Visa Options for Doctors

(This revised article was previously published in INDIA New England News, Entrepreneurs’ Resource Guide, September 15, 2002.)

Trends in visa options for doctors are difficult to predict due to the continuing debate over whether there is a surplus or shortage of physicians in the country.  A surplus of physicians is resisted (especially by organizations representing the existing physician workforce) because studies indicate this could lead to increased health expenditures, a depletion in physicians’ salaries, and a negative impact on the economy.  However, the debate is being increasingly dominated by more recent studies indicating a looming physician shortage crisis, and by consumer complaints.  Representations referring to the ‘shortage’ can lend support to an application for any of the number of visa options which are available to doctors.  There follows a general overview of temporary visa options for doctors.

The H-1B Category for Specialty Occupations

The H-1B category applies to persons qualified to perform services in “specialty occupations”.  This covers alien physicians seeking to enter the United States in order to teach or conduct research, to practice clinical medicine, or to obtain graduate medical training.  It is possible to obtain H-1B status for a residency or training position, but the employer will need to meet all the complex requirements of this category.  If the physician wishes to engage primarily in patient care s/he will need to pass Steps 1, 2 and 3 of the USMLE (United States Medical Licensing Exam).  This is an additional federally mandated requirement for physicians in the H-1B category.  It may not be a requirement of the state’s licensing standards (usually Steps 1 and 2).  The exam requirements do not apply to a graduate of a U.S. medical school, or a physician of national or international renown.  The other requirements specific to direct patient care are: passing the ECFMG English language proficiency test; a license to practice medicine in a foreign state or graduation from a medical school in a foreign state; and a license or other authorization required by the state of intended employment (if the state requires it).

The J-1 Category for Exchange Visitors

This is a broad category and includes students, trainees, professors, research scholars, and medical residents.  For medical training and residency programs only the ECFMG (Educational Commission for Foreign Medical Graduates) can provide sponsorship.  The US Department of State has restrictions on sponsoring a change from academic/research J-1 status to clinical J-1 status, but it is not impossible to do this.  In obtaining J-1 status, the physician may become subject to the infamous two year home residence obligation.  This restriction (referred to as “Section 212(e)”) may be noted in the passport or on the J-1 certificate of eligibility (Form DS-2019).  The two year restriction may not always apply.  Seek advice in this respect because sometimes these restrictions are notated on passports incorrectly.  It may be possible to persuade the USCIS that the restriction does not apply.  A waiver of the two year restriction can be obtained if a recommendation is made by a U.S. interested government agency, or if the physician works for three or more years in an area designated as having a shortage of primary health care professionals.  Other waiver categories may be applicable.

The O-1 Category for Aliens of Extraordinary Ability

The O-1 category is for aliens of extraordinary ability in the sciences, arts, education, business or athletics.  This category is often confused with the green card category for aliens of extraordinary ability which can be self-sponsored.  The physician will need an employer to petition for the O-1.  Representations to the USCIS in this category can be very interesting for all parties to work on as alien physicians of this caliber have varied backgrounds.  Some of the criteria include scientific, scholarly, or business-related contributions of major significance in the field, authorship of scholarly articles in the field, and receipt of nationally or internationally recognized prizes or awards for excellence in the field of endeavor.  You do not need a “Nobel Prize”!  The main caveat here is that there may be additional scrutiny from the USCIS if this category is being used for a residency or a training position.  In this case emphasize that the physician will be working in his/her field of extraordinary ability.

Other Categories

Other categories include B-1 (business visitor), E-2 (investor), F-1 (student), TN (Trade NAFTA), depending on what the physician is coming to do in the United States.  The B-1 category has been the subject of many changes and revisions recently.  In certain circumstances a student at a foreign medical school may come to the US in B-1 status to take an elective clerkship at a U.S. medical school affiliated hospital as part of the foreign medical school’s education program.  Proposed USCIS rules will regulate the acceptance of honoraria by B visitors.  Other changes have been in response to security concerns.  Canadians and Mexicans may qualify for TN status as an alternative to the H-1B category.  This has some advantages, however, physicians entering in TN status are limited to teaching and/or research and only incidental patient care is permitted.  This rule applies even if the TN physician graduated from a US medical school.

The application of immigration law to physicians is becoming increasingly specialized, and therefore once you have an idea of the general options it is always best to seek the advice of an expert in this area.