International Clinicians/IMGsKeys to Immigration

Presented by: Immigration Attorney Carl Shusterman toAMN Workforce Summit November 7-8, 2013

Courtesy of the Law Offices of Carl Shusterman

Internationally Born Medical Graduates

An Essential Resource:

IMGs make up 25% of the physician workforce (includes US IMGs)

Are most represented inNephrology 45%Internal Medicine 37%Psychiatry 32%Oncology 30%Pulmonology 30%Anesthesiology 28%Pediatrics 28%Gastroenterology 28%

Source: AMA Physician Master File

Courtesy of the Law Offices of Carl Shusterman

IMGs by Country (Top Ten)

Country Percent TotalIndia 20% 47,581Philippines 8.7% 20,861Mexico 5.8% 19,929Pakistan 4.8% 11,330Dominican Republic 3.3% 7,892Former USSR 2.5% 6,039Grenada 2.4% 5,708Egypt 2.2% 5,202South Korea 2.1% 4,982Italy 2.1% 4,978

Source: AMA Physician Master File

IMGs in U.S. come from 127 countries

Courtesy of the Law Offices of Carl Shusterman

IMGs Heaviest Concentration by State as a Percent of All Active Physicians

1. New Jersey 39%2. New York 38%3. Florida 35%4. Illinois 33%15. Texas 25%All United States

25%

Source: AMA Physician Master File

Courtesy of the Law Offices of Carl Shusterman

IMGs: Number of Potential Candidates Coming Out of Residencies

Total graduating residents per year: 25,000Number of IMGs: approximately 7,000

Courtesy of the Law Offices of Carl Shusterman

Visa Options For Residents & Fellows

J Status (training visa)H-1B Status (employment

visa)Permanent Residence and

Other Options

Courtesy of the Law Offices of Carl Shusterman

Consequences of J Status for IMGs

2-Year Home Residency Requirement Must return to Country

of Nationality or Last Residence for 2 years before obtaining H or L visa or Green Card

Courtesy of the Law Offices of Carl Shusterman

How to Obtain a J Waiver

PersecutionExceptional Hardship

To USC/LPR SpouseTo USC/LPR Child (under 21 & unmarried)

Interested Governmental Agency (IGA)

Courtesy of the Law Offices of Carl Shusterman

J Waivers: Interested Governmental Agencies

Federal AgenciesARCVAHHSDRA

Conrad State Programs

Courtesy of the Law Offices of Carl Shusterman

Conrad 30

Primary care and/or specialistsAll 50 states participateSome have 10 “flex” spots – the physician

does not have to practice in an underserved area, as long as he/she sees patients from underserved areas

Some states run out of spots, some do notCheck with Mr. Shusterman’s office

Courtesy of the Law Offices of Carl Shusterman

Medical Residency/Fellowshipon H-1B Status

Passage of USMLE, Parts I, II & IIIAcceptance to Residency ProgramH-1B Petition

Courtesy of the Law Offices of Carl Shusterman

H+1B Visa

No 2-year rule; doctor does not have to practice in an underserved area

Courtesy of the Law Offices of Carl Shusterman

But there is a cap!

85,000 H+1Bs per yearApril 1st is filing datePhysicians who receive J waivers are

exempt from capSo are doctors who work at academic

institutions, government or non-profit research institutes

Courtesy of the Law Offices of Carl Shusterman

Permanent ResidenceEmployment Options

PERMNational Interest

Waiver The Law (1999) The Regulations (2000) The Lawsuit (2005)

Courtesy of the Law Offices of Carl Shusterman

What about Canadian Physicians?

They are not considered IMGsLMCC accepted in almost all states for

licensureCan qualify for H-1B if they have a U.S. exam

(USMLE, FLEX, NBME)But don’t need a U.S. exam for a green card

Courtesy of the Law Offices of Carl Shusterman

Immigration Reform Bill in Congress

Would make the Conrad 30 program permanent

Would make J status “dual intent”Would exempt spouse/children from 2-year

ruleWould make it easier for H-1B MDs to change

jobsWould eliminate per-country quotasWould provide a faster route for green cards

to physicians and their families

Courtesy of the Law Offices of Carl Shusterman

We Link to Governmental Sites Conrad 30 Programs HPSA/MUA List ECFMG/USMLE Job Opportunities

Finding IMG Resources Onlinehttp://shusterman.com

Courtesy of the Law Offices of Carl Shusterman

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