H-1B visas are perhaps the most common temporary options for physicians. Similarly, physicians often receive permanent residence through an employer-sponsored I-140 petition. Both of these immigration options require that the foreign national have certain licenses and credentials.
Physicians are eligible for H-1B status to engage in teaching or research or for clinical practice if they meet the H-1B visa requirements and examination and licensing requirements to work in the U.S.
The examination requirements include passage of all steps of the USMLE, FLEX, or NBMEE. A combination of the examinations cannot be used to satisfy the H-1B requirement even though it may satisfy some states licensing requirements.
To determine eligibility requirements for state licensure, contact the state medical boards. Some states may not grant a license until the physician obtains a social security number but the social security office will not grant a social security number until the physician obtains an H-1B visa which leads to a “catch-22” for some physicians. To overcome this obstacle, obtain a statement from the state medical board stating that they cannot issue a license to the physician until he/she obtains an H-1B visa and submit this statement with the H-1B petition. The immigration service will then grant the H-1B for one year so that the physician can obtain a social security number.
To obtain an H-1B for teaching or research positions, the foreign medical graduate or physician must meet all other requirements of the H-1B by demonstrating that he/she has all of the necessary qualifications to fill the specialty occupation. Foreign medical graduates must provide evidence that they are graduates of a medical school in the U.S. or in a foreign country or have a full and unrestricted license to practice medicine in a foreign country. Also, the foreign medical degree or license must be equivalent to an M.D. in the U.S. An ECFMG certificate may be sufficient as evidence that the foreign medical degree or license is equivalent to an M.D. but the immigration service may still request an educational equivalency degree evaluation. Physicians applying for H-1B for teaching or research positions that involve no more than incidental patient care are not required to pass the required examinations (FLEX, USMLE, or NBMEE) and there is generally no license requirement.
For a physician to obtain an H-1B visa to work in a position that involve direct patient care either as a clinical medical practitioner or as a graduate medical trainee, the physician must be sponsored by an employer and must maintain an employer-employee relationship with that employer. The credentialing and licensure requirements are extensive and must be carefully documented in the H-1B petition. However, a foreign medical graduate who is nationally or internationally renowned in the field of medicine may be exempt from the licensing examination and English language competency requirements.
The degree requirements for physicians seeking an H-1B visa as a clinical medical practitioner or graduate medical trainee are the same as the degree requirements for physicians seeking positions that only involve teaching or research with some incidental patient care.
Satisfaction of the examination requirements for some physicians can be challenging since the examinations have changed over the years with the U.S. Medical Licensing Examination (USMLE) being the only examination offered currently. The physician must pass all three steps of the USMLE. Physicians who have passed the older examinations such as steps 1 and 2 of the Federal Licensing Examination (FLEX) or all three parts of the National Board of Medical Examiners Examination (NBMEE) or an equivalent examination as determined by the Department of Health of Human Services (HHS) will also satisfy the examination requirement of the H-1B. As mentioned previously, passage of a combination of the examinations cannot be used to satisfy the H-1B requirement even though it may satisfy some states licensing requirements.
Many graduate medical trainees or residents are not eligible for an H-1B to enter a residency program since most states require that the FMG complete one year of residency training before being eligible to take step 3 of the USMLE. FMGs interested in being sponsored for H-1B status must travel to a state that allows the physician to take the USMLE prior to completing the first year of their residency programs.
Graduates of Canadian medical schools who have passed the Medical Council of Canada Qualifying Examination (MCCQE)/Licentiate of the Medical Council of Canada (LMCC) must also pass all three steps of the USMLE or equivalent in order to qualify for an H-1B. However, physicians may be exempt from the English competency examination if they graduated from a Canadian medical school accredited by the Liaison Committee on Medical Education (LCME).
All physicians applying for an H-1B to provide direct patient care in the U.S. must provide evidence of their proficiency in oral and written English unless the physician graduated from a medical school accredited by the LCME. Acceptable evidence of proficiency in oral and written English is a certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) showing the beneficiary passed the English language proficiency test.
Finally, all physicians applying for an H-1B to work directly with patients must have a license or other authorization by the state where the physician will be working. Physicians who change H-1B employers are required to have the appropriate license or authorization for the state where they intend to work.
The physician must meet the admissibility requirements established by section 212(a)(5)(B) of the Act, relating to examinations that immigrant physicians must pass in order to immigrate. Evidence must be provided that the physician has passed parts 1 and 2 of the National Board of Medical Examiners Examination (NBMEE) or an equivalent examination as determined by the Secretary of Health and Human Services (HHS), and evidence that the beneficiary is competent in oral and written English.
Examinations equivalent to the NBMEE include the:
Visa Qualifying Examination (VQE)
Comprehensive Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS)
U.S. Medical Licensing Examination (USMLE)
A combination of the examinations cannot be used to satisfy the I-140 requirement even though it may satisfy some states licensing requirements. Satisfaction of the examination requirements for some physicians can be challenging since the examinations have changed over the years with the U.S. Medical Licensing Examination (USMLE) being the only examination offered currently.