1. Introduction to Physician Immigration

2. Business Immigration Paralegal - Physician Immigration
Christopher J. Brelje Immigration Attorney Rachel Bus
Kerri Smith
Business Immigration Paralegal - Physician Immigration
3080 N. Litchfield Road
Goodyear, Arizona
(623)
Chris: ext. 104
Rachel: ext. 102
Kerri: ext. 105

3. Immigration Terminology
US Citizen:
Native born
Naturalized/Acquired Under CCA
Foreign Nationals (Two Categories):
Immigrant:
Legal Permanent Resident (“LPR” or “green card”)
Conditional LPR (marriage to USC or EB-5 case)
Non-Immigrant:
Work status (e.g. H-1B, L-1, TN, etc.)
Non-work status (e.g. B-1/B-2 visitor)
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4. Immigration Terminology
Visa: A document issued by the U.S. Department of State (DOS) through a US Embassy or Consular Post outside the US and placed in a foreign national’s passport
Status: An immigrant or non-immigrant classification given by the U.S. Department of Homeland Security (DHS) at the time of entry as evidenced by an I-94 card or similar document or database entry
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5. Visa Example
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6. Sample Electronic and Paper I-94s
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7. Common “Non-Immigrant” Employment Classifications
J-1: exchange visitor
H-1B: specialty occupation (professional)
H-2B: temporary/seasonal workers
L-1: intracompany transferee
TN: specific occupations under NAFTA
O-1: individual of extraordinary ability
OPT: optional practical training for students
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8. Two Most Common Hiring Paths for Foreign Medical Graduates Completing Medical ResidencyJ - 1
IGA J-1 Waiver
Exempt from H
1B Cap 1B
(must work in underserved
area)
(never been i
n J
status )
Plan A: consular
processing
Previously
Counted
against cap?
(no location restriction) No
Yes
October 1 start date
Cap
Subject
Filing
Plan B: bridge strategy
Exempt from Cap or
“at” argument
exempt filing
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9. J-1 Exchange Visitors
An Exchange Visitor visa is for those participating in an approved Exchange Program to study, research, teach, or receive graduate medical training
Department of State determines employment entities that can act as Exchange Sponsors
Employment is authorized only under the specific terms of the Exchange Program
Most foreign nationals must satisfy a 2-year home residency requirement upon completion of the J-1 program
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10. J-1 Exchange Visitors - Waivers
IGA waiver of the 2-year home residency requirement (Physicians only)
Requires the recommendation of an Interested Government Agency, plus:
Arrangement to be employed full-time in H-1B status in a medically underserved area
Obtaining a No Objection letter from his or her home country (if J-1 program funded by the government)
Agreement to begin employment within 90 days of the receipt of the waiver
Obtaining sponsorship from State Health Dept. or other Interested Government Agency
Waiver of the 2-year home residency requirement (Available to all)
Establish exceptional hardship to US citizen or Permanent Resident family member; or
Probable persecution (based on race, religion, etc.)
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11. Essentials of H-1B Status
Limited to jobs that require at least a Bachelor’s Degree
Foreign national can qualify with a foreign degree deemed equivalent to a U.S. Bachelor degree or a combination of post-secondary education and work experience
Prevailing Wage requirement
Six-year maximum
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12. H-1B Cap 65,000 Annual limit for new H-1B visas
Additional 20,000 for Master’s degree or higher from U.S. University
High demand results in a lottery
Applications must be filed in the first week of April
Employment begins no earlier than October 1 for an initial period of up to 3 years
Law Offices of Brelje and Associates (623)

13. H-1B Cap Alternatives Cap-Exempt Employment Permanent Residency
J-1 Fellowships
O-1: Aliens of Extraordinary Ability
E-2 Entrepreneur
H-1B1 & E-3 (only available to nationals of Chile, Australia, and Singapore)
TN NAFTA (only available to citizens of Mexico and Canada and only for physicians in teaching or research positions)
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14. Cap Exemption
Employed by Institute of Higher Education, Government Research Organization; or Related or Affiliated Nonprofit Entity
Must demonstrate “active, working relationship” if relying on affiliation with institute of higher education and must demonstrate that one of the nonprofit entity’s “fundamental activities” directly contributes to research or the educational mission of the government research organization/institute of higher education.
Employed “at” Institute of Higher Education, Government Research Organization; or Related or Affiliated Nonprofit Entity
Physician must spend majority of time at the qualifying entity and the work performed must directly and predominately further the normal, primary or essential purpose, mission, objective or function of the institution. 
J-1 IGA waivered physicians are exempted from the cap
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15. Transition from Cap-Exempt to Cap-Subject Employment
“Concurrent Employment”
Must be working for cap-exempt employer at the time of filing
Subsequent Cap-Subject petition
H-1B Portability
Timing Considerations & Risks
B-1 Bridge or J-1 Extension
Consular Processing
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16. Moonlighting & Concurrent Employment
No Cap considerations
Requires H-1B petition by 2nd employer noting concurrent employer
Employment Contract considerations
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17. Pathways to employment based permanent residence “green card”
Nonimmigrant Visa
EB-1 I-140, NIW I-140
PERM Labor Certification
EB-2 I-140
Green Card Application
STEP 1
STEP 2
STEP 3
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18. PERM Based I-140 Immigrant Visa Petition
The PERM Labor Certification process includes:
Filing a Prevailing Wage request with Dept. of Labor (Form ETA-9141),
Testing the U.S. labor market through Recruitment, and
Filing the PERM Certification with Dept. of Labor (Form ETA- 9089)
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19. Physician National Interest Waiver EB-2 I-140
An alternative to PERM for qualified physicians
A PERM Labor Certification is not required, similar to EB-1
Requirements for PNIW include:
Five-year commitment to the underserved area
Employment agreement covering a full five years of employment
Support from the State Health Agency or Interested Government Agency (e.g. Department of Veterans Affairs)
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20. QUESTIONS?
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