MEDICAL EMPLOYERS: HOW WILL YOU FILL YOUR STAFFING NEEDS?
Thanks to the new global economy, today's talent pool includes not just U.S. workers, but workers from around the world.That's why a comprehensive recruitment plan often features an immigration component to deal with the regulations governing the employment of foreign workers.
As a health care human resources professional, what aspects of immigration law do you need to incorporate into your staffing and recruitment plans? What strategies can help you ensure retention of foreign-born physicians, nurses, technologists and other professionals? What pitfalls do you need to avoid?
YOUR RESPONSIBILITIES AS AN EMPLOYER
  1. An employer cannot knowingly hire an "alien" (i.e., a non-citizen) who is not authorized to work in the U.S.
  2. An employer must also verify that every employee hired after November, 1986 is authorized to work in the U.S. Verification takes place when the employer and employee complete the "Employment Eligibility Form," commonly known as form I-9.
  3. The employer must keep adequate records in case of an audit.
HOW ARE FOREIGN CANDIDATES QUALIFIED TO ENSURE PROFESSIONAL STANDARDS ARE MET?
Two types of professionals - physicians and nurses - are treated differently when it comes to H-1B processing.
In order to obtain an H-1B for the purposes of practicing patient care medicine, physicians must pass all parts of one of the following examinations: (1) United States Medical License Exam (USMLE); (2) National Board of Medical Examiners (NBME); or (3) the Federation Licensing Exam (FLEX). Only the USMLE currently is being given. An international medical graduate (IMG) also must complete a medical residency in the U.S. before he or she can obtain a state medical license (remember that a state license must be attached to the H-1B petition). Even graduates of Canadian medical schools, who are not considered IMGs, must complete one of the exams listed above before they can qualify for an H-1B.
Registered nurses usually aren't considered professionals for purposes of obtaining an H-1B since most hospitals routinely hire staff nurses who lack a Bachelor of Science in Nursing (BSN). However, if an employer can establish that a particular RN position requires a four-year degree (say for a supervisory position), an H-1B may be approved. For the most part, however, there is no temporary visas for nurses. The Nursing Relief For Disadvantaged Areas Act Of 1999 permits certain hospitals to sponsor up to 500 nurses a year to enter the U.S. in temporary "H-1C" status. However, due to restrictions contained in the law, less than a dozen hospitals nationwide have been able to qualify to petition for H-1C nurses. Given the magnitude of the nurse shortage, a generally-applicable temporary visa category for nurses is badly needed.
WHAT ARE AN EMPLOYER'S IMMIGRATION OPTIONS?
1. The H-1B Visa
The H-1B Visa is a temporary work visa for professionals, good for up to six years. In most professions where a college degree is necessary, an employer may petition for a worker to obtain an H-1B. In health care, such professionals include dentists, dietitians, medical technologists, nutritionists, occupational therapists, pharmacists, physical therapists, psychologists, recreational therapists, researchers and physicians.
Drawback: there is a quota.
Since 1991,there has been a quota on the number of H-1B visas that can be issued during the federal fiscal year (September 30 to October 1). The quota was raised in both 1998 and 2000 to 195,000. On October 1, 2003, the quota fell to its pre-1998 level of 65,000. The quota was reached on February 17, 2004 although there are certain legal exceptions primarily for institutions of higher education and their affiliates as well as for nonprofit and government research organizations.
Drawback: the status is temporary.
Generally, a person may remain be employed in the U.S. in H-1B status for a maximum of six years.
At the end of six years, the H-1B worker must either leave the country for one year, change to another temporary status, or apply for "adjustment of status" to permanent residence.
Solution: Look to Canada or Mexico.
H-1B and H-1C visas are not the only temporary visas available to health care professionals. The North American Free Trade Agreement (NAFTA) allows the following health care professionals from Canada or Mexico to enter the U.S. in "TN" or "Trade NAFTA" status: dentists, dietitians, medical technologists, nutritionists, occupational therapists, pharmacists, physicians (teaching and research only), physical therapists, psychologists, recreational therapists and (perhaps most importantly) registered nurses. TN status is relatively easy to obtain and can be renewed indefinitely, which makes Canadian nurses, who usually speak English as their first language, a particularly good option.
Best Solution: Assist the employee to immigrate to the United States, become a permanent resident and eventually a citizen.
Our law firm assists the employer in completing the three-step green card process.
Step One is Labor Certification. Unless the foreign professional is a "superstar" (i.e., a person of extraordinary ability in his or her field), an outstanding professor or researcher, or a person whose employment clearly is in the national interest, then his or her employer must undergo the labor certification process in order obtain a green card on the employee's behalf.
Step Two is the Visa Petition. Once the Labor Department has approved labor certification, the employer must submit a Visa Petition to the Department of Homeland Security. In the petition, the employer must demonstrate it has the financial ability to pay the worker's salary and establish that the employment is full-time with no definite termination date. Documents establishing the worker's education and prior experience Documents must be attached to the petition. Canadian-trained physicians do not have to show they have passed the USMLE, NBME, or FLEX to obtain a green card, even though they must do so to obtain an H-1B.
Step Three is the Application for Permanent Residence. Once the visa petition is approved, and the worker's priority date is "current", the worker and his family may apply for permanent residence.
 In 1996, the immigration law was changed so that some health care workers are considered "excludable." These include nurses, PTs, OTs, medical technologists, medical technicians, PAs, and speech language pathologists. These workers must obtain a certification that their education, training, and English-language ability are equivalent to U.S. workers in the same occupation before they can obtain green cards.
Our Goal: Only the highest quality professionals are sought for our employers. This ensures quality health care for Americans and more efficient hiring and lower turnover for employers.
 
What we offer you
Assistance in completing the  CGFNS or the NCLEX examinations.
Job Placement: We will assist you in finding a job in the United States without having to pay a "middleman".
Great Pay & Benefits - Hospitals sponsor foreign-born nurses for permanent residence in the United States.
They pay foreign-born RNs at the same wage rates as U.S.-born RNs. Your benefits package is identical to that of U.S. nurses, including health insurance, parking, vacation and sick leave, etc.
We will complete the green card process for you and help your family members to immigrate to the United States.
 

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