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Recruiting & Candidate Development

Immigration Reform Bill Would Make It Easier to Recruit International Physicians

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Each day, thousands of professionals who specialize in recruiting physicians for hospitals, medical groups, community health centers and other organizations wonder if there is anything that could make their jobs easier.

This is not because they are looking for a free ride. It is because with the doctor shortage becoming more severe, finding physicians has become one of the most challenging tasks in healthcare today.

Fortunately, there is some good news.

The pending Comprehensive Immigration Reform bill (S.744) would make significant and far reaching changes in the laws governing the immigration of internationally-born physicians to the United States. There would be beneficial changes to both the J waiver program and H-1B status. As an added bonus, the path to a green card for international physicians would be easier and faster. The net result would be more opportunities for internationally trained physicians and a significantly smoother path for recruiters who assist in the on-boarding process.

J-1 Status

Many internationally-born physicians obtain J-1 status to complete their graduate medical education in the United States. Upon completion of their residency training, these physicians must either return to their countries of origin for two years or obtain a waiver of this requirement, usually through sponsorship by an “interested government agency.”

Sponsorship is usually conditional upon the physician agreeing to practice for three years or more in a medically underserved area. Prior to 1994, only Federal agencies could sponsor internationally-born physicians for J waivers. In that year, Senator Kent Conrad of North Dakota introduced a bill that was signed into law which permitted States to sponsor 20 physicians per year for J waivers. This program has since been extended numerous times, usually for 2 or 3 years at a time. In 2002, the number of J waivers under the Conrad program was increased to 30 per state.

Proposed Changes to the J Visas and Waivers

The pending legislation would make the Conrad program a permanent part of the immigration law.

J status for internationally-born physicians completing medical residencies/fellowships would be classified as a “dual intent” status, similar to H-1Bs and L-1s. A physician could no longer be denied J status on the ground that he or she did not intend to return to his country of origin. Spouses and children of J-1 physicians would no longer be subject to the two-year home residency requirement.

The number of Conrad waivers available to a state could be raised in increments of five depending on the usage of waivers in various states during the previous year. In addition, the number of J waivers available to physicians working in academic medical centers outside of medically underserved areas could be raised under certain conditions.

Physicians who received J waivers would no longer be required to work in H-1B status, but could work in any immigration status for which employment is authorized.

If a physician’s J waiver were denied under the Conrad program because the state had used up all of its slots for the year, the physician could obtain a six-month work permit if he or she agreed to seek a J waiver from a state which has not used all of its J waivers.  After that, the physician could extend his or her work permit from the time that the employer in the new state filed a Conrad waiver until the DHS either granted a change of status or denied the waiver application.

If a J waiver physician’s employment terminated before completion of the three-year period, he or she would not be considered to be out-of-status. Instead, the physician would be given 120 days to locate a new job in a medically underserved area and for his or her new employer to submit a petition for employment authorization on the physician’s behalf.

Proposed Changes to H-1Bs and Green Cards

Where a physician completes his or her residency/fellowship in cap-exempt H-1B status, and an employer has submitted a cap-subject H-1B petition on his behalf, his H-1B status would automatically be extended to October 1 so that the physician does not become out-of-status or unemployable between July and October. However, if the physician’s H-1B petition is rejected, denied or revoked, his or her status and employment authorization would terminate after 30 days.

Physicians who qualify for National Interest Waivers (NIWs) by completing the five-year service requirement in a medically-underserved area or for the Veterans Administration would be granted green cards without regard to numerical limitations. This would occur whether a physician completed the five-year requirement before or after the enactment of the CIR bill.

The spouse and children of a physician would also be exempt from numerical caps whether the physician obtains a green card through an NIW or through PERM.

In a significant move, per-country limitations would be eliminated for the employment-based green card categories. This would dramatically reduce the time that it currently takes physicians born in India to qualify for green cards.

All of these changes would make it considerably easier for internationally trained physicians to work and live in the United States, and easier for physician recruiters to do their jobs.




Carl Shusterman is the managing attorney of Law Offices of Carl Shusterman based in Los Angeles, CA. He has specialized in immigration law for over 30 years and his six-attorney law firm represents clients in all 50 states. Mr. Shusterman is a 1973 graduate of the UCLA School of Law. He served as an attorney for the U.S. Immigration and Naturalization Service (INS) until 1982 when he entered private practice. He is authorized to practice before the Supreme Court of California, the Federal District Court in the Central District of California, the U.S. Court of Appeals in a number of different circuits and the Supreme Court of the United States.

Mr. Shusterman is a former chairman of the American Immigration Lawyers Association (AILA), Southern California Chapter and served as a member of AILA\'s National Board of Governors (1988-97). He has chaired numerous AILA Committees, spoken at dozens of AILA Conferences and has contributed a number of scholarly articles to AILA\'s publications. Mr. Shusterman is a Certified Specialist in Immigration and Nationality Law, State Bar of California. He has served as a member of the Immigration and Nationality Law Advisory Commission for the State Bar.

He has been named as one of Best Attorneys in America and as a SuperLawyer for many years. He is a frequent writer and lecturer on immigration law. Mr. Shusterman has testified as an expert witness before the Senate Subcommittee on Immigration in Washington, D.C. His website,, receives over 1,000,000 hits each week, and his free, e-mail newsletter has over 60,000 subscribers in more than 150 countries.

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