PERMANENT RESIDENCE FOR THE FOREIGN PHYSICIAN
Who Benefits?
Health care employers that employ foreign physicians are often asked to support or sponsor the physician in the permanent residence process. What are the incentives for the physician to seek U.S. permanent residence, and how does the employer benefit from the process?
From the physician's perspective, U.S. permanent residence is an important objective, if the physiciann intends to live and work in the United States long term. Physicians who have received graduate medical training in the United States have many quality of life and financial incentives to remain in the U.S. after they have completed their residency or fellowship training. Whether they trained as a J-1 Exchange Visitor, or as an H-1B specialty occupation worker, they will typically need to enter the medical work force in H-1B status. If they trained as J-1, they have up to six years to work in H-1B status, and time within which to complete the permanent process time. However, the physician who has trained as H-1B has used up 3 to 4 years, and in some cases 5 years of H-1B time. These physicians are on a much tighter time schedule within which to commence and complete their permanent residence process.
Physicians who are India or China born have a different problem. The India and China categories in the second employment based categories are chronically backlogged. Indians and Chinese can expect to wait 2-4 years longer than other nationalities, for the availability of a permanent visa. A place in the visa queue is established when the employer commences the permanent residence process, through the filing of an application for alien labor certification (PERM). Bottom line: Employers of Indian and Chinese born physicians should commence the process as quickly as possible.
For other nationalities, it is also a good idea to begin the PERM process as soon as possible, as it is also possible for the "rest of the world" to develop backlogs in the visa queue, and as in all immigration procedures, delay is seldom helpful, what with processing delays and other unexpected issues that can arise.
What does the employer benefit from this somewhat expensive and complicated process? First, it is helpful to remember that immigration sponsorship by an employer is not mandatory, it is totally discretionary. But as a practical matter, it is usually desirable to sponsor the physician, in order to improve the chances for long term physician retention. Sponsorship for immigration does not guarantee that the physician will stay beyond completion of the permanent residence process. However, employer refusal to sponsor practically guarantees that the physician will leave, because he or she definitely needs a permanent residence case in order to stay in the U.S. beyond the six-year H-1B limit.
Secondly, immigration sponsorship is a useful recruitment tool. An employer who is willing to offer an immigration budget as part of the physician contract, has a greater chance of recruiting the physician.
Permanent residence sponsorship usually is beneficial to both employer and physician. Usually, it is advisable to start the immigration process as soon as possible, in order to establish a place in the visa queue.
