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Navigating Immigration: Presented to

Navigating Immigration: Presented to The Pennsylvania Association of Community Health Centers Annual Conference. | 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com | wendy@goldblumhess.com | 101 Greenwood Ave. Ste 380 Jenkintown, Pennsylvania 19046. By:

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Navigating Immigration: Presented to

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  1. Navigating Immigration: Presented to The Pennsylvania Association of Community Health Centers Annual Conference | 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com | wendy@goldblumhess.com | 101 Greenwood Ave. Ste 380 Jenkintown, Pennsylvania 19046 By: Wendy Castor Hess, Esq. & Karen M. Pollins, Esq. Lancaster, PA October 7, 2014

  2. What is an IMG? • International Medical Graduate = physician who obtained a medical degree abroad; • Includes U.S. citizens who chose to go to medical school abroad; • Includes foreign born physicians who obtained Lawful Permanent Resident status or U.S. Citizenship; • Our focus will be on IMGs who come to the U.S. to pursue training/employment on a nonimmigrant (temporary) visa… Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  3. Recruiting Foreign Physicians & Providing Immigration Sponsorship • Great tool for recruiting and retaining qualified physicians! • Be careful not to discriminate in recruitment process! Treat all applicants the same – ask the same permissible questions: • Are you legally authorized to work for [our health center] in the U.S.? • Will you require visa sponsorship? • Type of visa sponsorship will depend on foreign physician’s current and previously held visa status… Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  4. Two Arms of Employment-Based Immigration Law for Physicians Nonimmigrant Immigrant (temporary) (green card) Can lead to U.S. Citizenship Professional Training EB-1 EB-2 EB-3 J F H-1B O Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  5. Nonimmigrant (Temporary) Options for IMG Physicians: H-1Bs, J-1s, J-1 Waivers and O-1s Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  6. H-1B Temporary Worker • Nonimmigrant visa classification for IMG trainees or practicing physicians to work for a specific employer • Duration: up to 6 years (with exceptions) • H-1B cap (65,000 + 20,000 visas per fiscal year – not enough to meet demand in recent years) • Certain institutions exempt from cap: (1) colleges/universities, (2) affiliated nonprofits and (3) nonprofit government/research organizations • J-1 Waiver beneficiaries also exempt Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  7. Requirements for H-1B Physicians • Medical degree; • USMLEs – Steps 1, 2 and 3 • ECFMG Certificate for English language fluency (not required for Canadian physicians); and • Valid state medical license. Note: Trainees with temporary licenses may be limited to H-1B status in 1-year increments (instead of the typical 3 years) Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  8. H-1B Petition Process • Obtain certified Labor Condition Application from U.S. Department of Labor • File H-1B Petition with U.S. Citizenship & Immigration Services – detailing position and IMG’s qualifications (degree, USMLEs, ECFMG certification, license, etc.); • Processing Time: • ~ 2 - 4 months via regular processing • 15 days via Premium Processing Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  9. J-1 Exchange Visitor • Nonimmigrant visa classification that permits IMGs to obtain post-graduate medical training • Duration: program length + 30-day grace period (generally limited to 7 years) • Pro: No annual cap! • Con: Requires return and physical presence in home country or country of last residence for two years. Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  10. Post-Training Options for J-1 Physicians • Go home– satisfy two year home residence requirement; • Obtain a waiver of J-1 two year home residence requirement; • Obtain O-1 or other nonimmigrant visa status (defers, does not eliminate, two-year home residence requirement); or • Obtain Asylum/Withholding of Removal. Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  11. J-1 Physician Waiver Options • Federal Interested Governmental Agency (IGA); • State Department of Health – Conrad 30 Program; • Exceptional Hardship; • Persecution. *** IMGs are ineligible for “no objection” waivers. Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  12. Federal IGA Waivers • Direct clinical employment by Interested Government Agency: e.g. Department of Veterans Affairs (VA), Delta Regional Authority (DRA), Appalachian Regional Commission (ARC). • Conducting outstanding research: Department of Health & Human Services (HHS)/NIH. Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  13. ARC J-1 Waiver • Physician must have job offer at a HPSA facility in an ARC county that serves Medicare, Medicaid and indigent patients • Limited to primary care • Need support of state DOH/governor • Physician must commit to working full-time (40 hours) for 3 years • Good faith recruitment effort in 6 months prior to waiver application submission • Contract restrictions – non-compete prohibited; liquidated damages required Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  14. Conrad State 30 J-1 Waiver Program • 30 slots per state per year • Physician needs job offer at a facility in a federally-designated underserved area (HPSA, MUA/P) • Exception: 10 of the 30 may be for physicians not located in federally-designated underserved areas, but who treat patients from such areas (FLEX) Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  15. Federal Conrad 30 Requirements • Must provide full-time (40 hours) clinical services (i.e. direct patient care) • 3 year service term (fulfilled in H-1B status) • Physician must agree to begin employment within 90 days of USCIS approval Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  16. Other State-Specific Considerations • Primary care versus specialty care • Application periods • Contract restrictions (e.g. non-compete clauses) • Filing fees • Reporting requirements • Number of slots utilized • FLEX waiver policy Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  17. J-1 Clinical Waiver Process • Register – Physician submits Application to obtain case number with U.S. Department of State (DOS) • Apply – Employer submits J-1 Waiver Application to State Department of Health (DOH) • DOH recommends waiver to DOS • DOS recommends waiver to USCIS • USCIS issues final waiver approval Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  18. Exceptional Hardship J-1 Waiver • Hardship to U.S. Citizen or Permanent Resident spouse or child • Need to show hardship if physician returns for two years either with or without qualifying relative • Process: • I-612 Application filed with USCIS • Reviewed by DOS Waiver Review Division • Processing time: ~ 4 - 8 months Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  19. Persecution J-1 Waiver • Persecution based on race, religion, or political opinion • IMG may also be eligible for asylum • Process: • I-612 Application filed with USCIS • Reviewed by DOS Waiver Review Division • Processing time: ~ 4 - 8 months Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  20. Immigrant (Permanent or “Green Card”) Options for IMG Physicians: NIWs and PERMs Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  21. Green Card Process • IMG physicians are usually in the Employment-Based, Second Preference (EB-2) category for “advanced degree professionals” • Generally a 3-step process (1) Labor Certification (PERM) Application filed with U.S. Department of Labor (2) I-140 Immigrant Petition filed with U.S. Citizenship & Immigration Services (USCIS) (3) I-485 Application to Adjust Status filed with USCIS (if priority date current…) Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  22. Introducing the Visa Bulletin Employment Based - October 2014 Visa Bulletin Messages: • “Priority Date”= date Application / Petition is filed with government • For those that require PERM, date PERM filed • For those that do not require PERM, date I-140 filed • There is a backlog for 2ND PREFERENCE physicians born in India and China Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  23. Labor Certification - PERM • Employer must place ads (i.e. test the labor market) to show that it was unable to recruit minimally qualified, willing and available U.S. workers for the position • Must show that IMG physician will be paid the “prevailing wage” in the area of intended employment Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  24. National Interest Waiver (NIW) • Waiver of labor certification requirement • IMG physician must agree to work in a medically-underserved area (HPSA, MUA/P) for 5 years • State DOH supports the NIW and issues a letter certifying that the medical service is in the “public interest” • Good option for IMGs who already have 3-year service obligation pursuant to J-1 waiver Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

  25. CONCLUSION • Although complex, immigration laws allow the recruitment of highly-qualified IMG physicians by U.S. employers! • Keys for Success: • Careful screening and strategic planning • Advance planning • Open communication • Participation by employer, IMG and legal counsel throughout process Goldblum & Hess| 215.885.3600 | 215.885.0324 (fax) | www.goldhess.com |

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