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Healthcare Blog

October Visa Bulletin Released

The October Visa Bulletin has been released. This is the first quarter of the 2010 US Fiscal Year. The news is not positive.

EB1: All Current
EB2: All Current, except China (22MAR05), India (22JAN05)
EB3: All 01JUN02, except China (22FEB02), India (15APR01), Mexico (01MAY02).

Based on these processing times, a typical EB3 Nurse takes over 7 years to arrive in the United States, and even longer if the nurse was born in China, India, or Mexico. The US nursing shortage certainly has abated in the last few months, but all credible economists opine that the nursing shortage will reemerge with a vengeance shortly after the economy turns and employment numbers stabilize.

MU calls on Congress to review the employment based visa immigration policy in this country and offer up an alternative to these ridiculous processing times. There is an excellent piece of legislation that, if passed, will create a special immigrant visa category for nurses. The legislation is H.R.2536 - Emergency Nursing Supply Relief Act and is sponsored by Rep. Wexler (D-FL) and Rep. Sensenbrenner (R- WI). The ENSRA is a good place to start.

FCCPT Type II Suspended

On September 1, the FCCPT suspended the FCCPT Type II Visa Screen process. FCCPT has determined that the original purpose of the Type II had been accomplished. The idea behind the Type II was to streamline the process for applicants already in the US. The streamlined process under Type II did not include an educational credential review.

Applicants with Type II Applications that are pending before FCCPT may complete the Type II service or they may change to the Type I service, prior to December 31, 2009. More information on the suspension of the Type II program is available at the FCCPT website.

Must I Pay Unlicensed H-1B Workers?


A client of mine recently asked me an interesting question. This client recruits Physical Therapists, although the lesson applies to all licensed occupations. They are getting ready for their H-1B hires to enter the US in October. But they have a question about when they need to pay these workers, many of whom have not yet received their licenses.

First a little background. The National Physical Therapy Exam (NPTE) is not offered overseas. Accordingly, all PTs must enter the US in order to sit for the licensing exam. The USCIS often approves unlicensed PTs for H-1B visa status, and there is ample Guidance to support these decisions.

My client’s approved PTs must then come into the US, sit for the NPTE, and then obtain their state license. Once they obtain the state license, they can begin their PT work.

The problem is that this plan bumps up against the Department of Labor’s rules on salaries to H-1B workers. 20 CFR 731(c)(6) and (7) say that H-1B workers must be paid their salaries within 30 days of entering the US. This may be problematic because it is rare that the worker enters the US, sits for the exam, and is granted the license in just 30 days.

Subsections (c)(6) and (7) also says that worker must be paid once s/he “enters into employment,” which includes “reporting for orientation” and “studying for licensing examinations”.

There are a few solutions to this dilemma, although none of them are ideal from the employer or employee’s perspective (my experience is that the H-1B workers would be willing to sacrifice all or some of their pay while waiting for the results of their licensing exam):

One solution that is in compliance with (6) and (7) is to make sure that the PT is fully ready to take the licensing exam when the PT enters the US so that you can use the full 30 day period before entering the employee into employment. If at all possible, training, and orientation should be done outside the US.

Another solution is to bring the H-1B worker into the US to take the licensing exam, and then immediately cycled back out of the US while waiting for the remainder of the licensing process. H-1B workers who aren’t in the US aren’t subject to (6) and (7).

A last strategy is initially to file the workers for part-time or hourly H-1B status. This doesn’t obviate the need to pay the wages, but can reduce the salary obligation.

AAIHR Annual Meeting

The AAIHR is holding its Annual Meeting of Members September 16, 2009 in Washington DC. The agenda includes the election of the next term’s Directors. On September 17, 2009 the AAIHR members will be walking the halls of Congress and will be promoting the ENSRA for inclusion in the CIR. Staffing companies and recruiters are invited to join via the AAIHR’s webpage.

H-1B For Nurses

I often am asked by employers and nurses, whether they can be sponsored for an H-1B visa.

There are two key concepts:

1. The nurse must hold at least a Bachelors degree in nursing (e.g. BSN); AND
2. The position must normally require a Bachelors degree.

MU has seen the most success in these scenarios:

A. The hospital is offering the nurse a position as a Clinical nurse specialist (CNS), Certified registered nurse anesthetist (CRNA), Certified nurse-midwife (CNM), or a Certified nurse practitioner (APRN-certified) Critical care and the nurse holds the certification;

B. If the nurse will be working in an Administrative position ordinarily associated with a Bachelors degree, such as Charge Nurse or Nurse Manager;

C. If the nurse will be working in one of these specialties: peri-operative, school health, occupational health, rehabilitation nursing, emergency room nursing, critical care, operating room, oncology and pediatrics. And the hospital will attest that these roles are only offered to those with Bachelors degrees. Some magnet hospitals have the BSN as its standards, and these make great destination hospitals for H-1 RNs.

Reform Minded?

Late last week Homeland Security Secretary Janet Napolitano hosted 130 immigration reform leaders at the White House. The purpose of the meeting was to tamp down the growing chorus that the administration was ignoring immigration reform. The President even dropped in. The plan may have worked. Many would-be critics of any CIR legislative delay went and released positive messages shortly after the meeting.

For those interested in healthcare immigration reform, the next few months are critical. If you are interested in liberalizing needed visas for US healthcare workers, now is a good time to meet with your local Congressional delegation, as they are all in their home districts until early September.

Meeting with Congressional representatives is surprisingly easy. All that one needs to do is to place a simple call to the Representative’s office. These phone numbers are readily available on Representatives’ webpage. Everyone who is interested in the US should take the time to contact their Congressional representatives and/or have their friends and family in the US do so.

The message is a simple one:

1. The Department of Labor predicts that the Registered Nurse occupation will grow faster than any other job in the next seven years. (Chart at Table 8 of link).
2. There are not enough US nurse educators to train the next generation of nurses.
3. There is an excellent piece of legislation that, if passed, will create a special immigrant visa category for nurses. The legislation is H.R.2536 - Emergency Nursing Supply Relief Act and is sponsored by Rep. Wexler (D-FL) and Rep. Sensenbrenner (R- WI).
4. The legislation calls for 20,000 nurses per year, for three years. An additional $1,500 is added to visa fee. The $90 million that this legislation raises goes directly to US nursing schools who can use the funds to train the next generation of US nurses.

H-1B Cap History

The recent economic downturn greatly has impacted H-1 filings. As I have explained in the past, these lower numbers provide compelling evidence against the argument that internationally-trained workers are being used to displace American workers and lower US workers salaries. That argument just doesn’t jibe with what is actually happening.

In the first five days of this H-1B season in April, the USCIS says that it received 42,000 H-1B petitions. The total is now about 45,000. This tiny increase in number is attributed to two factors: (i) the tougher measures being employed by both USCIS and the DOS; and (ii) the current economic condition in the US.

H-1B History:

(Note- Fiscal Year runs from October 1 of the prior year until September 30 of the next year. You may file for an H-1B 6 months in advance of the October 1 start of the fiscal year. In other words, the FY2010 H-1B “season” began on April 1, 2009).

FY 2009: Immediate (First week of April 2008)
FY 2008: Immediate (First week of April 2007)
FY 2007: April 1, 2006 - May 26, 2006
FY 2006: April 1, 2005 - August 12, 2005
FY 2005: April 1, 2004 - October 1, 2004
FY 2004: April 1, 2003 - Feb 17, 2004
FY 2003: Not reached (Cap was 195,000)
FY 2002: Not reached (Cap was 195,000)
FY 2001: Not reached (cap was 195,000)

Politics in the Spotlight

President Obama has just announced that the CIR bill, which is long-desired by immigration reformists, will be pushed off until 2010. The President remains committed to the cause but he is concerned that his efforts on health care, global warming, and the financial crisis will be hampered by another major issue like immigration. This strikes a blow against the healthcare immigration community, who was hoping that a CIR bill could be the force behind liberalized healthcare visa reform.

The other political issue in the spotlight is the resignation of Sen. Sen. Martinez (R-FL) and Sen. Bailey-Hutchinson (R-TX). On one hand these two Senators have been general supporters of immigration reform and so their resignations are unwelcome. Sen. Bailey-Hutchison particularly has been a leader on healthcare visa reform.

On the other hand, since both are Republicans, their influence in Senatorial matters is negligible at this point. Also, since they both are from states with increasing immigration populations, it is expected that any replacements will be unlikely to hinder any CIR legislation. To do so would alienate their constituency.

My thoughts on the chances of retrogression relief

As readers of my blog surely are aware, retrogression has made it difficult for nurses to enter the US on the immigrant visa because of the long processing times. There is an excellent piece of legislation that, if passed, will create a special immigrant visa category for nurses. The legislation is H.R.2536 - Emergency Nursing Supply Relief Act and is sponsored by Rep. Wexler (D-FL). The bill should allow for nurses to enter the US in about one year's time once the program is up and running.

The key question is whether the ENSRA will ever be acted upon. Presently, the legislation, like all immigration related legislation that isn't deemed critical, has an effective hold on it. Congress would like to address all special immigration at once in a massive Comprehensive Immigration Reform bill (CIR). And they would like to do it this fall. Sen. Schumer is taking the lead. The hope is that Sen. Schumer (D-NY) can craft a piece of legislation that will not suffer the same fate as CIR did when it was last offered.

The good news for those in favor of increased nurse visa numbers is that Sen. Schumer has long been a champion of increased nurse visa numbers. In 2005 he led the charge for a special Nurse Exempt visa that was signed into law in May 2005. That bill provided 50,000 visas for nurses and their families. Sen. Schumer is expected to introduce the bill this fall. Because of Sen. Schumer's past work on liberalized nurse visa numbers, I am optimistic that he will either encompass Rep. Wexler's ENSRA or use the principles behind the ENSRA in his CIR.