Securing a Visa Eligible Position: Job Search Guidance for Nephrologists with Visa Requirements

More than one-third of nephrology trainees are on a visa and will require employer sponsorship. Navigating the job search and immigration process can be a challenge. We’ve compiled a few important tips to help you be successful as you seek career opportunities that qualify.

It’s never too early to start looking for a job

As a visa-holder, everything is a matter of timing. You will have a series of deadlines to hit no matter what path you take, so it is essential to be proactive. The best way to do this is to start looking for a job as soon as possible. We recommend beginning your search 12-18 months in advance of your graduation date or the date you’d like to transition employers if you’re already working. Make sure you note your visa status on your CV so prospective employers are aware. 

Use your network to get connected with others who have navigated the job search as a visa holder. Former fellows who have found visa-eligible jobs can tell you if their current practice is hiring again.

Do your research. Ads posted on industry job boards will generally include information about visa eligibility. If you are on a J-1, you can research underserved areas that qualify in regions you are interested in living. 

Understanding your Visa Requirements

Whether you are seeking jobs that qualify for your H-1B visa or J-1 visa, you’ll want to make sure to understand your current status, how long you have remaining in status and what steps you may want to take to ensure you secure a job in time. It’s a good idea to connect with an immigration attorney to discuss your case and understand the requirements and associated timelines.

H1-B Visa

For doctors who are training on H1-Bs, there are two challenges. The first is that a person can only spend six years in H1-B status. Fellowship and residency usually take up 5-6 years of this. That means these physicians need to do some urgent green card processing. 

It is essential that you plan in advance how you’re going to navigate the green card process.  The best way to do this is by getting a job very early, so an employer can help you through the process. Physicians need to be putting in the work around the intersection of residency and fellowship to make sure they don’t run out of time. 

During training, most H1-B physicians are working in nonprofits or hospitals that are academic in nature. So, most of these physicians are exempt because they are at nonprofit organizations.
When H1-B physicians go to look for a job, it is important to understand there is a nationwide cap on how many H1-Bs there can be. But there are exemptions. These exceptions are for institutions of higher education, nonprofit organizations that are affiliated with higher education, and the government. If you are looking for a job at a for-profit organization such as a private practice, you are immediately subject to the national cap. To solve this, there is a nationwide lottery. Those that are chosen get to keep their H-1B status, the rest do not. Getting selected in the lottery is challenging. In 2022, there were over 400,000 physicians in the lottery, but only 85,000 H1-B visa slots were available. 

There are some ways to improve your odds. For example, if you have an advanced degree from a US college, you get some extra help because you get to go through twice, but other than that, everyone is in the same bucket. Then there are ways to have a workaround. If a physician is employed by a for-profit institution such as a private practice, but works most of their time at a nonprofit hospital, that is an exemption.  These are rare cases, but they do happen.

The lottery should always be considered a last resort and you should have a back-up plan in place in the likely event you aren’t chosen in the lottery.

J-1 Visa

Every physician who comes to the US on a J-1 for the purpose of a medical residency or fellowship promises that when they complete that training they return to their home country for two years. This requirement doesn’t go away under most circumstances. There is no waiting period or even exception for marriage. The only way around this two-year requirement is to get a waiver, the most common of which is a J-1, which involves signing a 3-year contract to work in an underserved area that is designated by the Health Resources Services Administration (HRSA).

Of these kinds of waiver programs, the most well-known is the State Conrad 30 program. The rule is that each state can support 30 physicians per fiscal year.  The challenge with these programs is that each state, regardless of size, gets the same number of physicians. So, California gets the same number of allotted physicians as Rhode Island.  This is done so that there are still incentives for physicians to go to smaller, less popular locations. You can research guidelines in the states you’re interested in pursuing to understand how they issue their 30 waivers, in addition to when the program begins accepting applications and when it closes. Some states are more competitive so if you have a specific geographic preference, you’ll want to start early to try to secure a waiver.

In addition to the Conrad 30 program, there are agencies of the U.S. government that are empowered to provide waivers for the same contract term. The important difference is that federal agencies are allowed to offer as many waivers as they want — they are uncapped. This makes them an invaluable resource for anyone looking for visa eligible positions.

There are several of these federal agencies, each of which specializes in a different kind of medicine or demographic:

Appalachian Regional Commission serves 423 counties across 13 states in the Appalachian region, including all of West Virginia.

Delta Regional Authority covers counties in 8 states, with virtually all of Louisiana.

Southern Crescent Regional Commission is brand new and covers counties in 8 states all along the east coast and Gulf of Mexico. The emergence of the SCRC is very exciting as it covers the entire state of Florida, which is an extremely popular destination. Guidelines are still being finalized, but it should be ready by the time the fiscal year resets in October.

It’s important to note that each of these agencies has similar, but still different, requirements and guidelines.  On top of that, every state has a federal program that administers how they allot their waivers differently from every other program. While there is no standardization between states or agencies, there are some commonalities. For example,  the types of things that vary between agencies and states are relatively consistent. Specifically, deadlines and rubrics are almost always different from state to state or agency to agency.

Immigration Counsel

If you have worked with an immigration attorney on your case previously, stay in touch so you are aware of deadlines and the next steps that may be required. Once you have identified a job opportunity that qualifies, check to see if they have an immigration attorney they prefer to use. Many employers who can sponsor a visa have done so before and will have an immigration attorney whom they’ve used previously. They can easily connect you with them to get the immigration process started.  However, if you’ve used another immigration attorney who you prefer to work with who knows your case already, feel free to ask the employer if you can continue working with yours.  

Keep in mind that for H1-B visa sponsorship, the US Department of Labor mandates that all fees and costs be paid for by the sponsoring employer. None of these can be passed on to the employee. For J-1 visa sponsorship, the cost issue is less clear-cut. Many employers will still pay the fees even though it’s not legally required.  

Connect with USRC

The Physician Services team at US Renal Care has many years of experience helping visa holders find a job and can provide guidance along the way. Our website, US Renal Link, is a free resource to help nephrologists succeed on the most crucial career steps. We help nephrologists find their ideal job and provide resources to equip you throughout the process. Our Job Board lets you browse openings from all over the country, sort by geographic preference, visa eligibility and more. We also host several nephrology-specific events throughout the year, including fellowship program dinners where we cover tips to secure your ideal nephrology job, immigration guidance, how to negotiate contracts and more. Contact us to schedule a meeting with your program. Learn more about our open positions here

Immigration attorney Elissa Taub contributed to this article.

Elissa J. Taub is an attorney in the Memphis office of Siskind Susser PC, where she practices primarily in the areas of physician and nurse immigration. She has extensive experience with J-1 waivers, H-1Bs, O-1s, EB-1 extraordinary ability petitions, National Interest Waivers and labor certification based green cards, as well as a variety of other business and family immigration processes.