1. Visa Contacts and Process for Graduate Medical Education International Services and Graduate Medical Education Program Coordinator Training 1/12/2017

2. Collaborate to determine best visa options and resolve issues
Who is involved…
Collaborate to determine best visa options and resolve issues
Training Program
GME
International Services (ISO) consulting with the Fragomen law firm as needed.

3. Immigration Options
Visa Considerations for Residency and Beyond – All foreign national physicians need appropriate status to participate in U.S. graduate medical education (this includes foreign national physicians who are U.S. medical school graduates)
Options include:
F-1 OPT
J-1 and less common is the J-2 (spouse would be on a J-1)
H-1B
Permanent residency
Note: The program must determine in advance if it will support H-1B visa applications and apply this policy consistently to all candidates.

4. F-1 OPT
F-1 Optional Practical Training (OPT/EAD) encouraged for the first year out of U.S. university or college in F-1 status (adds 1 year of potential visa sponsorship); Good for 12 months maximum
Must apply before graduation with help from Foreign Student Advisor at F-1 sponsoring university, and have EAD in hand to begin program
Resident must change from F-1 to J-1 or H-1B past PGY 1
H-1B processing can start 6 months prior to expiration of F-1 OPT/EAD.

5. Some distinctions between J-1 and H-1B
J-1 (ECFMG)
H-1B (VUMC)
Cost Responsibility
Resident ($325 plus $180 SEVIS fee for initial application)
Department (fees for new H-1B with can run between $1,900 and $3,500)
Renewal
Annual
USCIS approves H-1Bs up to 3 years. Most residents issued 1 year H-1Bs
Maximum Length
7 years
(9 years with exceptional need approval)
Six years of physical H-1B time in the U.S.
Home Country Requirement
Yes, 2 years unless waiver obtained No
Moonlighting
Not permitted
Internal possible (verify with ISO prior to approval)
Non-ACGME Programs
Only if “non-standard training program application” approved
As long as they have U.S. equivalent of MD degree and completed all parts of USMLE, then permitted
Return Costs
Not required
One-way airline ticket must be offered to the foreign national
Employment of Spouse
J-2 can be employed with EAD
Not authorized in H-4 status
Application
Processed through GME office, fairly quick turnaround for most applications (4-6 weeks) and generally easy process
Processed through ISO (and Fragomen law firm) more lengthy processing
Required
USMLE Step 1, Step 2 (CK/CS), Current ECFMG Certificate
MD degree or foreign equivalent, USMLE Step 1, Step 2 (CK/CS), and Step 3, TN license or qualify as exempt

6. J-1 Visa
Educational Commission for Foreign Medical Graduates (ECFMG) is the sponsor of J-1 physicians.
The J-1 Exchange Visitor visa is a temporary, non-immigrant visa reserved for educational training purposes. (Spouse and children are referred to as J-2 dependents.) Full-time participation in the approved training program is required to maintain J-1 status.
The Training Program Liaison (TPL) with ECFMG for VUMC-GME is Trish Craft and Molly Cole serves as back-up TPL.

7. J-1 Process
Initiate J-1 process by providing to Trish including incoming housestaff name, contact , ECFMG number and start date.
Trish or Molly will initiate contact with the incoming housestaff and copy you.
Due Dates: For “on-cycle” hires for initial or continuation applications by March 24th of the hiring year. Annual process for continuation.

8. J-1 Visa Process
Please provide offer letter signed by the Program Director and accepted by the incoming house staff. Include start and end dates of the appointment year, specialty and sub-specialty of the training program, training level (PGY level) and stipend amount.

9. J-1 Visa Process
If your training program is not an ACGME Accredited program please consult with Trish as this may be a “Non-Standard” Training Program Application to ECFMG and you may need to provide a Training Program Description for the application.

10. J-1 Considerations/Requirements
Strong ties to the home country required with return expected unless waiver obtained (2 year home residency required post training)
Moonlighting not permitted
Medical Insurance – Aetna Select meets requirement
Keep TPL informed of any issue or change which must be reported to ECFMG (travel, serious incidents such as medical concern, missing physician or dependent, safety concerns or allegations such as abuse, charges or arrest, negative press, foreign government involvement, etc.)
Cross-Cultural Activities expected for cultural exchange

11. What is an H-1B? Temporary work status for up to 6 years
An H-1B visa allows an employer to temporarily employ a foreign worker in the U.S. on a non-immigrant basis in a specialty occupation.
Temporary work status for up to 6 years
No foreign residence required; dual intent applies
ISO must file the H-1B petition; prospective employees cannot obtain H-1B visas on their own
Can request up to 3 years at a time
Must depart U.S. for one year to get another 6
Possible exceptions to 6 year limit – consult if needed.

12. H-1B Considerations
Costly, expect that once a case initiation is submitted a fee will be charged to the department. Costs can run $1,900 to $3,500 (with premium processing)
H-1B is employer specific – does not allow for employment outside petitioning employer (no moonlighting outside of petitioning employer)
Per Department of Labor regulation, the H1B worker must be paid the higher of the prevailing wage for the occupation in the area or employment or the actual wage being paid to all other individuals with similar experience/qualifications for the specific employment.
6 year limit is difficult to overcome
Liability for Employer
H-4 Spouses may NOT work

13. Requirements (H-1B)
Materials needed for petition processing training program/department:
Complete Case Initiation Request on ISO website (information you provide on form is used to complete USCIS and DOS forms – must be accurate)
Detailed Job Description – including program length
Copy of Supervising Physicians License (PD)
Verification of license exemption (GME will help obtain)
Materials needed from Resident:
Copies of all educational materials
Copies of USMLE’s and ECFMG certificate
Copies of all previous immigration documents

14. Case Processing Steps Week(s) One – Three:
KEY:
I – Immigration Services
D – Department
E – Employee
Week(s) One – Three:
D. Contact VUMC Immigration Services Office (ISO) with the candidate’s current status and expiration if there are any questions.
D. Gather the information needed for the case initiation form:
Select H-1B for a new employee or a current employee who is not on H-1B
Select H-1B Extension for a current VUMC employee on a H-1B
D. Submit the Case Initiation Form including the Visa Deemed Export Questionnaire (VDEQ) which appears at the end of the form.

15. Online Case Initiation

16. Case Processing Steps
KEY:
I – Immigration Services
D – Department
E – Employee
Week(s) One – Three (cont.):
I. ISO sends VDEQ to VUMC Exports for review and return.
I. ISO sends petition and approved VDEQ to Fragomen for legal processing.
I. ISO log’s case for internal tracking and sends department “Receipt”
Premium Processing is determined by ISO based on the processing times and data collected from the visa case initiation form.

17. Receipt

18. Case Processing Steps Cont.
KEY:
I – Immigration Services
D – Department
E – Employee
Week(s) Four – Seven I. Department Cost Center is charged at the end of the month I/E. Employee completes questionnaire and submits necessary documents requested by Fragomen I. Labor Condition Application (LCA) is prepared and a posting notice is sent to the department via containing instructions D. Posting notice is reviewed and posted in two conspicuous locations for 10 business days LCA is submitted to the Department of Labor for approval - at the end of 10 business days the posting notice is removed and sent to 2525 West End Ave, 5th floor

19. Collection of Information

20. LCA Posting Notice

21. LCA Posting Notice
A six page posting notice can be provided upon request.
Govt. LCA Filing:
Processing takes no less than 7 days, typically averages around 14 days

22. Case Processing Steps Cont.
KEY:
I – Immigration Services
D – Department
E – Employee
Week Eight – Ten
I/D. Employer support letter is reviewed, printed on letterhead, signed by the supervisor and ed back to Fragomen only if needed for the specific case H-1B Petition with approved LCA is sent to USCIS  
USCIS Processing
(Regular 6 – 8 months, Premium Processing 15 days)
I. USCIS sends a notice confirming receipt of the petition
Note: An employee with an H-1B from another company may begin work at this time
I. USCIS sends an approval notice which is forwarded to the employee and department contact via
Note: An employee changing status may begin work at this time
E. Employee picks up documents including the new I-94 card from ISO

23. Processing Times - Government
USCIS
Standard processing runs 6-8 months depending on work load
Premium Processing – USCIS must approve, deny or request additional info within 15 days – Cost is $1225

24. What is a Request for Evidence (RFE) ?
If the USCIS officer feels there is not adequate information to make a decision or needs more recent information to make a decision the officer will issue an RFE. There is no standard timeframe for when USCIS will provide a final determination on an RFE.

25. H-1B Requirements
License as required by the state where physician will practice
Holds unrestricted license to practice in foreign country or has graduated from U.S. medical school
Passage of all 3 steps of USMLE’s
*Licentiate Medical Certificate of Canada is NOT equivalent to USMLE for H-1B purposes
If graduate of U.S. Medical school then not required to pass USMLE’s.

26. Travel
Visa vs Status
The employee should complete a Travel Letter Request before departure and a Re-Entry Form after arrival
The employee can get access to these forms after reaching out to ISO at

27. Changes to Position
Any changes to the job title, job duties, location or salary must be reported as significant changes may require an amendment to the H-1B petition

28. Termination
When employment ends – based on termination, resignation or expiration of the H-1B and I-94 – the foreign national may be out of status and may need to exit the country.
Any break in employment must be reported (except vacation)

29. Fees

30. QUESTIONS??? For more information please visit the ISO website: or

31. Common Acronyms OPT = Optional Practical Training
STEM = Science, Technology, Engineering and Math
USCIS = U.S. Citizenship & Immigration Services
ECFMG = Educational Commission for Foreign Medical Graduates
IMG = International Medical Graduate
DOS = Department of State
DOL = Department of Labor
LCA = Labor Condition Application
SEVIS = Student & Exchange Visitor Information
FN= Foreign National
GME = Graduate Medical Education
POE = Port of Entry
CBP = Customs & Border Protection
ICE = Immigration & Customs Enforcement

32. Reference
For an overview of all ISO processes and detailed information please refer to the ISO website: