2018 MN Rural Health Conference Session # 1F: Making Immigration Work for Labor Shortages in Rural Communities

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Gladys Pope
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1 2018 MN Rural Health Conference Session # 1F: Making Immigration Work for Labor Shortages in Rural Communities Presented by: Robert Aronson, Fredrikson & Byron Loan Huynh, Fredrikson & Byron Cassie Tinius, CentraCare Health June 25, 2018

2 Objectives of Program: Immigration Update Immigration Sponsorship Strategies for Rural Healthcare Providers Making Immigration Work for Physician Recruitment and Retention Resources to Assist in Integration into the Community

3 Immigration Update Buy American, Hire American Executive Order Extreme Vetting and Increased Scrutiny Immigration Enforcement

4 WHAT IS GOING ON IN HEALTHCARE STAFFING? WHERE DOES IMMIGRATION FIT IN?

5 Employment Visa and Other Options for Health Care Positions H1B Specialty Occupation J-1, Trainees & Interns O-1, Extraordinary Aliens in the Sciences & Business Country Specific Options TN, Mexico & Canada E-3 Australia H-1B1, Chile & Singapore OPT Extensions for STEM occupations E-Verify employers Curricular/Optional Practical Training (CPT and OPT)

6 H1B Specialty Occupation First choice for professional positions Applicant must have a bachelor s degree or equivalent Six year limitation Employer specific H-1B Cap vs. H-1B Cap Exemption

7 What is the H 1B Cap? 65,000 H-1B Visa Numbers + 20,000 Supplement Application Period Opens April 1 st Demand Substantially Exceeds Supply

8 F 1 Students OPT/CPT F-1 Students can request (CPT) curriculum practicum training while studying part-time, full-time in summer. OPT upon graduation provides 12 months employment for any employer in field of study. STEM EAD 24 months additional work authorization for e-verify employers with training plan.

9 The E 3 and H 1B1 Professionals E-3 Australia Available only to citizens of Australia Same eligibility requirements as H-1B No limitation regarding renewals/extensions Two year Admissions period H-1B1 Chile and Singapore Available only to citizens of Chile and Singapore Same eligibility requirements as H-1B No limitation regarding one year renewals/extensions

10 O 1 Extraordinary Ability Allows individuals with sustained national or international acclaim in the arts, athletics, science or business field to work in the United States Must show outstanding ability Initial approval up to 3 years, can be extended annually in 1 year increments Examples of qualifying O-1s: Business executives, Ph.D. scientists/researchers, critical employees Can use premium processing (but can take 2-3 months to prepare)

11 TN NAFTA Visa Available only to Canadians and Mexicans Limited to certain professional occupations such as management consultants, accountants, scientific technologist, engineers, systems analysts, dentists, nurses, or technical writers Status granted for three-year period (Note: Mexicans receive one year visa but granted three year status upon entry) No limit on renewals Canadians can apply at Port of Entry or Pre-Flight Inspection, or USCIS if in the U.S. Mexicans can apply at U.S. Consulates in Mexico or USCIS if in the U.S. Can be prepared quickly, within 2 weeks

12 Spousal Visas and Humanitarian H4 EAD Grounds Approved I-140, subject to backlogs and unable to file I-485 Adjustment of Status * at risk L2/E2 EAD Can apply upon entry of principal beneficiary in L1 or E status

13 Immigration Sponsorship Strategies for IMGs International Medical Graduates (IMGs) - Definition

14 Why Even Consider International Physicians? Shortages in Physician Workforce Non-Traditional Physician Provider Source Immigration Steers IMGs into Hard-to-Fill Positions o Geographic o Practice Specialty o Safety-Net Positions Immigration as Retention Tool

15 Disincentives to IMG Recruitment Time Expense Working with Attorneys (Ouch!) Cultural/Linguistic Concerns Stability/Duration of Commitment Concerns with Clinical Capabilities Complexity of Immigration Process

16 A Recruiter s Perspective Practical Tips Recruitment Strategies Establishing the Internal and External Partners Managing the Immigration Discussion Costs and Fees

17 What to Do When Considering IMG Candidate? Contact Immigration Counsel Early in Recruitment Cycle Get Strategy Memo o Great Recruitment Initiative o Troubleshoot at the Beginning

18 How to Get Competitive Edge in IMG Recruitments Understand Objectives of IMG o Good Job/Career Advancement o Stable Immigration Address Immigration Objectives Up-Front Form the Team/Involve Immigration Counsel Sensitive to Dependents/Spousal Issues Demystify Permanent Resident Process Consider Transparent IMG Policy

19 Three (3) Paradigms of IMG Recruitment i. J-1 Exchange Visitor ii. H-1B Temporary Worker iii. Permanent Resident

20 J 1 Exchange Visitor

21 What is a J 1 Exchange Visitor? Temporary, Non-immigrant Visa Limited to Graduate Medical Education Seven Years Duration Mandatory Two-Year Home Residential Obligation

22 Implications of Two Year Residence Obligation As long as the obligation remains in existence, a J-1 physician is ineligible for: o H-1B Visa o Permanent Residence

23 J 1 Physician s Options Upon Conclusion of Graduate Medical Education (GME) Get a Waiver Return to Home Country for Two Years O-1 Option (Quite Selective) as Alien of Extraordinary Abilities

24 J 1 Waiver Options: 3 Options Exceptional Hardship to Anchor Relative Persecution Sponsorship by Government Agency

25 Why Would Government Agency Override IMG s Return to Home Country? Single Reason: To Serve the Public Interest

26 4 Government Waiver Paradigms Physician-Scientist (NIH) USG Employer (VA; U.S. Army) Federal Government Agencies (HHS or Regional Agencies) State Departments of Health (Conrad State 30 Waiver)

27 Conrad State 30 Waiver Program Administered by State Department of Health Limit of 30 waivers per fiscal year o FLEX Waivers for Non-Medically Underserved Placements o Waivers: Restricted to HPSA/MUA/MUP Opens October 1 Valid for Primary Care or Specialty Care Physicians

28 Underlying Policy: To Expand the Safety-Net to Medically Vulnerable Patient Populations

29 If Waiver Granted, Then What? 3-Year H-1B Obligation Need to Fulfill or Else Ineligibility for Permanent Residence Retention Function

30 H 1B for IMGs with J 1 Waivers Temporary, Non-immigrant Six Years Duration Employer Sponsored/Employer Specific Always Exempt from H-1B Cap

31 Permanent Residence Options Two Basic Options: PERM Labor Certification Application National Interest Waiver

32 Integration into the Community Timelines for Permanent Residence Make Immigration Work for your Retention Program Attention to Spouse and other Dependents

33 Final Thoughts: Putting the Pieces Together Need for Advanced Planning Putting Together the Team Attorney as Part of Recruitment Team Develop Immigration Policy Cost Considerations/Cost Underwriting

34 Questions?

Immigration Options for Foreign Students

TERMINOLOGY Immigration Options for Foreign Students Myers Thompson PA 400 1 st Avenue North, Suite 520 Minneapolis, MN 55401 (612) 349-3062 jmedeiros@myersthompson.com John Medeiros Attorney Nonimmigrant