Submission of your state license is a requirement for filing the H-1B petition. You should allow yourself plenty of time to apply for a license in the state in which you intend to practice. You should do this while you have plenty of time left in J-1 status so that you can obtain a permanent license. If you obtain a temporary license with an expiration date USCIS may only grant your H-1B up until the date your license expires.

For help with your immigration issues call us at 415-986-6186 to schedule a consultation.  You can also always visit my website at: www.doctorsimmigrationlaw.com where we have free articles and resources to help you.

Typically many H-1B residents complete their residency in July. Normally if a doctor participates in a residency program as a H-1B resident s/he is not subject to the H-1B cap; however when you change employers to a for profit employer you will be “cap subject.” There are only 65,000 H1B visas available each fiscal year (which begins on October 1 of each year). The earliest that an H-1B petition can be submitted is 6 months before the start date of employment. Consequently, you must apply for a position with a start date of October 1st but there is a gap between the date your residency ends, typically July 1st, and the day you can start employment – October 1st. This gap in status is called the “cap gap”.

It is imperative that you plan appropriately for this gap by either extending your residency program until October 31st or returning to your home country until the beginning of your start date.

It is important that the physician works in an area that is considered a designated medically underserved shortage area or areas. The Department of Health and Human Services designates the medical shortage areas.

States do have some discretion in evaluating Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) and it is important that you determine the state’s methodology in determining whether the health care facility falls within a designated medically underserved area at the very beginning of the waiver process.  There are three primary HPSA designations that many states recognize for the J-1 Waiver Conrad 30 program.  The three designations are:  Geographic location, Federally Qualified Health Center and Population Group.  In addition many states also allow facilities to work in a location that is in a Medically Underserved Area (MUA).  It is important to verify with the State’s Health Department to ascertain whether the specific location qualifies as a designated shortage area, since states have the discretion to determine whether or not they will allow you to work in the specific location.

You may visit http://hpsafind.hrsa.gov/ or http://muafind.hrsa.gov/ to find out if the location is in a HPSA or MUA.

If the Department of State or State Health Department’s applications are not submitted with all correct documentation or an application was not completed accurately the State Health Department will either notify you of the errors or deny the application.  If the application is delayed the state may give the employer a deadline to rectify the error.

Some states will not provide a deadline but rather review other applicants. Thus, an incomplete or erroneous application could result in a denial.  In January 2009 we prepared and filed an application in California and there were only a couple of remaining slots left out of thirty.  Thus, our physician had waited until quite late before deciding to file her application.  We expeditiously completed her application and submitted it before the slots were filled.  In this instance we were able to take advantage of an earlier applicant’s mistake. When we filed our application we were informed by the State Health Department that someone ahead of us had failed to make a copy of their application. The State would therefore not consider this application as timely filed until they received another copy of the application.  This small mistake may have jeopardized the other Doctor’s ability to reside in the United States since our application was filed before that applicant was able to rectify their error.

The Employment Contract must include specific terms to comply with the State’s J-1 Waiver Conrad 30 requirements. Each state has their own unique employment contract requirements but in general many states require the following terms to be included in their contract:

• The contract should include the location of employment and designate the Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) ID number;
• The employment contract must indicate that the physician will work full-time (40 hours per week) at the specified health care facility;
• States may also require that the termination of the agreement only be for cause and not by mutual agreement;
• The Physician’s salary should be included in the contract;
• The field of practice and job duties may also be required in the contract;
• Some states also require the list of benefits, and amount of paid or unpaid leave provided to the physician;
• Some states require specific language to appear in the contract such as: “All Amendments to this Agreement shall adhere to State and Federal J-1 Visa Requirements;”

It is imperative that the correct terms required by the State Health Department are included in the agreement or certain states will not continue to process the application.

We worked with a large health care facility and physician that typically requires their employees sign their standard employment agreement.

Initially, they were not willing to cooperate with the physician to include the required terms necessary for the J-1 Waiver Conrad 30 program.  However, after I explained to the health care facility the necessity of incorporating the J-1 Waiver Conrad 30 terms the facility amended their contract.  Since this was a large institution with a Human Resources Department it took approximately one month for their HR and legal department to approve and incorporate the changes in the contract pursuant to my suggestions.  The physician prudently retained our office well in advance of the J-1 Waiver Conrad 30 filing schedule and we were able to revise the contract and submit a successful application resulting in a successful J-1 Waiver Conrad 30 application.

Last year I was talking to a very bright primary care physician who wanted to start the J-1 Waiver process approximately one month prior to completing residency.  Unfortunately for this doctor, I had to explain to him that he may need to return to his home country and wait for the J-1 waiver to be approved (since it takes the State Health Department, Department of State, and USCIS 2.5-7 months to adjudicate a J-1 Conrad 30 Waiver application).

In order to avoid this mistake, you should start the job search one year before completing residency.  For instance, if you are completing residency in July 2012, you should commence your job search ideally on July 1, 2011. Consequently, I recommend that you file your J-1 Waiver application early in the application cycle which will increase your employment opportunities and likelihood of obtaining a J-1 Waiver.  

The J-1 Waiver Conrad 30 program (or State 30 waiver) is a State Department Health waiver utilized by foreign medical graduate (FMG) physicians. Designated State Health Departments may recommend this waiver based on an offer to the FMG of full-time employment at a health care facility in a designated health care professional shortage area or at a health care facility which serves patients from such a designated area.

If you are on a J-1 visa and would like to obtain a J-1 Conrad 30 Waiver, you should commence the J-1 Waiver process early.  For example, if you complete your residency in 2012 it is prudent to start the process in 2011, one year before you complete your residency.

Many states allow J-1 physicians to file their J-1 waiver applications in the fall.  Popular states such as Florida, Texas, New York and California usually fill all of their thirty slots each year.  Many states accept applications on a first come first serve basis such as California, Texas and Washington.  Other states, such as Pennsylvania, will look at the healthcare needs in the specific area.

With this in mind, it is advantageous for you to commence preparation of the J-1 waiver Conrad 30 application in your third year of residency or one year before your residency ends. Planning well in advance of your graduation is paramount because of the following:

• Licensing – To ensure that you obtain the appropriate state license you should apply for it before your J-1 visa expires. Submission of your state license is a requirement for filing the H-1B application.  When applying for your license you should apply for the type of license that does not expire.  If your license has an expiration date the United States Citizenship and Immigration Service (USCIS) may grant your H-1B visa up until the date your license expires.)

• No objection letter- If you received funding from your home government, you will need to obtain a no objection letter. Depending on your home government, it may take anywhere from a few months to a year or longer to obtain this document.

• Prevailing Wage Requirements – The prevailing wage as set forth by the Department of Labor must be paid to the physician working in H-1B status. After you find an employer, you should confirm that the employer is willing to pay the prevailing wage.  The employer must pay the prevailing wage in order to meet H-1B requirements.

• Letters of recommendation – Some J-1 waiver Conrad 30 programs require letters of recommendation from mentors or professional colleagues. It can take two or more months to obtain appropriate letters.