International Clinicians/IMGs Keys to Immigration

Presented by: Immigration Attorney Carl Shusterman to AMN 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 in

Nephrology 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 Total

India 20% 47,581

Philippines 8.7% 20,861

Mexico 5.8% 19,929

Pakistan 4.8% 11,330

Dominican Republic 3.3% 7,892

Former USSR 2.5% 6,039

Grenada 2.4% 5,708

Egypt 2.2% 5,202

South Korea 2.1% 4,982

Italy 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: 25,000 Number 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

Persecution Exceptional Hardship

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

Interested Governmental Agency (IGA)

Courtesy of the Law Offices of Carl Shusterman

J Waivers: Interested Governmental Agencies

Federal Agencies ARC VA HHS DRA

Conrad State Programs

Courtesy of the Law Offices of Carl Shusterman

Conrad 30

Primary care and/or specialists All 50 states participate Some 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 not Check with Mr. Shusterman’s office

Courtesy of the Law Offices of Carl Shusterman

Medical Residency/Fellowship on H-1B Status

Passage of USMLE, Parts I, II & III Acceptance to Residency Program H-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 year April 1st is filing date Physicians who receive J waivers are exempt

from cap So are doctors who work at academic

institutions, government or non-profit research institutes

Courtesy of the Law Offices of Carl Shusterman

Permanent Residence Employment Options

PERM National 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 IMGs LMCC accepted in almost all states for licensure Can 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 rule Would make it easier for H-1B MDs to change jobs Would eliminate per-country quotas Would 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 Online http://shusterman.com

Courtesy of the Law Offices of Carl Shusterman

How to Keep Current

Physicians Immigration Guide Social Media

• Free Subscription to our monthly e-mail newsletter 60,000 subscribers

Courtesy of the Law Offices of Carl Shusterman

International Clinicians Registered Nurses

Courtesy of the Law Offices of Carl Shusterman

Registered Nurse Supply and Demand • Nursing workforce has grown to 2.8 million nurses

• One third of RN’s are over the age of 50

• The average age of a nurse is 44.6 years

• 16% of RN’s live in rural areas.

• Nursing workforce is expected to be 3.45 million by 2020

• 500,000 replacement nurses will be needed by 2020

• Total number of job openings due to growth and replacement is 1.2 million

The U.S. Nursing workforce: Trends in Supply and Education April 2013 Bureau of Labor Statistics Employment Projections 2010-2020, February 2012

Nurse Shortage by

2020 +/- 1.2m (BLS)

Courtesy of the Law Offices of Carl Shusterman

Foreign Educated NCLEX Passers

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Passing Candidates 6682 10152 12870 14954 14760 20942 22879 18935 13808 8880 6018 5388

6682

10152

12870

14954 14760

20942

22879

18935

13808

8880

6018 5388

0

5000

10000

15000

20000

25000

Internationally Educated Nurses Passing the NCLEX-RN: 2001 - 2012

2004 3.5% of RNs

in U.S are foreign-

educated (100,791)

Courtesy of the Law Offices of Carl Shusterman

2004: Quota of visa numbers are issued specifically for shortage occupations which includes RN’s December 2006: The visa #s issued in 2004 for shortage occupations were depleted December 2011: Cut off dates progressed to January 2006 for most of the world October 2013: Current cut off dates for nurses are:

Most of world 10/1/2010 Philippines 12/15/2006 India 9/22/03

Visa Retrogression

Courtesy of the Law Offices of Carl Shusterman

Where do Intl. nurses come from?

3673

974

605 426 398

0

500

1000

1500

2000

2500

3000

3500

4000

Philippines India Canada South Korea Puerto Rico

Top 5 Countries for NCLEX Candidates in 2012

Philippines

India

Canada

South Korea

Puerto Rico

The Philippines contributes the highest

number of NCLEX passers, almost 4 times

higher than the next largest contributor

Courtesy of the Law Offices of Carl Shusterman

Intl. Nurse Migration process • Recruitment

• English Language

• NCLEX or CGFNS exam

• Visascreen®

• Immigrant / Non immigrant Visa

• Relocation / Orientation

Courtesy of the Law Offices of Carl Shusterman

Type of Visas for Nurses

Courtesy of the Law Offices of Carl Shusterman

TN Visa • Temporary Visa issued to qualifying Canadian or Mexican citizens

• NCLEX, Visascreen and employment letter required

• Border Crossing for issuance

• $56 to issue, $325 to renew

• Valid for up to 3 years, renewable

Courtesy of the Law Offices of Carl Shusterman

• Legal Permanent Residents

• Green Card Process

• Green Card Costs

• Green Card expiration / renewal

• Eligible for Citizenship after 5 years

• Timeline to issuance

Green Card

Courtesy of the Law Offices of Carl Shusterman

Immigration Reform

Courtesy of the Law Offices of Carl Shusterman

Comprehensive Immigration Reform

• CIR bill (S.744) passed the Senate in June 2013

• No nurse provision but more visas in the EB-3 category

• Democrats may introduce a Comprehensive Immigration Reform bill in the House of Representatives before the end of 2013

• While some movement on immigration is still possible in the rest of 2013, priorities for now are budget and healthcare

Courtesy of the Law Offices of Carl Shusterman

OGP RN Experience and Specialty Mix CCU/TELE, 27

DIALYSIS, 8

ER, 55

ICNN, 13

ICU, 85

LD/PP, 18

MS, 173

OR, 35

PACU, 11

PEDS, 20 PICU, 5

PSYCH, 6

CCU/TELE

DIALYSIS

ER

ICNN

ICU

LD/PP

MS

OR

PACU

PEDS

PICU

PSYCH

450 nurses visa eligible 120 Nurses ready to

start within 3 months 55% BSN or higher 13.5 years experience Can start in 2-3 months Open to location and

shifts

Courtesy of the Law Offices of Carl Shusterman

Questions?