Physicians
Labor Certification for Physicians
Immigration based on an employment offer as a physician must also include labor certification from the Department of Labor, unless exempted from that requirement. To obtain labor certification the physician must have a state license in the state where the labor certification is filed at the time it is filed or must be able to obtain license within a proximate time of the person's entry. The Labor Certification process is explained elsewhere on this website.
Immigration Under the National Interest Waiver for Physicians in Underserved Areas
Physicians working in medically underserved areas qualify for national interest waivers of the requirement for labor certification, making the process smoother, time-saving, and more predictable.
To obtain the benefit of this law:
(1) The physician must agree to work full-time in a Health and Human Services Department (HHS)-designated underserved area or a Department of Veterans Affairs (VA) facility;
(2) A federal agency or state public health department has to determine that the work is in the public interest;
(3) The physician must work full-time for an aggregate of 5 years (not including time on J-1) before he or she is eligible for Adjustment
of Status or Immigrant Visa, and
(4) the 5 years must be completed within a 6 year period from the time the person is employment authorized, or if already employment authorized from the time of the approval of the worker petition.
To support a national interest waiver a physician must submit:
(1) a contract of employment or if self-employed an attestation;
(2) evidence of employment in a health shortage area or Veterans Administration and in a designated speciality by HHS for the HPSA;
(3) a letter dated within six months of filing the petition from a federal agency or from the department of public health of the State attesting that the physician's work is in the public interest;
(4) evidence that the physician meets the admissibility requirements of Immigration and Nationality Act ยง212(a)(5)(B) regarding USMLE; and
(5) evidence of a waiver of the two-year home residence requirement for a non-immigrant J-1, who under an exchange program must return to their home country for two years prior to applying for permanet residence, if applicable.
The National Interest Waivers for physicians are limited to those practicing in family or general medicine, pediatrics, general internal medicine, obstetrics/gynecology, and psychiatry.
The national interest waiver for physicians in underserved areas relieves the
petitioner only from the labor certification process. If you are:
- A petitioner requesting a national interest waiver on behalf of a qualified alien physician, or
- An alien physician self-petitioning for second preference classification,
based on medical service in a Health and Human Services Department-designated underserved area or a Department of Veterans Affairs facility, you still must meet all eligibility requirements for this immigrant classification in order to be eligible for the national interest waiver.
Other Alternatives for Physicians:
H-1B Visas for Physicians
A foreign physician may now enter the U.S. under certain conditions to practice medicine with an H-1B visa.
Current regulations permit a graduate of a medical school who is coming to the U.S. to perform services as a member of the medical profession, if:
She or he is coming pursuant to an invitation from a public or nonprofit private educational or research institution or agency in the U.S. to teach or conduct research, or both, at or for such institution or agency (physician may do incidental patient care);
or has complied with each of the following:
(1) Has passed the Federation licensing examination (administered by the Federation of State Medical Boards of the United States) or an equivalent examination as determined by the Secretary of Health and Human Services. Parts 1 & 2 of FLEX (Federation Licensing Examination), and Steps 1, 2 &3 of the NBME (National Board of Medical Examiners) have been replaced by Steps 1, 2 and 3 of the USMLE (United States Medical Licensing Examination). and
(2) Has competency in oral and written English, as demonstrated by passage of the English language proficiency test given by ECFMG (Educational Commission for Foreign Medical Graduates), or is a graduate of a school of medicine which is accredited by a body or bodies approved for the purpose by the Secretary of Education (regardless whether the school of medicine is in the United States).
The ECFMG certification is required for all foreign physicians as a prerequisite for entering medical training programs in the United States. Applicants must pass four examinations for ECFMG certification: USMLE Steps 1 & 2 (or its equivalent), TOEFL (Test of English as a Foreign Language) and Cas (Clinical Skills Assessment). Candidates need only take USMLE Step 1 and TOEFL prior to taking the Cas exam.
Foreign physicians seeking H-1B status must also:
(1) Have a license to practice medicine from a foreign state, or have graduated from a medical school in the United States or in a foreign state, and
(2) If she or he will provide direct patient care, they must also have a medical license or other authorization to practice medicine required by the state of intended employment.
J-1 Visa The J-1 Visa allows a physician who is entering U.S. to participate in an exchange visitor program that has been designated by the DOS (formerly U.S. Information Agency); and whose participation includes such purposes as teaching, studying, observing, conducting research, consulting, receiving training (e.g., student to do post-graduate work; scholars doing research; medical students). Admission may be for up to 18 months for training to several years for a college or university student.
E-2 Visa Physicians as Investors: A foreign physician may invest in a medical practice and obtain an E-2 visa if she or he is from a treaty country and is not involved in patient care.
O-1 Visa
The regulations state that O visas are available to people of "extraordinary ability" working in the sciences, arts, education, business, athletics, or the motion picture and television industries. USCIS policy, however, has interpreted these areas to include any field of endeavor.
Extraordinary ability means distinction, which is defined as prominent, leading, or well-known in the field.
Foreign physicians may enter without the certifying examinations where physician is of national or international renown. Doctors of national or international renown are not within the definition of foreign medical graduates and are therefore exempt from the restriction.