Coronavirus Immigration Ban and the Foreign Physician

[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.

1. It should have substantial merit and national importance.
2. The applicant should be well-positioned to advance the proposed endeavor.
3. 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!