[Editor's Note: Today's guest post submitted by a regular reader going by the name of International MD. He brings to light another segment of docs feeling the strain from coronavirus. We hope this article can be of some help to them. We have no financial relationship.]
Are you an immigrant doctor in the middle of a pandemic and an immigration ban? You have options.
Doctors have been catapulted into the limelight and are more stressed than ever. Fearing for their lives, scared of infecting their family, concerned about practicing a specialty that is generating minimal revenue during the pandemic. I understand. I am part of that group. There is a group of forgotten doctors that have added stress, doctors who remain hidden from the American public. The immigrant doctor.
One out of four doctors is born outside the United States. Many are foreign citizens and went to medical school in another country. I have been an international medical graduate (IMG) for more than 15 years. An IMG is a physician that went to medical school outside the United States, and then took a series of tests and certifications to be able to train and practice in a specialty in the US. Most IMGs are foreign-born and do their specialty on a visa.
Visa Options for Doctors
J-1 Visa
This is a training visa.
H-1B Visa
This is a skilled worker visa.
These visas are contingent on your employment. That is, if you are an IMG on a visa and you voluntarily or involuntarily discontinue your job or stop working, or get fired because the institution went broke and it can’t financially support doctors, then you and your family (assuming they depend on your legal status) have to leave the country.
The Threat of Losing Immigration Status
If you are a doctor in the United States on a work or training visa and your family’s legal status depends on you, and you get COVID and die, your family loses their immigration status and has to leave the country. Let that sink in for a minute.
As a doctor you are risking your life to save others, which is a calling, but if you are no longer employed, even if it is temporary, while the economy recovers, then you are going to need to leave the country. If you die, then your family needs to leave. Where? Wherever you came from. That, in my opinion, is added stress.
IMGs have to endure a long and difficult process to become a legal permanent resident which is also known as obtaining a green card. Those of us who have been lucky to get this status understand its value now more than ever.
There is an incredible amount of mental fatigue from always being worried about your legal immigration status. Personally, I have been very close to losing my legal status at least twice. As an IMG, every time we apply to obtain a visa, or renew it, or change it, you know there is a real chance that it is game over. Then what? Do I have to sell my house, the cars, pull the kids from school? Go back to my country and start my life from scratch? Yes, that is a real scenario, which has happened and is currently happening.
Obtaining Legal Permanent Resident Status
How do I get to the regular amount of a doctor's stress and get out of this impending doom of losing it all? The answer is, you have to become a legal permanent resident and obtain a green card. There is no way around it.
The purpose of this writing is to attempt to help IMGs in these difficult situations.
I am not an immigration attorney, and this is not personalized legal advice, this is my personal opinion, but some might find it helpful. Use only what you think would be valuable, discard the rest.
I will try to describe possible options under different circumstances. I am making assumptions that the economy will be bad for a few months or a couple of years, and that job opportunities will be less and that we will then achieve a level close to normalcy within the next 2 years.
Advice for J-1 Visa Holders Graduating This Year
The objective of those on J-1s should always be getting rid of its restrictions.
#1 You can go back to your country for 2 years and reenter the USA with an H-1B visa after that time period.
This is not a bad idea if you think you can live there for 2 years. Maybe it would be a good time to be with your parents or family in the middle of this catastrophe. Maybe this is a trial run of what would it be like to be a doctor in your country, maybe you will decide to stay. I have seen this happen before. Doctors go back all the time and they find out that they really missed home and their families and decide to stay home. Your kids growing up enjoying the rest of the family would be nice.
Now, when you reenter the US you will have to find an employer that can give you an H-1B and do a PERM labor certification through the labor department for you to get permanent residency and a green card. So, as always, not simple, and it is a long process, but it has been done by many.
#2 J-1 Waiver for Underserved Area
Another option would be to obtain a J-1 waiver in an underserved area. This is doable, depending on the specialty and the job. If you are an emergency physician, an ICU physician, or another specialty in need, I think there should be a place in the United States that is underserved, looking for frontline providers, that can get it done.
Now, if you are a highly specialized doctor, looking for a very specific job, chances are it is not going to work. The underserved places might not have that kind of need, but you can always try to do the waiver based on your wide range specialty and not on your niche.
Remember, you will switch to H-1B for 3 years and then you can change to permanent residency. You still need an employer that will get you PERM labor certification through the labor department to obtain the green card. The PERM process can take months to years.
#3 Apply for Another Residency or Fellowship
If you have been only 3 or 4 years on a J-1, then you can apply to another residency or fellowship on a J-1 that can last 1 to 3 years, and hopefully, things will be better by then. I would choose something you are willing to do and find attractive; there is no point in staying in the country to be miserable. Again, once you are done with training, you will still have to decide to go back home or do a J-1 waiver.
Advice for H-1B Visa Holders
Here the objective should always be to get a green card if you want to stay in the United States. Here are your options:
#1 Marriage
If your significant other is a US citizen and you were thinking about marrying, this would be a good time. I would not advocate getting married just to obtain a green card. First, it would be illegal and second, being married by choice has it challenges, let alone being married for convenience. Don’t be unhappy.
#2 Obtain Employer-Sponsored PERM Certification
You need to have your employer get you through a PERM through the labor department. If not, you will run out of time (6 years) on H-1B. The PERM takes sometimes a year or more, and the institution has to pay money and do the legwork. In my opinion, this should always be part of your initial contract with your employer and in writing. If not, then leave and go to another employer that will do this for you. You need a plan to get the green card.
#3 Obtain a National Interest Waiver (NIW) I-140
This is a self-petition that can lead to obtaining a legal permanent residency and a green card. You have to prove to the government that it is in the interest of the United States to grant you a waiver and not go through PERM and labor certification through the labor department. It is based on 3 things.
- It should have substantial merit and national importance.
- The applicant should be well-positioned to advance the proposed endeavor.
- It would be beneficial to the United States to waive the requirements of a job offer and a labor certification. There is not much guidance on this category, and it is discretionary. You need to have publications, awards, recognition in your field, and almost prove that you have superpowers. But in COVID times, it seems to me, being a doctor is your superpower, and makes a compelling case to attempt the NIW, because you are doctor, and we need doctors more than ever.
A final option, which seems very costly for anybody including doctors, would be an investor EB-5 visa. This is for foreign investors that promote economic growth and create at least 10 jobs in the United States. This will grant you a green card. It used to be the minimum investment was around $500,0000 US dollars. In November 2019 the law changed and is now a $900,000 dollar minimum investment.
Advice for O Visa Holders
Some have said that the O stands for oxygen. You have to demonstrate an extraordinary ability to obtain this visa and you have to have a sponsor. This is a non-immigrant visa and is a temporary option, but is not conducive to the ultimate goal of obtaining a green card. In my opinion, it isn't a good long term plan, and you should get rid of it.
If you are a physician that trained in the United States and are on an O visa, that means that you were on a J-1 or an H-1. If you were on a J-1, you need to stop postponing the issue and confront reality — you need to get rid of the J-1 restrictions. Again, either go back home for 2 years or do a 3-year J-1 waiver in an underserved area. If you were on an H-1B and now are on an 0 visa, that means that you have proven to the US government that you have an extraordinary ability and you might as well have obtained a national interest waiver (NIW) and then you would be in the clear for your green card application.
Coronavirus Immigration Ban
For many nationalities, including mine, it can take five to ten years to get a green card. I am sorry, but that is the current system. There is little you can do, but to be patient.
This new environment in legal immigration is now even more complex. As of the day I am writing this post (May 2020), there is a temporary halt to new green cards. There are exemptions and caveats of all sorts, and we will have to understand the new restrictions as they unfold. Here's what we know about the executive order:
- Initially, it will suspend immigration for people seeking green cards for 60 days (June 21).
- Seems that J-1s and H1-Bs for doctors are not affected by the executive order.
- Current green card applications and naturalizations also are not part of the order.
- Green card applications for EB-1 outside the US will be affected, and also relatives such as parents, adult children, and siblings of green card holders that are applying for permanent residency will be affected.
- Some USCIS offices are now open but many still remain closed.
This country, more than ever, cannot afford to lose doctors, including immigrant doctors. As IMGs we can spend energy on thinking why the rules are unfair or why are they being constantly changed, but my suggestion is we focus on learning and understanding these rules so we can succeed. We are doctors and we are immigrants, in the middle of a pandemic, and against many odds, we will succeed. Because if you got here, then you can get there.
Are you an immigrant doctor or medical student seeking permanent resident status? How has the coronavirus immigration ban affected you? Comment below!
Thank you for a comprehensive overview of this complex subject. It is very nuanced and different for every individual, depending on their visa status, country of origin and medical specialty.
I would add EB-1 (Extraordinary Ability) route to obtain a Green Card for at least some physicians. Yes, it is a huge enterprise- the time and effort it takes is measurable in months- not hours or days- but it is well-worth it- especially for docs from countries like India- whose wait time for a Green Card can be up to a couple of decades.
The murmur in Congress regarding expansion of Conrad 30 due to COVID will be a welcome respite for J1 visa holders, let’s hope it goes through.
Best,
PFB
I don’t see the option of becoming a citizen, or perhaps joining the military. Are these options?
Citizenship is a step later than a Green Card. One goes from being a visa-holder (which is a non-immigrant status) to being a Green Card holder (immigrant status) to being a citizen (if they so desire). You have to be a GC holder for 5 years before you can apply for citizenship.
As for the military, it is not a choice many make. I had a colleague from training who went this route- he joined the Reserves and got his citizenship this way.
Thanks for the response.
I don’t believe a NIW I-140 pushes you ahead of the line for green card application. You will still have to do EB-2 or EB-1 application and that will determine how quickly you get green card.
NIW is EB2 (counter-intuitive but it is employment-based 2, although there is no need for employment offer). For any green card application, whether it is EB1 extraordinary ability, NIW for physicians (which is different from your regular NIW), or investor green card, the process is always I-140 first and then I-485 (OR both I-140 and I-485 together if you’re in United States, which is what I did to get my NIW green card). Getting I-140 approved doesn’t take years. It likely takes somewhere around 6 months but more recently, a little under 12 months. It is the next step I-485 which can really really drag things on depending upon which country you’re from. If you’re from India, well sorry to say but your wait time to become “current” (meaning your application would actually start processing) is 11 years. During that time you’re perpetually on H1B. The only respite is EB1 extra-ordinary ability where you also don’t need employment offer but criteria for EB1 is a lot more stringent than for NIW. Even on that, priority date for Indians is 3-4 years.
Any time your status is “current” depending upon your country of citizenship, you are already ahead of the line.
Thank you for this topic pertinent to so many readers. I would add that Congress has acknowledged the significant burden that the healthcare workforce is currently under, as well as the crucial role that immigrant workers play in the response to COVID-19.
There are 2 bills in Congress that serve as short-term and long-term solutions to the legal immigration fiasco that so many doctors find themselves in:
Healthcare Workforce Resilience Act (S3599) – Utilizes up to 40,000 unused immigrant visas to allocate them to up to 25,000 nurses and 15,000 doctors who are already working in the US, and have already fulfilled the criteria for legal immigration but are stuck in the backlog. This provides these workers and their families some safety and certainty that would come with permanent resident status.
Conrad State 30 and Physician Access Reauthorization Act (S948) – Proposes enhancements to the pre-existing Conrad 30 program, which includes giving the option to physicians to work 2 additional years (beyond the 3-year J1 waiver requirement) in a healthcare professional shortage area or a medically underserved area and be rewarded with an expedited permanent resident status (independent of country cap limitations).
There are organizations dedicated to immigrant physicians such as the Physicians for American Healthcare Access who have created a means for an interested person (that I hope would include most WCI readers) to contact their representatives regarding both bills.
https://paha.us/letters-to-policymakers/
I am glad that this problem is being highlighted on WCI, and I hope that WCI readers can be a part of the solution as mentioned above. Please support your colleagues and their families!
Thanks for writing this post. There should be special investment guidance for foreign medical grads who are pursuing training in US. I, for instance, didn’t start my retirement account until I literally had a physical copy of my green card in my hand, officially confirming that I would be in this country for long-term (well, even that’s no guarantee as a minor conviction can get a green card holder deported, but still overall better than being on a visa).
Thank you for writing on this topic. I am actually going through such tough situation. My H1B expires soon being on the 6th year. My PERM got delayed and couldn’t renew my H1B until PERM is approved. I have applied for I485 through my husband’s pending green card application via I140 NIW and waiting for EAD based on this. I will be out of work until that comes through. After all the years of training and hard-work, I feel lost and now I don’t have much choice but to stay with hand tied and not being able to provide care to my patients when it’s needed the most. I have gone through multiple people and offices but no one has answers but to wait.