Medical Graduates (FMGs) and H-1B Visa
H1 B, foreign workers, h1b visa, lawyers
Foreign Medical Graduates or FMGs may use the H-1B category
- they are undertaking teaching or research; or
- they are performing direct patient care (either as
interns or residents as part of graduate medical education,
or in a private medical practice or private or public health
care institution), provided several conditions are met.
Requirements for FMGs to perform direct patient care under the
- The alien doctor must have passed the Federation
Licensing Examination (FLEX) (parts I and II). Equivalent
examinations designated by the Secretary of Health and Human
Services include the National Board of Medical Examiners
certifying examinations (parts I, II, and III) and the
United States Medical Licensing Examination (steps 1, 2, and
The doctor is competent in oral or written English, as
demonstrated by passage of the English language proficiency
test given by the ECFMG (Educational Commission for Foreign
Medical Graduates), which currently sponsors foreign doctors
for graduate medical education in the J-1 category;
The doctor has a full and unrestricted license to
practice medicine in a foreign state or he or she has
graduated from a medical school in a foreign state; and
He or she has a license or other authorization required
by the state of intended employment to practice medicine (if
the state requires such a license or authorization).
For alien graduates of U.S. medical schools, items 1, 2, and
3 need not be met. Those doctors need only show that they
are graduates of U.S. medical schools and that they have a
state license. Similarly, Item 1 and 2 are inapplicable to
alien physicians who are of national or international renown
in the field of medicine and who have graduated from a
medical school in a foreign state. All other general
requirements of the H-1B category are applicable to FMGs,
alien doctors who are graduates from U.S. medical schools,
and alien physicians of national or international renown
seeking H-1B status. As a result, H-1B petitions for all
alien doctors are subject to the labor condition application
process as well as the annual cap.
FMGs seeking H-1B status must comply with identical
procedures applicable to other professionals seeking H-1B
classification. Their employer must file a petition for H-1B
status with the INS, and the petition must be supported by a
labor condition application (LCA). Furthermore, once the
petition is approved, the FMG must obtain a visa from a U.S.
consulate prior to admission to the United States.
Alien Physicians of Extraordinary Ability and O-1 Visa
Alien physicians of extraordinary ability also have the
option of using the O-1 nonimmigrant category. Such physicians
must have sustained national or international acclaim, with
extensive documentation of their achievements in the medical
field. With regard to graduates of foreign medical schools who
meet these standards, seeking entry in the O-1 category may be
the better alternative than the H-1B category given the simpler
procedures involved in obtaining O-1 status.
Canadian and Mexican physicians may also be eligible for TN
status under the North American Free Trade Agreement (NAFTA).
The main disadvantage in using this category, however, is that
the TN physician may engage only in teaching or research and
cannot engage in direct patient care; this rule applies as well
to Canadian and Mexican nationals who are graduates of U.S.
Preparation of Supporting Documentation for H-1B
The H-1B petition for an FMG must be submitted to the INS
with the following:
- A company letter stating the specialty occupation of the
beneficiary and containing a full description of the nature
of the duties which the beneficiary will be performing, the
anticipated length of stay and the arrangements for
- A copy of the LCA certified by the DOL .
- Form I-129W.
- Evidence that the FMG passed the Parts I and II of the
Federal Licensing Examination (FLEX) or an equivalent
examination (Steps 1, 2, and 3 of the U.S. Medical Licensing
Examination (USMLE) or Parts I, II, and III of the National
Board of Medical Examiners certifying examinations (NBME).
- Evidence that the alien has competency in oral and
- Evidence that the resident/physician position to be
filled by the FMG is a specialty occupation.
- Evidence that the FMG has a license or authorization
required by the state of intended employment, if the state
requires such license or authorization.
- Evidence that the physician has a full and unrestricted
licensure to practice medicine in a foreign state or has
graduated from a medical school in the United states or in a
- The employment contract (because a written contract is
not required, a summary of an oral understanding can be
- Evidence of the alienís status during past six years
if within U.S. during this time.
- Filing fee.
Note regarding the supporting documentation:
The employer must describe the job duties for the
position in the company support letter. In addition, the
employer should also outline the alienís prior education,
training or experience to show that the alien possesses the
credentials required by the H-1B category. Further, the
terms of employment, including the salary to be paid to the
alien, should be included in the letter. A summary of the
contract should be included in the company letter. This
summary should include a statement of the temporariness of
the alienís employment and the employerís intention to fully
comply with INS regulations including complying with the
terms of the LCA and paying the alienís return
transportation if terminated before the end of the period of
*Note that FMGs engaged in "specialty occupations" not
involving patient care or teaching or research may also use
the H-1B category, without the restrictions imposed for the
two uses described above. This use of the category might
arise for FMGs in private industry, such as a medical
director at a pharmaceutical company or a researcher with a
private for-profit employer.
As you can see, the process is complex and requires detailed
preparation of the necessary filings. For assistance with your
H-1B visa, please feel free to contact your immigration lawyers
Attorneys/Lawyers to assist you
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