No. Federal sponsoring agencies such as the Appalachian Regional Commission and the Department of Health and Human Services do require physicians to practice primary care or psychiatry in order to obtain a waiver. Some states participating in the Conrad 30 program do not. If you wish to practice as a specialist you will need to find an employer that is both in a HPSA or MUA and that is in a state participating in Conrad 30 and allowing specialists to obtain waivers.

What Happens Once J Physicians Get A Waiver?

They then work in H-1B status for a particular employer for a minimum of three years.

Can IMG's Obtain GME Authorization With Any Kind Of Visa Besides The J-1?

Yes, IMGs can now enter residencies using H-1B Temporary Work Visas. An H-1B is a visa that allows foreign professionals to work in the U.S. for up to six years. The H-1B is an employer sponsored visa. In the case of physicians, the residency program acts as the sponsoring employer. At the end of the six year temporary employment period, H-1B holders must return to their home countries, unless they have obtained permanent residence (a green card) to stay in the U.S.

Can Physicians Training On H-1B's Obtain Employment?

Yes. Once their training is over, the physician can be hired by an employer willing to sponsor the physician for another H-1B. The H-1B, is then "transferable" from one employer (the residency program) to another.

However, the physician must be able to obtain a green card before his H-1B expires. Even if the physician works for multiple employers, the H-1B is only good for six consecutive years.

Isn't There A Quota On H-1B Visas?

There is a national limit of 195,000 H-1B visas per year, and high tech workers used to get most of them. However, since high tech is no longer using as many H-1B visas, more are available for health care and wait times to get them are shorter. Also, there is a new program called Premium Processing that, for a fee of $1,000, guarantees a return of the H-1B petition in two weeks. Combined with the preliminary paperwork involved, turnaround time for H-1Bs using Premium Processing is only about 6-10 weeks.

Keep in mind, however, that Congress will revisit the issue of the H-1B quota soon. The 195,000 figure may be kept, or the quota could be significantly reduced. If it is, processing times could become longer if backlogs develop.

What About Licensure?

Physicians must obtain a license in the state of intended employment before the H-1B petition may be filed.

The usual rule is "licensure plus 60 days" --- that is, once the physician is licensed in the state it takes about two months to get the H-1B. However, with premium processing, this is reduced to "licensure plus 30 days."

What Does It Take To Get A Green Card?

There are several approaches and it can be quite complicated.

However, a standard approach is to go through "Labor Certification." This is a process by which the employer shows that it has tried to hire a U.S. citizen for the position without success. The employer must advertise the job in a major national publication (usually JAMA), then review all the CVs that come in to make sure that no qualified U.S. applicant is available.

Thanks to inefficiency and mounting backlogs, it can take years for H-1B applicants to obtain a green card.

Another method is through the "national interest waiver." In this method, the employer demonstrates that it has been historically impossible to recruit a physician to the area and that a physician is greatly needed by the service population. This can reduce processing times to less than a year. Here again, the client should be in a HPSA or an MUA, or it may not be able to qualify for a national interest waiver.

IMGs who get green cards through a national interest waiver must stay in their communities for five years.

The IMG also might have a U.S. citizen relative, or he or she may be a medical "superstar" and therefore qualify for a "superstar" (O) visa - but these are rare.

How Long Does It Take To Get A Green Card?

There are four Immigration Service processing centers in the U.S. - so processing times can vary. In the Northeast, they are backlogged for two to three years. As mentioned above, however, with a "national interest waiver," the time can be reduced. With the recent reorganization of the Immigration Service, time frames could be affected, but it is too early to tell yet what affect the reorganization will have.

Is There A Quota On Green Cards?

Yes. Only about 5,000 people from each country can get a green card through employment each year. This creates backlogs for people from countries that have a lot of applicants - in particular, India and China. It would take an Indian or Chinese physician even longer to get a green card than it would for a physician from other countries.

How Do I Avoid An Immigration Meltdown?

If you have an employer interested in sponsoring you for a waiver, be sure to consut with an immigration attorney before you go very far in the process. This way you can ensure you have a clear path to employment and ensure that there will be no surprises. Make sure both you and the employer understand the steps involved, the costs, and the time it will take.