Temporary and Permanent Visa Options for Physicians and Nurses
According to the American Association of Medical Colleges, “the US could see an estimated shortage of between 37,800 and 124,000 physicians by 2034. Similarly, the American Association of Colleges of Nursing projects that the U.S. will “experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows” through 2030. Foreign born physicians and nurses are critical to ensuring the health care system in the US can provide Americans with the best care available in the coming years. Then following information provides a basic overview of possible options for sponsoring physicians and nurses in temporary and permanent employment. For more information, please contact us.
Foreign physicians and International Medical Graduates (IMGs) are eligible for J-1 exchange visitor visas to participate in US graduate medical education programs or training at accredited US schools of medicine in a clinical or non-clinical setting. Physicians must pass required testing administered by the Educational Commission on Foreign Medical Graduates (ECFMG) and provide a statement of need for US training from their country of nationality. A foreign physician may also qualify for a J-1 as a professor or research scholar if they are not working as a practitioner.
As a J-1 recipient, physicians may be subject to a 2-year foreign residency requirement prohibiting them from changing status to H or L, or adjusting to permanent resident status, before returning to their home country for two years after their J-1 program ends. However, foreign medical graduates who obtained J-1 status to pursue graduate medical training or education may request a waiver of this requirement based on the request of a designated state public health department or its equivalent. This is known as the Conrad State 30 waiver program. Waiver applicants must have: (1) a full-time offer of employment at a health care facility in a designated “health care professional shortage area” or a facility which serves patients from such a designated area; (2) agree to begin employment at that facility within 90 days of receiving the waiver; and (3) sign a minimum 3-year work contract. Each state’s public health department can request 30 waivers per federal fiscal year.
Foreign physicians are permitted to come to the US on H-1B visas to perform medical services if the physician has been invited by a public or nonprofit private educational or research institution or agency in the US to teach, conduct research, or both, at the institution or agency, or, if coming as a clinical physician, meets the following requirements:
- Has passed the licensing examination administered by the Federation for State Medical Boards of the US or an equivalent recognized test credential examination as determined by the Secretary of Health and Human Services;
- Has competency in oral and written English by passing the English language proficiency test given by the ECFMG or is a graduate of a school of medicine accredited by a body approved for the purpose by the Secretary of Education; and
- Possesses ECFMG Certification unless a graduate of an accredited medical school in the US, or is of national or international renown.
Foreign physicians must also possess an M.D. or license to practice medicine from a foreign state or must have graduated from a medical school in the US or in a foreign state and, if providing direct patient care, have a medical license or other authorization to practice medicine required by the state of intended employment.
The H-1B may also be granted for residency programs.
Physicians may enter under TN status, which is reserved for nationals of Canada or Mexico under the USMCA trade agreement. TN physicians may do research or teach with incidental patient care, but may not practice medicine. They must possess an M.D. or Doctor en Medicina, or a sate/provincial license. IMGs may not enter in TN status to perform medical services.
The O-1A visa is for nonimmigrants who possess extraordinary ability in several areas including medical science. Physicians who have gained substantial national or international acclaim in their field of practice may provide evidence of publications, publicity, critical employment, and significant contributions to the field, among other criteria, to be deemed qualified for the O-1A visa. Further the O-1A visa may still be issued regardless of whether a prior J-1 visa holder has fulfilled their 2 year home residency requirement.
IMGs are generally precluded from entering the US as immigrants to work in the medical profession unless they possess a certification form the ECFMG or equivalent, are a doctor of national or international renown, a graduate of an accredited medical school in the US, or are entering to work in an area other than medical practice.
Physicians may qualify for an immigrant visa under the EB-2 visa preference category if they possess the equivalent of a US medical degree and the position requires as much, they meet the minimum requirements of the position, and they have overcome the unqualified physician provision of the INA which includes proof of passing the US Medical Licensing Examination (USMLE). Physicians must also possess state licensure at the time of filing of the Labor Certification, and possess ECFMG Certification unless they have gone to an accredited school.
Physicians may be eligible to skip the Labor Certification requirement if they qualify for the Physician National Interest Waiver (PNIW) which requires that they work in a health shortage area, or the VA, and that their work is deemed by a federal agency or public health department as in the public interest, for an aggregate of 5 years (not including time spent on J-1). If visa numbers are available, a physician may submit an I-485 adjustment of status petition concurrently, but it will not be approved until the 5-year requirement is met.
To qualify for an H-1B temporary employment visa, the foreign national must be filling a position that qualifies as a specialty occupation, meaning that the position requires a US bachelor’s degree or equivalent, and the foreign national must possesses a US bachelor’s degree or the foreign equivalent.
While many registered nurse positions do not require a bachelor’s degree or equivalent in nursing, the petitioner may still be able to establish that the position is a specialty occupation if the nursing position is advanced. For example, Advance Practice Registered Nurses (APRN), who obtain an advanced level of education and training required for certification, certified nurse midwifes, certified nurse specialists, and certified nurse practitioners. Additionally, nurses in specific areas such as addiction, cardiovascular, critical care, emergency room, genetics, oncology, pediatrics, and other areas where a nurse may not work directly with patients but must have an active RN license may qualify as specialty occupations as well.
When determining if a position qualifies as a specialty occupation, USCIS will weigh a number of factors including (1) the nature of the petitioner’s business; (2) industry practices; (3) a detailed description of the duties to be performed; (4) advanced certification requirements; (4) ANCC Magnet Recognized status; (5) clinical experience requirements; (6) training in the specialty requirements; and (7) wage rate relative to others within the occupation.
Nurses must also pass the foreign nurses exam (NCLEX-RN) and obtain state licensure. In some cases, USCIS will approve an H-1B without licensure if the state or local authority requires proof of lawful employment before granting a license. In this case, the H-1B approval will only be valid for 1 year, and the license must be obtained before an extension request may be granted.
The H-3 visa allows for noncitizens to temporarily enter the US as trainees for up to 2 years to receive training in any field, other than graduate medical education or training, that is not available in their home country. The trainee must be invited by an individual or organization, which must demonstrate that the training is not available in the trainee’s home country, they will not be placed in a position which is in the normal operation of the business, they will not engage in productive employment, and they will receive training that will benefit them in pursuing a career outside of the US.
Nursing students may enter the US for educational training as F-1 students. After completing their studies, they may be eligible for Optional Practical Training (OPT) for one year of employment related to their area of study.
Canadian and Mexican nationals may be eligible for a TN visa as a registered nurse. Applicants must possess a State/provincial license, or licenciatura degree to qualify.
Registered Nurses are eligible for EB-3 immigrant visa preference category, and may file both a Form 9089 (PERM Labor Certification) and Form I-140 directly with USCIS under the Schedule A, Group 1 designation. This can significantly reduce the typical processing time for obtaining a green card, as external advertisement and Department of Labor certification is not required. Nurses must still obtain relevant state licenses before submitting the applications. If visa numbers are available, a concurrent Form I-485 may also be filed if the nurse is present in the US.
Nurses (licensed practical nurses, licensed vocational nurses, and registered nurses) must obtain a Healthcare Worker Certificate (VisaScreen), provided by the Council of Graduates of Foreign Nursing Schools (CGFNS), or an equivalent certified independent credentialing agency, whether their education was completed abroad or in the US. This applies to nurses engaged in clinical and supervisory work, but not those operating in a non-clinical capacity, such as teachers, researchers, and managers of healthcare facilities, those receiving training under F, J, or H-3, spouses and dependents, and persons obtaining AOS or IV under family-based on employment-based petitions not involving direct medical care, refugee adjustment, registry, cancellation, or legalization.
If you are interested in learning more about visa options for medical professionals, please contact us today.