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 Immigration FAQ for Canadian Physicians

Following are several questions Canadian physicians frequently ask about U.S. immigration laws. NewPhysician is not a law firm and does not offer legal advice. If you wish to speak with a national expert in this field, please access www.shusterman.com, the web site of Carl Shusterman. Mr. Shusterman is a leading practitioner of health care related immigration law. He can be reached at 213-623-4592.

What Do Canadian Trained Physicians Need To Do To Practice In The U.S.?

Physicians who completed medical school and residency in Canada have several options when it comes to practicing in the U.S.

One option Canadian physicians can pursue is to obtain a temporary "H-1B visa." This type of visa is reserved for professionals and is good for up to six years. The advantage of the H-1B is that it usually can be obtained fairly quickly (see below).

To qualify for an H-1B, Canadian physicians must receive an offer of employment from a U.S. based medical group, hospital, or other employer. An initial step, then, is securing a job offer in the U.S. Of course, Canadian physicians also can immigrate to the U.S. through a family relationship with a U.S. citizen or green card holder or through marriage to a U.S. citizen or green card holder. We are only concerned here with "employment based" immigration, however, not "family based" immigration.

Do Canadian Physicians Need A U.S. Qualifying Exam To Obtain An H-1B Visa?

Yes. Canadian trained physicians need to have completed one of the following exams to qualify for an H-1B.

*USMLE *FLEX *NBME

Why Are H-1B Visas a Good Option?

During the high tech boom of the 1990s, H-1B visas were quickly snatched up by computer professionals, and the annual quota of 195,000 was rapidly filled. Waiting lines developed to get H-1Bs, and it took many months for Canadian physicians to obtain H-1B visas.

Now, however, H-1Bs are much easier to come by. The line for H-1Bs has gotten shorter because 1) the high tech bust has reduced the number of computer professionals seeking H-1Bs, and 2) the Immigration and Naturalization Service (INS) recently introduced a system called Premium Processing. Under this system, the INS guarantees a two-week processing time on H-1B petitions, with the payment of a $1,000 "premium." This premium, and most other immigration expenses, are usually paid by the employer.

Does This Mean Canadian Physicians Can Obtain An H-1B In Two Weeks?

No. Before an "H-1B petition" can be submitted, the physician has to obtain a license in the state in which he or she will be employed. Also, there is preliminary paperwork that the employer must complete prior to submitting the H-1B petition. The employer must attest that the physician will be paid the prevailing wage and that the physician is not being brought in to break a strike.

What it does mean, though, is that Canadian physicians who have a U.S. exam can get an H-1B in a matter of 2 or 3 months, provided there are not hold ups due to licensure. It should be noted, however, that Congress is reexamining the annual quota of H-1B visas that will be allowed. The 195,000 quota may be reduced next year, which could lengthen the time in takes for Canadian physicians to obtain an H-1B.

For now, however, H-1Bs represent a very good option for Canadian physicians seeking to immigrate to the U.S. because neither they nor the U.S. employer has to wait very long.

What Happens When The H-1B Expires?

While the H-1B is a temporary visa good for up to six years, holders of this visa can elect to "adjust their status" while they are on an H-1B to "permanent resident." A permanent resident or green card holder may stay in the U.S. indefinitely. The physician is sponsored by their employer for a green card and the employer must demonstrate to the government that no U.S. physician is able and willing to take the position. This process can take some time, but generally can be completed within about two years.

Do Physicians On H-1B's Have To Remain With Their Employers?

No. A physician on an H-1B can accept an offer of employment from another U.S. based employer. However, the employer will have to file a separate H-1B petition. In addition, the physician can only remain in H-1B status for six years consecutively, regardless of how many times they switch employers.

Physicians do have to stay with their employer to obtain a green card for most of the processing period, but not all of it. If you are on an H-1B and your employer files for a green card on your behalf, you must stay with that employer for most of the time it takes for the green card to come through, which may be three to four years. This provides some security to the employer because the physician is locked in for at least the short term. Once the physician obtains a green card, he or she has an unrestricted right to employment.

Do Canadians Have To Have a U.S. Exam To Get a Green Card?

Interestingly, Canadian physicians do need a U.S. exam to qualify for a temporary H-1B visa, but they do not need one to qualify for a green card. It is a strange quirk in U.S. immigration policy, but the threshold is higher for Canadian physicians seeking temporary status than it is for a physician seeking permanent status.

The main requirement for Canadian physicians seeking an employment based green card is that they be licensed in the state where they will be employed. Over 40 states consider the Canadian exam (LMCC) to be the equivalent of the USMLE or other U.S. exams. Therefore, Canadian physicians can get licensed in most states without taking a U.S. exam.

The drawback to this method, however, is that it takes longer than applying for an H-1B. Depending on the state of employment, it can take a year or more for Canadian physicians to obtain a green card. This may be longer than some physicians or potential employers wish to wait.

The most desirable Canadian candidates from a U.S. employer's point of view are those who have a U.S. exam. There are some employers, however, who have long-term needs and are willing to wait. Canadian physicians without a U.S. exam are best served by finding potential employers in the U.S. who are willing to work through the immigration process.

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