VISA STRATEGIES FOR INTERNATIONAL
MEDICAL GRADUATES IN GME PROGRAMS
WEBINAR – WEDNESDAY, NOVEMBER 3,
2010
1
Educational Commission for Foreign Medical Graduates
ECFMG Services & Visa Options
for Foreign National Physicians
Presented by:
ECFMG – Exchange Visitor Sponsorship Program
Eleanor Fitzpatrick,
p
, Manager
g
Irene Anthony, Assistant Manager
2
Learning Objectives
Upon completion of the webinar, participants should have a
better understanding of:
z ECFMG Certification Requirements
z ECFMG J-1 Sponsorship Requirements
z
z
z
z
z
z
U.S. Federal Regulatory Requirements
S
Sponsorship
hi A
Application
li i P
Process
Roles and Responsibilities
Special Appeals to the U.S. Department of State
Effective Pre-Screening Recruitment
Alternate Visa Options for Foreign National Physicians
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
3
ECFMG Certification
C tifi ti Requirements
R
i
t
z
Medical Education Credentials
z
z
z
z
Completion of medical school curriculum of at least 4 years
School and g
graduation yyear listed in The International Medical
Education Directory (IMED) www.faimer.org/resources/imed.html
Primary source verification of medical diploma and transcript by
ECFMG
USMLE Exams
z
z
z
Step 1 Basic Science
Step 2 Clinical Knowledge (CK)
Step 2 Clinical Skills (CS)
4
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
IMG & Entry
IMGs
E t into
i t U.S.
U S GME
z
Complete ECFMG Certification (if IMG)
z
Apply
pp y for U.S. Residency
y Training
g Position
z
z
z
z
z
Apply to training programs through ERAS
Interview with programs
Enroll in the NRMP Match
Secure a contract / letter of offer
Seek Appropriate
pp p
U.S. Training
g Visa / Status
(if foreign national physician)
5
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
ECFMG J-1
J 1 Vi
Visa Sponsorship
S
hi
Sole Sponsor of J-1 Physicians in Clinical Training
z
Temporary, non-immigrant visa
z
Full time educational training / GME
Full-time
z
Not employment
z
Two-year
Two
year home residency obligation INA §212(e)
z
Non-immigrant intent INA §214(b)
z
Seven-year maximum for progressive training
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
6
ECFMG J-1 Sponsorship Requirements
z
z
z
z
ECFMG Certification
GME Contract / Letter of Offer
“Statement of Need” from Ministry of Health in
Country of Most Recent Legal Permanent
Residence
Adequate Prior Education
J-1 Regulations 22CFR§62.27(b)
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
7
J-1 Visa Sponsorship:
Roles and Responsibilities
U.S. Department of State (DOS)
U.S. Department of Homeland Security (DHS)
Student & Exchange Visitor Information System (SEVIS)
ECFMG
Exchange Visitor Sponsorship
Program (EVSP)
Regional Advisor
Host Institution
Training Program Liaison (TPL)
Program Director
J-1 Physician
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
8
Roles and Responsibilities in the
J-1 Visa Sponsorship Process
z
DoS and DHS oversee J-1 program and visa processes
9
z
Track J, F, M visa holders in the SEVIS database
ECFMG, through its EVSP Regional Advisors,
evaluates applications and approves visa sponsorship
9
Interfaces with DoS and DHS in SEVIS tracking
z
Host Institution/ TPL cooperate with ECFMG in providing
on-site monitoring of J-1 physicians
z
J-1 physician and J-2 dependents must comply with all
pertinent immigration laws and regulations
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
9
ECFMG J-1
J 1 Sponsorship Application
J 1 Ph
J-1
Physician
i i + TPL = C
Complete
l t A
Application
li ti
Sponsorship Available for Participation in:
z ACGME A
Accredited
dit d R
Residency
id
T
Training
i i
z ACGME Accredited Subspecialty Training
z Non-Standard
N St d d P
Programs (Advanced Fellowships)
z Board Examinations
Application Materials Available @ http://www.ecfmg.org/evsp/index.html
On-line Payment / Status updates through OASIS @ http://www.ecfmg.org
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
10
J-1 Sponsorship Application Process
z
Regional Advisor evaluates for eligibility
z
z
z
z
4 - 6 weeks for review
If approved, SEVIS record is created
ECFMG issues Form DS-2019
Sponsorship duration based on annual increments
(contract)
ECFMG notifies applicant via e-mail, provides
instructions for obtaining J-1 visa status
11
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
Special Appeals to the
U.S. Department of State
z
z
z
Changes in J-1 Visa Category
Exceptional Extensions of Stay Beyond Seven Years
Advisory Opinions in Unusual Circumstances
Reviewed on case-by-case basis;
contact EVSP directly for additional information
12
Required Reporting by Program
z
Arrival / Delays (within 30 days of SEVIS start date)
z
Proposed Changes to Approved Training Plan
z Leave of absence
z Remedial training
z Resignation or termination
z Gaps in training (i.e. licensure delay)
z
Legal Concerns
13
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
Effective Pre-Screening of IMGs
Wh what,
Who,
h t when,
h
why
h and
dh
how?
?
_______________________________________________________________
Best Practices:
z
z
z
Define institutional and program policies
Accuracyy and consistencyy in g
gathering
g and
evaluating the facts
Effective communication
14
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Pre-Screening IMGs
z
z
z
z
Education and Medical Credentials
Program Priorities
Immigration History and Options
Applicant’s
Applicant
s Personal Issues
15
Copyright©2010by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
M di l Education
Medical
Ed
ti
& Credentials
C d ti l
z
z
z
Medical education
Valid ECFMG Certificate
V lid medical
Valid
di l examinations
i ti
z
z
z
USMLE (FLEX, FMGEMS)
Dates, number of attempts, scores
Licensure requirement for position
______________________________________
Best Sources:
USMLE Transcript , CVS, ERAS, state medical license
16
Copyright©2010by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Medical Education & Credentials
Previous experience in U.S. or abroad
z
U.S. board credit
z
Change in specialty
z
Research
___________________________________
z
Best Sources:
Institution ERAS/CV,
Institution,
ERAS/CV specialty board,
board ECFMG,
ECFMG physician
17
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Program Priorities
z
z
z
z
Best fit for program
Begin
g training
g on time
Successful progression in training
Post training
g recruitment
________________________________
Best Sources:
ERAS, program, physician
18
•Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Immigration History & Options
z
C
Current
t and
d previous
i
visa
i status
t t
z
z
z
z
Type/s of activity
Restrictions
Duration of stay in United States
Consular processing
Security
S
it clearance
l
___________________________________________________
Best Sources:
ERAS / CV, U.S. sponsoring institution, physician
z
19
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Applicant’s Personal Issues
Dependents
z
z
z
z
Immigration status
Spouse’s
Spouse
s profession
Special needs / requests
___________________________________
Best Source:
y
Physician
20
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
D
Developing
l i
Best
B t Practices
P
ti
z
Gather the facts
z Be objective, ask the right questions
z
Consider the options
z Weigh the interest of institution, program and
physician
h i i
z
Communicate with all responsible parties
z Seek
S k consensus but
b t insist
i i t on compliance
li
21
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved
Q
Questions?
ti
?
Exchange Visitor Sponsorship Program
Tel: (215) 823-2121
Fax: (215) 386-9766
Copyright©2010 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.
22
NAFSA: Healthcare Institutions Interest Group (HIIG)
Other Visa Options
p
and Issues for IMGs in
GME Programs
Janice M. Bianco, Manager, International Physician Services, Cleveland Clinic,
biancoj@ccf.org
Janice Bogen, Director, Office of International Exchange Services, Thomas
y, jjanice.bogen@jefferson.edu
g @j
Jefferson University,
Scott Borene, Senior Attorney & President, Borene Law Firm, Minneapolis,
MN, sborene@borene.com
Michele Stelljes, HR Immigration Specialist, The Methodist Hospital System®
MMStelljes@tmhs.org
23
NAFSA: Association of
I t
International
ti
l Educators
Ed
t
z
z
z
HIIG: Healthcare Institutions Interest Group
one of many Special Interest Groups
9 000 members,
9,000
b
many off whom
h
serve
incoming students and scholars
Th
There
may be
b one on your campus who
h will
ill
partner with you to keep you informed of the
latest immigration information
24
H-1B Temporary Worker
Core Requirements: the IMG
o Must have passed USMLE Steps 1
1,
2CK/2CS & 3 (includes Canadian
medical school graduates)
o Must have a valid ECFMG Certificate
(Canadian MGs exempt – graduates
off Canadian
C
di medical
di l schools
h l ttake
k
USMLE through the NBME, so no
need for ECFMG)
o Must have either a training or
permanent license to practice
medicine
25
H-1B
H
1B Temporary Worker
Core Requirements: the Employer
z
z
z
z
Employer
E
l
must pay salary/benefits
l /b
fi ((no selflf
funding or third party funding), must be at
prevailing
p
g wage
g
Approved Labor Condition Application (LCA,
Form ETA 9035)
E l
Employer
mustt pay allll ffees associated
i t d with
ith
filing of H-1B petition (application fees &
attorney
y fees))
Application fees $325 for regular processing,
additional $1225 for premium processing
(rates effective 11/23/2010).
11/23/2010)
26
H-1B Temporary Worker
Employer Requirements Continued
C
z
z
z
z
Employer must pay the higher of the prevailing
or actual wage.
Prevailing wage must be from an approved
source
U.S. Department of Labor has the right
g to
question or deny an LCA if the source is
unacceptable in their opinion.
Employer must keep a public file which
contains documentation of how the wage was
determined and a comparison of the
actual/prevailing
t l/
ili wage
27
H-1B Temporary Worker
Employer Requirements Continued
Prevailing Wage Sources
Safe Harbor Source
U.S. Department of Labor Prevailing Wage Determination (allow 60
days)
Other Sources
Association of American Medical Colleges (AAMC), Survey of
es de t/ e o St
Stipends
pe ds & Benefits:
e e ts
Resident/Fellow
https://www.aamc.org/download/158738/data/2010_stipend_report.pdf
Industry Survey
Example:
p Towers Watson Survey
y Report
p on Health Care Clinical &
Professional Personnel Compensation
Employer Survey: an employer may hire a private survey company to
conduct a survey
survey. Employer cannot conduct their own survey
survey.
28
H 1B T
H-1B
Temporary W
Worker
k
Timing: 2 Types of Issues
Type 1: processing time issues, premium vs.
regular
l processing;
i
iis titime b
between
t
“M
“Match
t h
Day” and your June orientation enough?
((Recommend setting
g a deadline for taking/receiving
g
g score on Step
p 3))
Type 2: duration is 6 years total; will your
resident have enough
g time to complete
p
all
educational objectives? i.e. surgical
specialties; lengthy fellowships
29
H-1B Temporary
p
y Worker
Special Topics
z
Multiple worksites and short-term placement
20 CFR 655.735
655 735 LCA
Program training sites
Elective rotations
LCA responsibility
z 30 to 60 days in a fiscal year
z considerations and filing
30
H-1B Temporary Worker
Special Topics
The USCIS Administrative Site Visit and
g
Verification Program
z
z
z
z
I-129 Petition fact checks
Worker interviews
Examination of working conditions
Department of Labor Investigations
z
z
z
H 1B worker questionnaire published in 2009
H-1B
LCA fact checks
Examination of working conditions
31
Oth Vi
Other
Visa O
Options
ti
z
z
z
z
z
z
z
A1 2 with EAD
A1-2
E-1/E-2 Spouse (only) with
EAD
E 3D with EAD
E-3D
J-2 with EAD
K1-4 with EAD
L-2 Spouse only with EAD
NATO 1-6 Dependent with
EAD
z
z
z
z
z
z
T1
1-4
4 with EAD
V 1-3 with EAD
Pending Permanent
resident with EAD
Permanent Resident
Asylum applicant with EAD
Refugee or Temporary
Protected Status with EAD
EAD: Employment Authorization
Document
32
Employment Authorization
D
Documents
t (EAD
(EADs))
z
z
z
F 1 Optional Practical Training (OPT)
F-1
encouraged for the first year out of U.S.
Medical School in F1 status (adds 1 year to
H1 time);
i ) G
Good
d ffor 12 months
h maximum
i
Must apply before graduation with help from
F i Student
Foreign
St d t Advisor
Ad i
att F1 sponsoring
i
university, and have EAD in hand to begin
program
OPT STEM extension of 17 months NOT
g
available for residencyy training
33
EAD ffor J2
z
z
z
z
J2 EAD is good for the duration of J1
Principal’s eligibility only (up to 5 years
generally). If it is a long program, this may not
allow
ll
enough
h time
i
ffor completion
l i
Two year home residency requirement may
apply
l tto d
dependent
d t
Note: it takes time and filing fees to get the
document
Consider: Is it discriminatory to disallow this
status for your IMGs?
34
N t an Option
Not
O ti
z
z
z
z
TN (Trade NAFTA)
Cannot be used for residency training
May be used for research for individuals from
Canada or Mexico
O-1 Individuals of Extraordinary Ability
or Achievement
35
Visa Options for Foreign Physicians
Many More Options Off the J
J-1
1&H
H-1B
1B Beaten Path
Presenter on this Topic
z
z
z
O-1
O
1E
Extraordinary
t
di
Abilit
Ability
Employment Authorization
Documents (EAD)
Plus Many Other Exotic
Employment Authorization
Options
Scott M. Borene
Borene Law Firm, P. A.
ph: 612.321.0082
sborene@borene.com
36
1
O-1 Visa Basics
z
z
z
z
z
A person who “has
has extraordinary ability in the sciences,
arts, education, business or athletics which has been
demonstrated by sustained national or international
acclaim”
Usually requires extensive evidence
and supporting documentation
No Requirement
q
that the p
position requires
q
a person of O-1 caliber
Initial Validity of up to 3 years (extensions often available
y)
indefinitely)
Can be Obtained within 15 days or less after filing if
Premium Processing Is Used
37
2
Employment Authorization
Documents (EAD Options)
z
z
Usually based on Form II-765
765
Many Options Including:
z
z
z
DED, TPS
DED
TPS, F
F-1
1 OPT
OPT, J-2
J2S
Spouse, L
L-2
2S
Spouse,
E-2 Spouse,
(c)(9) Pending Adjustment Applicant on
Extraordinary Ability, National Interest Waiver,
Marriage-based
g
application
pp
etc.,
Deferred Action, Suspension of Deportation, and
many more
38
3
Other More Exotic Employment
p y
Options
p
z
z
z
z
z
More than 100 additional options
Infrequently used but can be valuable
Most are personal immigrant options
Immigrant can pursue without the knowledge,
consent or cooperation of the Employer
Unlike the H-1, usually the Physician hires
the lawyer and pays for these exotic options
39
4
Pre-Employment Inquiries Regarding
Sponsorship for an Employment Visa:
What is Permissible?
z
z
“Are
Are you legally authorized to work in the
United States? Yes or No”
“Will you now or iin th
the ffuture
t
require
i
sponsorship for employment visa status (e.g.
H 1B visa status)?
H-1B
Yes or No”
No
Cite: Letter from John D. Trasvina, Special Counsel U.S.
Department of Justice, Civil Rights Division, dated August 6,
1998.
40
5
Best Practices
z
z
Plan in Advance
Have A Policy
z
z
z
J-1s
J
1 O
Only?
l ?
H-1s or J-1s both ok?
G
General
l Policy
P li plus
l exceptions?
ti
?
41
6
Best Practices
z
Recommendation:
z
z
Whatever General Policy is selected, allow for
exceptions (e
(e.g.
g by special permission on written
application to an Ad Hoc Committee)
Warning on a “J-1
J 1 only”
only policy:
z
z
Appears simpler in the short term
But, can hurt long term career and immigration
interests of the Institution (particularly Academic
Medical Centers), Physician, and Family
42
7
Q
Questions?
If You Have Additional Immigration or Visa
Questions, Please Call.
612 321 0082
612-321-0082
43
8