Physician Immigration J1/H1B

J-1 Waivers for Physicians

J-1 physicians who have entered the United States through sponsorship form Educational Commission on Foreign Medical Graduates (ECFMG) for clinical training (residency and fellowship training) are subject to a two year home residence requirement. These physicians are not permitted to change to H or L status, or apply for a green card until they have returned to their home country for two years, or until they have been granted a waiver of the two year home residence requirement. Waivers can be very difficult to obtain. Even doctors who marry a US Citizen cannot secure a US Immigrant Visa (“green card”) without a waiver, or satisfying the two-year requirement.
The waivers available to J-1 physicians include interested government agency waivers, persecution waivers, and hardship waivers.
Clark Hill’s Immigration practice group has extensive expertise with J-1 and H-1B Physicians, J-1 waivers and green cards for Physicians. Please hit the “contact us” link below if you would like a free publication.

IGA Waivers

Interested Government Agency (IGA) waivers can be granted to those J-1 physicians who are sponsored by an employer based on a commitment to work for at least three years in a medically under-served area of the U.S. several agencies are willing to support a J-1 waiver, including the Department of Veterans Affairs (VA), the Appalachian Rural Commission (ARC), and the Department of Health and Human Services (HHS), Delta Regional Authority. Each state is permitted to grant up to 30 waivers each year (Conrad State 30 Program).
To be granted a waiver, the employer and the physician must comply with several requirements. They must demonstrate that they have entered into an employment contract, confirming that the physician will work for 40 hours per week, for a minimum of three years. Employers must be able to show that they have engaged in recruitment to search for minimally qualified US workers. The employer must also demonstrate that the work will take place in an area that has been designated by HHS as medically under-served, with two exceptions. First, a waiver sponsored by the VA does not require the work to be in an under-served area. Second, each state, through its Conrad State 30 Program, is permitted to grant up to five waivers for work that is not located in an under-served area, at the states' discretion. The waiver is initially filed with the interested government agency, then forwarded to the US Department of State, and finally to the US Citizenship and Immigration Services (USCIS). Processing times vary from 4-16 weeks. It is important to note that timing is a concern, especially if an employer is processing the J-1 waiver through the Conrad State 30 Program. Many states have established set application periods. Employers and Physicians will need to be aware of these deadlines in states that receive large numbers of J-1 waiver applications.

Hardship Waivers

Hardship waivers can be granted to those J-1 physicians who can demonstrate extreme hardship to a qualifying relative, including a US citizen or lawful permanent resident spouse and/or child. He/she must show that the qualifying relative would suffer extreme hardship both if the J-1 physician returned to his/her home country without the qualifying relative for two years, and that the qualifying relative would suffer extreme hardship if he/she returned to the J-1 physician's home country for two years. Extreme hardship can be demonstrated through medical, psychological, financial, and educational means. The waiver is initially filed with USCIS. If USCIS agrees that the qualifying relative would suffer extreme hardship if the two year home residence requirement is enforced, the waiver is forwarded to the US Department of State for their opinion. If the US Department of State also determines that extreme hardship exists, the waiver decision is sent to USCIS, where the waiver can be granted.
As an alternative, a J-1 physician is also permitted to apply for an O-1 visa. Note that a J-1 physician is not permitted to change his/her status from J-1 to O-1 in the US. The O-1 petition must first be approved by a USCIS Regional Service Center, and then the J-1 physician must apply for the O-1 visa at a U.S. Consulate abroad. Also, note that is the J-1 physician can obtain an O-1 visa, he/she remains subject to the two year home residence requirement.

H-1B Visas

US employers frequently use the H-1B Visa category to quickly hire foreign nationals. A foreign national generally qualifies for H-1B status if he/she holds at least a US Bachelor’s Degree (or equivalent) relevant to the field in which he/she will be working, and the position normally requires at least a Bachelor’s Degree as an entry-level requirement to perform the job. The H-1B Visa must be sponsored by a US employer. The H-1B Visa is usually granted for three years and extended up to a maximum of six years. Any time spent in the US working for another employer in H-1B or L-1 Visa status will count against the six-year limit. Another six years of H-1B Visa time may be available once the foreign national spends one full year outside the US. Foreign nationals may seek US Immigrant Visa (“green card”) status while on an H-1B Visa.
A petition for H-1B status must be filed with the USCIS Regional Service Center no more than six months before the requested start date. The USCIS may take several months to process an H-1B. However, for an additional $1,225.00 processing fee, the USCIS will review the petition in 15 days.

H-1B Extensions Beyond 6 Years

Extending H-1B Visas beyond the six-year limit is possible in some circumstances. Specifically, if the first step in the green card process (Immigrant Worker petition or PERM Labor Certification) is filed before the end of the foreign national’s fifth year in the US on an H-1B, then generally the H-1B can be extended one year at a time until the green card is approved or denied. Alternatively, if the H-1B employee cannot finalize his/her green card status because of priority date backlogs, then generally a three-year extension can be secured, as long as the I-140 Immigrant Worker Petition is approved, and the green card case remains pending. Finally, time spent out of the US while on an H-1B can be added to the time an H-1B employee can work in the US. This is referred to as recapture, and in general, any credible proof is accepted (passport stamps, copies of airline tickets, etc.

H-1B Cap

The US government limits the number of new H-1B Visas to 65,000 per year (the government’s fiscal year runs from October 1 to September 30). Once this limit, or “cap”, is reached, an employer cannot employ a foreign national in H-1B status until the next fiscal year begins. It is important to note that foreign nationals who currently hold H-1B status and are either extending and/or amending that H-1B status or are seeking H-1B status with another employer, are generally not subject to the cap. Foreign nationals who will be employed at and in furtherance of the basic or applied research of a governmental or non-profit research organization, or an institution of higher learning (college or university), are not subject to the cap. Finally, J-1 physicians who have been granted a waiver to work in a medically undesired area are also exempt from the cap.
20,000 additional H-1B's, beyond the 65,000 listed above, are available to foreign nationals who have a Master's Degree, or other advanced degrees, from a US college or university.


The employer must pay the H-1B worker the wage it pays similarly experienced US workers for the same job in the same location, or the wage as determined by a required wage survey, whichever is higher. H-1B workers generally must be paid from the sponsor’s US payroll. H-1B workers should not pay for any H-1B costs or attorney fees.

H-1B Portability

H-1B portability allows a foreign national, who currently holds H-1B status, to change employers more quickly. Once the new employer files an H-1B petition, and it has been received by the USCIS, employment with the new company may commence. This saves significant time, as the employer does not have to wait for approval of the H-1B, which could take several months. In some cases, H-1B workers may travel internationally while utilizing H-1B portability.

H-1B Extensions

H-1B employees who have an extension of status filed and pending are allowed to work for up to 240 days, while the extension is pending. International travel is not permitted once the status expires, even though the H-1B employee can continue working.

Changing H-1B Status and International Travel

A foreign national in the US in a lawful immigration status (other than H-1B), who is applying for a change to H-1B status, generally should not travel outside the US while his/her H-1B petition is pending. The USCIS can deny a change of status petition if it determines that a foreign national has departed the US while the H-1B petition is pending. However, these international travel limitations may not necessarily apply for foreign nationals changing from one H-1B employer to another H-1B employer.

Family Members
The H-4 Visa is available to the spouse and children (under the age of 21) accompanying the H-1B applicant to the US. The H-4 Visa is generally granted for the same period as the H-1B employee and must be extended accordingly. As with H-1B change of status petitions, international travel should be postponed for those filing a change to H-4 status. Time spent in the US on an H-4 does not count against that foreign national’s six-year limit on an H-1B, as described above, if he/she obtains a separate H-1B. H-4s are not eligible for US social security numbers but can apply for ITINs with the US Internal Revenue Service. H-4s cannot work but can attend a school or a university.


Assisted clients on how to respond to growing demands to make their companies and products more sustainable, a goal increasingly being adopted by companies in the health care industry

Tracks regulatory developments for health care industry clients to provide early warning of significant new regulations or risks to a company's business, particularly concerning issues relating to FIFRA compliance for chemicals which claim to reduce Ebola, norovirus, and other viruses that are unlikely to have been explicitly testing in the original pesticide registration process 

Advised on methods of responding to regulatory agency and press concerns about the presence of "toxic" chemicals in products used by the health care industry

Commented on EPA rulemaking s for a trade association representing a segment of in the health care industry 

With assistance from  Kristi Gauthier,  Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan.  U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier,  which had been sued by a healthcare service provider for unpaid patient attendant care fees.  The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law  fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee).  Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits.  Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority.  As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney  fees are recoverable for our client.  Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.

Antitrust and Trade Regulation - Reported antitrust decisions include the following: Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 815 F.2d 270 (3d Cir. 1987), rev’g, 632 F.Supp. 653 (M.D. Pa. 1986), cert denied, 484 U.S. 851 (1987); Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 745 F.2d 248 (3d Cir. 1984), aff’g, 574 F.Supp. 457 (M.D. Pa. 1983), cert. denied, 471 U.S. 1060 (1985).

Representation of rehabilitation entities.
Represented non-profit hospital in a conversion to for-profit status.
Represented hospital in merger transaction.

Managed Care and Health Care Industry Litigation - Counseled clients and litigated third party reimbursement and accounting for reimbursement issues.

Represented physician parties in corporate split-ups.
Represented major corporation in various acquisition and divestiture transactions involving developing technology.
Representation of medical billing companies.

Managed Care and Health Care Industry Litigation - Practiced before state and federal agencies and the courts relating to Medicare and Medicaid reimbursement issues.

Represented nephrology clinics in a merger into a publicly traded company.
Represented parties in sales of medical practices to hospitals and in divestitures of medical practices from hospitals.
Representation of medical staffs and hospitals on amendments to medical staff bylaws.
Formation of and counsel to medical professional corporations.

Antitrust and Trade Regulation - Antitrust litigation experience includes representing clients in the insurance, health care, soft drink, construction, manufacturing, hardware and building materials industries.

Formation of joint ventures between hospitals and physicians.

Managed Care and Health Care Industry Litigation - Litigated issues related to institutional providers’ Medicaid cost reports.

Represent healthcare insurers, third party administrators, managed care organizations and others in contractual, business and other disputes. Representation includes counseling clients and litigating issues regarding payments, accounting for payments, third party administration and self-insured health plan issues, fraud claims, among others

Antitrust and Trade Regulation - Lead Counsel in an antitrust case which successfully put an end to a decade’s long boycott against one of the largest dental insurers in the country.

Managed Care and Health Care Industry Litigation - Litigated provider participation status under the Medicare program.

Counsel to mid-market health care companies including cancer treatment centers, dialysis centers, sleep labs, and ambulatory surgery centers providing lead counsel and coordinating legal counsel on a wide array of matters including corporate matters, operations, acquisition and divestiture transactions, joint venture projects, corporate governance, business planning and financial transactions, and legal compliance.

Formation of joint ventures among physicians.

Health Care Industry Litigation - Participated and litigated in several federal bankruptcy and state court receivership proceedings of hospitals.

Clark Hill PLC Receives National and Regional Rankings in the 2021 Edition of Best Lawyers “Best Law Firms”Clark Hill Attorneys Selected for Inclusion in the 2021 Edition of Best Lawyers in AmericaClark Hill Attorneys Named to DBusiness Magazine's 2020 Top Lawyers ListClark Hill PLC Receives National and Regional Tier 1 Rankings in the 2020 Edition of Best Lawyers “Best Law Firms”Clark Hill Attorneys Named 2019 Michigan Super Lawyers & Rising StarsClark Hill Attorneys Named 2019 “Leaders in their Field” by Chambers USAClark Hill Strasburger Member Corinne Smith Named to Trinity University Alumni Association BoardHealth Care Attorney Kevin Wood Featured in Texas Medical Association Article on Investments in Medical PracticesClark Hill Attorney Andrew B. Turk Featured in AZ Business Leaders 2019Clark Hill PLC Receives National and Regional Tier 1 Rankings in the 2019 Edition of Best Lawyers, “Best Law Firms” Sixty-Six Clark Hill Attorneys Named 2018 Michigan Super Lawyers & Rising Stars143 Clark Hill Attorneys Selected for Inclusion in the 2019 Edition of Best Lawyers in AmericaClark Hill Attorneys Named 2018 “Leaders in their Field” by Chambers USAClark Hill Attorneys to Present at the 2017 MCMCFC Spring Management ConferenceClark Hill Princeton Welcomes Attorney Jeanne StiefelClark Hill Attorney Andrew B. Turk Named Top AZ Business Leader by AZ Business MagazineClark Hill Attorney Gerald “Jud” DeLoss to Present Behavioral Health Managed Contracts Webinar on July 14, 2016Clark Hill Attorney Gerald “Jud” DeLoss to Present at the American Health Lawyers Association Annual Meeting in Denver, CO, on June 28, 2016Clark Hill Attorney Andrew B. Turk Named 2016 Top 100 Lawyers in Arizona by AZ Business Magazine
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