Many healthcare facilities located in rural and health shortage areas face challenges recruiting physicians, especially in high-demand specialties. However, many physician recruiters have been successful hiring foreign-born physicians to fill open positions and bring much needed care to their communities. These physicians can be a great option for hard-to-fill openings, but it’s important to understand the immigration and employment eligibility process in order to complete a successful hire. Here are five things every physician recruiter should know about recruiting foreign-born physicians.
1. Learn about J-1 visas, waivers, and work eligibility
The first step is to familiarize yourself with the terms commonly used when discussing hiring foreign-born physicians:
- A J-1 visa is granted to foreign medical graduates (FMGs) who desire to pursue graduate medical training in the United States. Upon completion of their medical training, FMGs are expected to return to their home countries for two years before applying for residency and work in the United States.
- A J-1 waiver removes the two-year home country obligation and allows a physician to apply for an immigration status that allows him or her to work lawfully in the United States. Healthcare facilities in designated shortage areas may sponsor candidates for a J-1 waiver to allow the physician to work in a lawful H-1B status. States are allotted up to 30 J-1 waivers annually, a majority of which are designated specifically for shortage areas.
- An H-1B visa is a temporary employment-related visa granted for an initial stay of three years with a possibility of an extension of another three years (for a total of six years), during which time a physician can work toward full citizenship while lawfully employed.
2. Get informed about the process
Jennifer Semling is manager of talent acquisition for Altru Health System. Headquartered in Grand Forks, ND, Altru serves a region of approximately 225,000 people in North Dakota and Minnesota, many of whom live in shortage areas.
Semling stresses the importance of understanding the process and knowing the dynamics that shape your region or state’s demand on allotted J-1 visas.
“Being really informed is the first step,” says Semling. “Make sure you understand the process and understand the restrictions around recruiting somebody who requires a J-1 waiver. Having a good understanding of what is available to you as far as visas helps the candidate know that you know what you’re doing. Importantly, it helps you not to overpromise and under-deliver. At some point, a J-1 candidate doesn’t have time to interview at a place only to find out they won’t even qualify for a visa.”
Semling further advises to have healthcare immigration legal expertise available to you, and to remain in close contact with your state’s Department of Health. This body oversees the first steps of the J-1 process and can help you understand what is available to you in your area.
3. Timing and planning is key
Jennifer Lynch is a regional director of provider recruitment for LifePoint Health. LifePoint owns and operates hospitals and healthcare facilities in 88 markets nationwide, predominantly in non-urban areas. Lynch recruits for nine facilities in towns where the population ranges from 8,000 to 100,000 people.
Lynch cites timing, planning, and preparedness as the most important factors for a successful J-1 hire.
“You have to know there’s a very strict timeline involved,” says Lynch. “Typically, the window for accepting J-1 waiver applications opens on October 1. In order to meet that timeline, all contracting must be complete and must account for time for an immigration attorney to review the contract. The facility has some legwork to do, the candidate has some legwork to do, and you must account for ample time.”
Being prepared for the October 1 window is critical. While some states may take months for all slots to be filled, others are gone within hours.
For example, Texas, one of four states in her territory, is notoriously difficult according to Lynch. “If you don’t have every duck in a row and a very certain sort of duck, you’re not going to get it,” she says.
4. Document your steps
Jennifer Waters-Plemon, physician and APC recruiter for Marshfield Clinic Health System in Marshfield, WI, underscores the importance of keeping appropriate documentation to support a J-1 hire.
In order to justify a non-U.S. citizen hire, several criteria must be met, including at least six months of advertising and recruiting for the position, records of the people you’ve recruited, and proof that the need cannot be met with a U.S. candidate.
“J-1 hires have helped our organization a lot in filling a lot of critical needs for which we are unable to get U.S. citizens to apply. But that’s a key part of the J-1 process — you cannot hire a J-1 if you have U.S. citizens that apply and are qualified for the position,” says Waters-Plemon. “So it’s important to document your efforts. In addition to advertising the position, we collect written letters of recommendation and complete a community assessment that documents all the reasons why a particular candidate is important to our community and to our clinic.”
5. Hire with a long-term mindset
Last, but not least, all three experts urge recruiters and physicians to look beyond the initial three-year commitment and look for a long-term fit.
“If you’re able to give candidates time and information, they can really focus on whether this opportunity and community are the right fit for them,” Semling says. “You don’t want to lose sight of the importance of finding that long-term match.”
“As a recruiter, one of the things I enjoy most is having conversations with folks and learning about how things are done in other countries and cultures,” Lynch says. “Don’t ever get a CV and deny them because they’re foreign-born or foreign-trained. Take the opportunity to have a conversation with that person because they may be exactly the fit you’re looking for.”
“Approximately 70 percent of our J-1 hires stay on at our organization longer than the three-year commitment, so to me that speaks highly,” Waters-Plemon says. “We would be foolish not to be open to J-1 candidates. There are a lot of foreign-born medical graduates, and if we don’t have U.S. citizens applying for those subspecialties, we’re basically eliminating physicians just based on immigration — not skills or training. It’s kind of a no-brainer.”