Foreign Medical Graduates
Solution to Physician Shortages
With the New Year here, and the Patient Protection and Affordable Care Act in place, our offices are buzzing with calls from medical facilities, hospitals, and clinics who need to hire foreign medical graduates to fill their shortage of physicians. The shortage of physicians is not a new problem, the shortage is merely being exacerbated by the previously uninsured individuals who are now able to seek medical care.
On February 9, 2013, the LA Times reported that only 16 of California’s 58 counties have the federal government’s recommended supply of primary care physicians. Moreover, nearly 30% of California’s doctors are nearing retirement age, the highest percentage in the nation.
In New York, State Health Commissioner Dr. Nirav Shah went on record to say that the state is short 1,100 primary-care doctors and when the Affordable Care Act kicks in he expects a million more New Yorkers to obtain insurance cards.
There is also a shortage of doctors in much of Florida. According to the Department of Health, 16 mostly small and rural counties have fewer than seven active physicians per 10,000 residents. As reported by CBS on June 22, 2013, Florida estimates that it would take at least 753 primary care physicians to eliminate those shortages.
Again, if your medical facility, like our medical facility clients, is feeling a shortage of physicians now, it is about to get a lot worse. As reported by Forbes on September 11, 2013, an estimated 7 million previously uninsured Americans will have coverage January 1, 2014, and that number will jump to 20 million by 2016. When combined with the millions of Baby Boomers that will be reaching Medicare age, the nation is facing a Perfect Storm of physician shortages. Forbes further reports that an estimated 75,000-150,000 new physicians will be needed over the next decade.
Your medical facility depends on having sufficient competent physicians on staff. So what is a medical facility to do?? You may want to consider hiring a foreign medical graduate physician (FMG Physician) to address the physician shortage your facility is, or could be facing.
Typically, a FMG Physician participates in U.S. residency programs under a J1 visa or an H1B.
FMG Physicians who complete residency in J-1 status are typically subject to the two year home country residency requirement under section 212(e) of the Immigration and Nationality Act (INA), and thus are required to return to their home country upon the completion of the J-1 program for two years. This requirement can be waived. There are four bases set forth in U.S. immigration law to waive the requirement of the FMG Physician to return to his or her home country:
• Waiver may be requested by an interested U.S. federal government agency;
• Waiver may be obtained via participation in the Conrad State 30 Program: Mandates, among other requirements, that the FMG Physician work full time for three years in a Medically Underserved Area (“MUA”) or in a Health Professional Shortage Area designated by the Department of Health and Human Services (HHS);
• Waiver based on hardship: Available for FMG Physicians who can demonstrate that their departure for two years would cause “exceptional hardship” to their United States citizen or lawful permanent resident spouse or child; or
• Waiver may be requested based on FMG Physician’s fear of persecution based on race, religion, or political opinion if obligated to return to home country.
Please see our previous posts on the topic of J-1 waivers. In addition to needing a J-1 waiver, a FMG Physician who completed residency in the U.S. on a J-1 visa also needs an H-1B visa or another employment related visa to work lawfully in the U.S. after approval of the J-1 waiver. The J-1 waiver merely waives the requirement to return to the home country for two years, the J-1 waiver does not give the FMG Physician status to live or work in the U.S. In order to obtain an H1B for the FMG Physician the medical facility must, among other requirements, file a labor condition application (LCA) with the Department of Labor (DOL). The LCA is supposed to ensure that the admission of the FMG Physician to work in the U.S. will not adversely affect the job opportunities, wages and working conditions of U.S. workers. Also note that only 65,000 H1B visas are available each fiscal year (which begins on October 1 of each calendar year). USCIS begin accepting applications on April 1st of each year and it is therefore wise to apply on or as soon after April 1st as possible. Thankfully, if the FMG Physician works for a non-profit or public institution (or a VA facility), s/he is not subject the 65,000 cap.
If a FMG Physician is completing residency in the U.S. in H-1B status instead of J-1 status, s/he would not need a waiver. Nevertheless, the FMG Physician would need to request a change of employer.
Also, because the FMG Physician can only be in H1B status for six years (in certain situations the H1B can be extended beyond the six year period) and because the FMG Physician likely used most of the allotted six year period to complete residency, it would be wise for the medical facility and the FMG Physician to develop an early strategy for taking the necessary steps leading to lawful permanent residence (a greencard) for the FMG Physician. Otherwise, the FMG Physician might be forced to return to their home country and the medical facility would once again be short a physician.
As you can see, sponsoring a foreign medical graduate can be a win-win situation for both your medical facility and the physician. If your medical facility is experiencing a shortage of physicians, it is definitely going to get worse this year and in coming years. A foreign medical graduate of your choice can help provide you with the physician services your facility depends on. Also, for the foreign medical graduate, the opportunity to work and stay in the U.S. is often more desirable then having to return to their home country.
At Ranchod Law, we represent both medical facilities and foreign medical graduates. Some of our clients are medical facilities (hospital and clinics of all sizes) who have already found or are looking into hiring a foreign medical graduate in their practice. We make the process smooth and easy for medical facilities, taking care of all the necessary filings and paperwork. We also represent foreign medical graduates who consult with us to discuss their options for staying in the U.S. Please contact us at (916) 613-3553. We have offices conveniently located in Sacramento and San Francisco and we serve clients remotely all over the U.S.