevailing Wage Determination and Notice of Filing A Prevailing Wage Determination must be prepared and filed with the DOL. The […]
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TN Options for Healthcare Industries

There are various visa and employment authorization options available for healthcare professionals wishing to gain employment in the United States. The TN nonimmigrant classification provides a convenient option for Canadian and Mexican healthcare professionals. Under the North American Free Trade Agreement (NAFTA), the United States, Canada and Mexico share special economic and trade relationships. TN work authorization was created under this agreement. According to NAFTA, the TN classification includes various jobs in the healthcare industry including: dentists; dietitians; medical technologists; nutritionists; occupational therapists; pharmacists; physicians; physical therapists; psychologists; recreational therapists; and registered nurses. Only professions specifically listed under NAFTA are eligible for TN classification. Canadian and Mexican citizens who fulfill the requirements for a TN may be authorized to work in the U.S. for up to three years, with the option to apply for extensions. In addition, the spouse and any dependents of the TN holder are permitted to live and study in the U.S. for the duration of the principals’ stay. It is important to note that there are various restrictions on these professions under TN classification. Importantly, a physician may only teach and conduct research while on a TN visa; clinical work is not permitted. Generally, TN work […]
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What is VisaScreen and Do You Need It to Get Your Visa?

If you’re a healthcare professional looking to work in the U.S., you should be sure to familiarize yourself with VisaScreen. VisaScreen: Visa Credentials Assessment Service is a comprehensive screening service for healthcare professionals.  Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) of 1996 requires specific health care professionals to complete a screening program before they can receive their occupational visa. The Department of Homeland Security issued a regulation, effective July 25, 2003, which implements the VisaScreen certification requirement for immigrant and nonimmigrant health care workers. This screening process is required to be completed before a foreign national healthcare worker can receive either a permanent or temporary employment visa, including Trade NAFTA status. VisaScreen is applicable for registered nurses, licensed practical or vocation nurses, physical therapists, occupational therapists, physician assistants, audiologists, speech language pathologists, clinical laboratory technicians (medical laboratory technicians) and clinical laboratory scientists (medical laboratory scientists). The screening process is comprised of an educational analysis, licensure validation, English language proficiency assessment, and for registered nurses only, an exam of nursing knowledge. Once all elements of the assessment are successfully completed, you will receive a VisaScreen certificate. The VisaScreen certificate satisfies U.S. Federal Screening requirements. This certificate […]
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