This educational session is designed to take the mystery out of complex immigration rules and provide you with the basic knowledge to successfully place foreign national physicians. Watch and get an in-depth overview of the most common H-1B visa alternatives and strategies that can help you place these physicians faster. Here's a summary of what you can expect to learn: You'll learn about other visa options to hire qualified medical providers now. You'll learn how some employers can avoid the H-1B cap and get H-1B visas year-round through available exemptions (“cap exemptions”) You’ll learn about a certain loophole in the H-1B cap – the concurrent H-1B – that can let private employers You'll learn about green card options as a viable alternative to H-1B visas

1. TOP 6 ALTERNATIVES TO H-1B VISAS
FOR FOREIGN NATIONAL PHYSICIANS
Ann Massey Badmus
Cowles& Thompson, PC

2. WELCOME NCHCR!
Practice Leader
Immigration Section
Cowles & Thompson, PC
www.badmuslaw.com
Ann Massey Badmus
Presenter

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? Questions will be answered
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4. AGENDA
H-1B Visa Overview
Alternative Hiring Options
Alternative Temporary Visa Options
Green Card Options

5. H-1B Visa Overview

6. H-1B Nonimmigrant Visas
A nonimmigrant (temporary) visa that
allows a non-citizen to be employed
in the United States for up to 6 years
in a “specialty occupation” for a
specific employer (“petitioner”).

7. What is a Specialty Occupation?
An occupation that requires
highly skilled specialized
knowledge and
A bachelor’s or higher degree
(or its equivalent) in the specific
specialty as a minimum for entry
into the occupation

8. Employee Qualifications
Have completed a U.S. bachelor’s or higher
degree (or its foreign equivalent) or
Have education, training, or experience in
the specialty equivalent to the completion
of such degree (3:1 rule) and
Possess full state licensure if required to
practice in the state of employment

9. H-1B Numerical Limitations - “H-1B Cap”
Quota of 65,000 new H-1B visas per fiscal
year (except Free Trade Act (FTA)
nationals)
20,000 per fiscal year for persons who
hold US Master’s degrees or higher
Applies to first-time H-1B or previously
cap-exempt H-1B employees

10. Alternatives to Cap-Subject H-1B Visas

11. COMMON REASONS TO LOOK FOR OTHER OPTIONS
H-1B visa cap application rejected
Too late to apply for H-1B cap visa
H-1B maximum limit of 6 years has been reached
H-1B visa application denied

12. HIRING OPTIONS – CURRENT H-1B PHYSICIANS
H-1B candidates previously counted in the
cap or former J-1 waiver doctors
Remaining time on 6 year maximum period
Check previous H-1B applications for the
physicians
Inside or outside the U.S.
Can apply any time

13. Cap-exempt
employers
Universities and non-profit petitioners affiliated with post-
secondary educational institutions
Government research organizations and non-profit
petitioners affiliated with government research institutions
For-profit employers who place employee at a non-profit,
university-affiliated facility for at least 50% of work week
Cap-exempt
beneficiaries
Physicians who are beneficiaries of J-1 IGA waivers only
(does not include hardship waivers or persecution
waivers)
HIRING OPTIONS – CAP EXEMPTIONS

14. For profit employer
offers part-time
employment to the
provider (ranges from
5 to 60 hours/week)
The start date of the
H-1B must be a date
before the
physician’s cap-
exempt H-1B expires.
Concurrent H-1B
petition is filed and
approved before
current cap-exempt
employment ends.
HIRING OPTIONS – CONCURRENT H-1B

15. Temporary Visa Options – Country Specific
H-1B1 Chile and Singapore
E-3 Australian
TN Trade NAFTA
E-2 Treaty Investor or Trader

16. Nationality – must be citizen of Singapore or Chile
Specialty occupation and other requirements similar to H-1B
Annual quota of 6,800 (1,400 professionals from Chile and
5,400 professionals from Singapore), never reached
18 month period of employment – no limit on extensions and
can change to H-1B if available
Dependent spouses cannot work
H-1B1 Specialty Occupation Professional Visa

17. Nationality – must be citizen of Australia
Specialty occupation and other
requirements similar to H-1B
Annual quota of 10,500, never reached
Two year period of employment – no limit on
extensions
Spouses can work upon USCIS approval
E-3 Specialty Occupation Professional Visa

18. Nationality – must be citizen of Mexico or Canada
Profession must be listed on the NAFTA occupations list -
8 CFR § 214.6 – Physicians – research only with limited clinical
No quota or limit on the number of TN visas each year
Three year period of employment – no limit on extensions
Dependent Spouses cannot work
TN Trade NAFTA Professional Visa

19. Nationality – owner and employee must be citizen of treaty country –
http://travel.state.gov/content/visas/english/fees/treaty.html
Investment must be substantial in a real, operating enterprise – e.g.
medical practice
Treaty investor must have controlling interest (50% or more) in the
company
Independent contractor
Spouses can work with USCIS approval
Treaty Investor (E-2) Visa Program

20. Must show sustained national or international acclaim in
applicant’s field of endeavor
Overall evidence must show applicant has “risen to the top
of the field”
Employer required and expert/peer consultation required
Three year initial period of employment, unlimited extensions
Dependent spouses cannot work
O-1 Extraordinary Ability Visa

21. National or internationally recognized prizes or awards
Membership in organizations requiring outstanding
accomplishments
Published materials in major or professional media about
applicant’s work
Judging the work of others, individually or on a panel
Original contributions of major significance to the field
O-1 Extraordinary Ability Visa (cont)
Must meet three(3)of these criteria:

22. Authorship of scholarly articles
High salary or compensation as compared to others in the
field
Performance in a leading or critical role for distinguished
organizations
Other comparable evidence
O-1 Extraordinary Ability Visa (cont)

23. Temporary Visa Options – Dependent
Spouses
H-4 (H-1B spouse with pending
green card application)
E-2 dependent
E-3 dependent
L-2
J-2 (may require waiver)Employment Authorization Document
(EAD)

24. Green Card Options

25. Employer’s application for specific physician
Employer must show no available and qualified U.S. citizen or
permanent resident physician through local recruitment
Employer must show ability to pay prevailing wage
Employee must be qualified at the time of filing of labor
certification
H-1B alternative: not a good option for doctors from India or
China because of long delays (5 years or more)
EB-2 PERM Labor certification

26. General – applies to any profession if work is in national interest
(physician researchers)
Physician – 5 years medical care in HPSA or MUA – specialties
accepted
Self-sponsored and self-employment possible – job offer not
required
Employment authorization document available while application
is processing, for most applicants
H-1B alternative: not a good option for doctors from
India or China because of long delays (5 years or
more)
EB-2 National Interest Waiver

27. Must show sustained national or international acclaim
in applicant’s field of endeavor
Overall evidence must show applicant has “risen to
the top of the field”
Must show prospective contribution to the United
States
Can be self-sponsored but must show prospective
employment in the U.S
EB-1A Extraordinary Ability
Great option for Indian doctors,
if qualified

28. TIMELINE
Immigrant Visa Number must be
available. There are long visa backlog
delays –
EB-2 doctors from India or China
Employment authorization available
within 4 to 8 months while waiting for
approval (in most cases )
Permanent Residence (green card)
within 1.5 to 3 years for most (subject
to fluctuation)

29. • Facts of each case are different.
• Other options may be available depending
upon employment circumstances.
• The information provided here is general in
nature and should not be relied upon for
specific situations and is not legal advice.
• Consult with an experienced immigration
attorney to get the right advice and
direction.

30. QUESTIONS?

31. THE IMMIGRATION PRESCRIPTION
Step by step, this book will show you how international
medical graduates can legally practice medicine in
the United States. You will learn:
 The various ways to waive the two- year foreign
residency requirement for the J-1 visas
 The best paths to permanent residence (green
card) and citizenship
 Your responsibilities as a legal immigrant
 How to get and maintain legal immigration
status for family members
 And more…!
For your copy and immigration updates, visit
www.physicianimmigration.com

32. FOR FURTHER INFORMATION
Ann Massey Badmus
901 Main Street
Suite 3900
Dallas, Texas 75202
214-672-2161
abadmus@cowlesthompson.com
www.badmuslaw.com