At a time when health care is critical, physician shortages and other challenges continue to beset the United States. Vacancies and shortages in health care staffing are causing glaring deficiencies in meeting patient needs – in some cases, throughout entire geographic regions. Our recent health care webinar reviewed several options for health care facilities and hospitals to address the shortage by increasing efforts to recruit health care workers from around the globe. We know that the different terms for visas and employment authorizations can often seem like alphabet soup. In that spirit, here are the ABCs of updates for health care immigration options:

Nonimmigrant visas

H-1B visas: Conquering the cap

These visas apply to specialty occupations, meaning those positions that require at least a bachelor’s degree as the minimum entry-level requirement. For physicians involved in any level of patient care, eligibility for H-1B requires ECFMG certification, passage of the United States Medical Licensing Examination (“the boards”), and an active medical license for the state in which the physician will practice. These visas are currently capped at 85,000 per year, with an H-1B lottery that takes place in March/April each year. Want a cap exemption? Find a college or university – any “institution of higher education” that’s not-for-profit – a government research organization, or a not-for-profit affiliate. Another option for healthcare workers from Canada and Mexico is to apply for a TN (Trade NAFTA) visa, whose qualifying jobs include various medical professionals—but for physicians, only those involved in research and teaching, not patient care. Chile, Singapore and Australian healthcare professionals have their own options (H-1B1 and E-3), which are not subject to the same numerical struggles as the H-1B.

O-1 visas: Extraordinary ability

These visas are given to individuals, often scientists and researchers, who have secured national or international acclaim. This acclaim must be proven and substantiated through awards, press coverage, research citations, letters of support, and selective professional memberships, among other methods. O-1 visas can be a sought-after option for physicians after a J-1 (see below).

J-1 visas: Cultural exchange

These “cultural exchange” visas, administered through the U.S. Department of State, include the category of “Alien Physician” for medical residents and fellows. There are some advantages to the J-1 over the H-1B: it is less costly to a health care institution to obtain, has no prevailing wage requirement, and does not eat into the H-1B maximum period. However, one major downside to the J-1 is the two-year home residence requirement – returning to one’s home country for two years at the conclusion of the J-1 program (residency or fellowship). Our immigration blog post recently covered strategies for waivers of the J-1 Home Residence Requirement.

Immigrant visas

PERM Labor Certification: Testing the labor market

This process is the most common path to permanent resident status via employment. It requires significant employer involvement, time, and patience – taking around one year to complete. U.S. Department of Labor law mandates that before being able to sponsor a foreign national employee for a “green card” through employment, the employer must first attempt to recruit someone for the offered position through newspapers, job fairs, websites, and other advertising methods before applying for the PERM labor certification. This is called “testing the labor market.” One major exception to this is for “Schedule A” occupations with perpetual shortages: in the health care field, professional nurses and occupational therapists. These workers can skip the PERM Labor Certification and go directly to an I-140 immigrant visa petition. This is often the first and only recourse for nurses, who typically would not qualify for an H-1B or any other temporary work visa.

Physician National Interest Waiver (PNIW):

Under this category, which waives the requirement of completing the PERM Labor Certification and the labor market test, physicians must agree to work full-time in a clinical practice for a period of five years, whether they are GP/primary care providers or specialists. They must serve in an area that is federally designated as medically underserved, with health care shortages and scarcities. A statement must be obtained from a federal agency or state department of health that has knowledge of the candidate’s qualifications and affirms their work is in the public interest.