Labor Certification for Physicians

Immigration based on an employment offer as a physician must also include labor certification from the Department of Labor, unless exempted from that requirement.  To obtain labor certification the physician must have a state license in the state where the labor certification is filed at the time it is filed or must be able to obtain license within a proximate time of the person's entry.   The Labor Certification process is explained elsewhere on this website.

Immigration Under the National Interest Waiver for Physicians in Underserved Areas

The national interest waiver for physicians in underserved areas relieves the petitioner only from the labor certification process. If you are:

• A petitioner requesting a national interest waiver on behalf of a qualified alien physician, or
• An alien physician self-petitioning for second preference classification,

based on medical service in a Health and Human Services Department-designated underserved area or a Department of Veterans Affairs facility, you still must meet all eligibility requirements for this immigrant classification in order to be eligible for the national interest waiver.

Other Alternatives for Physicians:

H-1B Visas for Physicians

A foreign physician may now enter the U.S. under certain conditions to practice medicine with an H-1B visa.

Current regulations permit a graduate of a medical school who is coming to the U.S. to perform services as a member of the medical profession, if:

She or he is coming pursuant to an invitation from a public or nonprofit private educational or research institution or agency in the U.S. to teach or conduct research, or both, at or for such institution or agency (physician may do incidental patient care);

or has complied with each of the following:
(1) Has passed the Federation licensing examination (administered by the Federation of State Medical Boards of the United States) or an equivalent examination as determined by the Secretary of Health and Human Services. Parts 1 & 2 of FLEX (Federation Licensing Examination), and Steps 1, 2 &3 of the NBME (National Board of Medical Examiners) have been replaced by  Steps 1, 2 and 3 of the USMLE (United States Medical Licensing Examination). and
(2) Has competency in oral and written English, as demonstrated by passage of the English language proficiency test given by ECFMG (Educational Commission for Foreign Medical Graduates), or is a graduate of a school of medicine which is accredited by a body or bodies approved for the purpose by the Secretary of Education (regardless whether the school of medicine is in the United States). 

The ECFMG certification is required for all foreign physicians as a prerequisite for entering medical training programs in the United States. Applicants must pass four examinations for ECFMG certification: USMLE Steps 1 & 2 (or its equivalent), TOEFL (Test of English as a Foreign Language) and Cas (Clinical Skills Assessment). Candidates need only take USMLE Step 1 and TOEFL prior to taking the Cas exam.

Foreign physicians seeking H-1B status must also:
(1) Have a license to practice medicine from a foreign state, or have graduated from a medical school in the United States or in a foreign state, and
(2) If she or he will provide direct patient care, they must also have a medical license or other authorization to practice medicine required by the state of intended employment.

J-1 Visa

The J-1 Visa allows a physician who is entering U.S. to participate in an exchange visitor program that has been designated by the DOS (formerly U.S. Information Agency); and whose participation includes such purposes as teaching, studying, observing, conducting research, consulting, receiving training (e.g., student to do post-graduate work; scholars doing research; medical students).  Admission may be for up to 18 months for training to several years for a college or university student.

E-2 Visa

Physicians as Investors: A foreign physician may invest in a medical practice and obtain an E-2 visa if she or he is from a treaty country and is not involved in patient care.

O-1 Visa

The regulations state that O visas are available to people of "extraordinary ability" working in the sciences, arts, education, business, athletics, or the motion picture and television industries.  USCIS policy, however, has interpreted these areas to include any field of endeavor. 

Extraordinary ability means distinction, which is defined as prominent, leading, or well-known in the field.

Foreign physicians may enter without the certifying examinations where physician is of national or international renown. Doctors of national or international renown are not within the definition of foreign medical graduates and are therefore exempt from the restriction.

Registered Nurses  

 "Long Beach Memorial Medical Center gave me a chance along with the help of attorney Janis Peterson-Lord, who helped me from petition to receipt of my green card.  I sincerely thank her office for all her help." Cecilia Birondo, RN

Registered Nurses and Physical Therapists Qualify Under

Schedule A Precertified Labor Certification

Permanent Residency Application

Schedule A means the list of occupations set forth at CFR § 656.10, with respect to which the USCIS has determined that there are not sufficient United States workers who are able, willing, qualified and available, and that the employment of aliens in such occupations will not adversely affect the wages and working conditions of United States workers similarly employed.  This means that those offered positions of professional nurse or physical therapist do not have to engage in the regular Labor Certification process which requires the prospective employer to show that there are no U.S. workers available for the position.

To qualify under the Schedule A precertified labor certification process a registered nurse:

1.      Must have a diploma, certificate, baccalaureate degree, or associate degree signifying successful completion of a program for professional nurses, and

2.      Must have a nursing license issued by the home country.

3.      Must have a job offer from a U.S. employer for a position that qualifies as a professional nurse.

        "Professional nurses" means persons who apply the art and science of nursing, which reflects comprehension of principles derived from the physical, biological, and behavioral sciences. Professional nursing generally includes the making of clinical judgments concerning the observation, care, and counsel of persons requiring nursing care; and administering of medicines and treatments prescribed by the physician or dentist; the participation in activities for the promotion of health and the prevention of illness in others. A program of study for professional nurses generally includes theory and practice in clinical areas such as: obstetrics, surgery, pediatrics, psychiatry, and medicine.

Occupations included under professional nurse are:

Director, School of Nursing Nurse, Anesthetist Nurse, Consultant Nurse, Head Nurse, Instructor Nurse, Office Nurse, Practitioner Nurse, Private Duty Nurse, School Nurse, Staff Nurse , Community Health Nurse, Supervisor Occupational Health Nurse, Supervisor Nurse, General Duty Instructor, Psychiatric Aide

4.      Must present evidence that you (i)  have passed the Commission on Graduates of Foreign Nursing Schools (CGFNS) Examination; or (ii) hold a full and unrestricted license to practice professional nursing in the State of intended employment, or (recently added alternative) evidence that you have successfully passed the NCLEX-RN test.

The CGFNS is an independent, nonprofit organization which developed this examination to test capabilities of foreign professional nurses in all areas of nursing for which American nurse graduates are responsible, and to give an objective estimate of their ability to pass licensure examinations in the United States. The examination is given yearly in April and October in the United States and approximately 30 other countries throughout the world.

5. Prior to the visa being issued, the Visa Screen certificate or certified statement must be obtained from the International Commission on Health care Professions.  The components of this requirement are:

a.       Proof of English language proficiency by the passing of all three sections of the Test of English as a Foreign Language ( TOEFL), or Michigan English Language Assessment Battery (MELAB), or the International English Language Testing Service test (IWLTS), or the Test of English in International Communications (TOEIC);

b.      An equivalency evaluation of the nursing credentials, including diplomas and license administered by ICHP, or, alternatively,

                                                  i.      A certified statement issued by CGFNS in lieu of the Visa Screen certificate for nurses who completed nursing education in English in a country so designated: at this time including Australia, Canada, Ireland, New Zealand, South Africa, the United Kingdom, and the United States.

                                                ii.      Along with evidence of passing the National Council Licensure Examination (NCLEX).

6.   The employer must submit financial documentation that shows that it possesses the ability to pay the wage of the applicant.