Legislative Update for MDs

Last week the House of Representatives passed a continuing resolution that if passed will extend the doctor’s Conrad 30 program, which provides a common path for doctor immigration. The Conrad 30 program provides each U.S. state with 30 waivers for J-1 physicians each fiscal year.

The legislation also includes extensions of the EB-5. E-Verify, and Religious Worker programs. These extensions, which are embedded in the annual government funding legislation is now headed to the Senate where it is expected to be considered today. The legislation is expected to pass before October 1, 2009, or else the government’s funding will dry up.

The legislation does not contain any “new” legislation, such as H.R.2536 - Emergency Nursing Supply Relief Act. Nursing and allied healthcare occupational visa reform is more likely to happen in early 2010.

New USCIS Site

On Tuesday I was asked to participate in a call with USCIS Director Alejandro Mayorkas. The Director reached out to several prominent bloggers. The purpose of the call was to get feedback on the new USCIS website. To the Director's credit, he participated directly on the call. He answered questions directly from the bloggers and had several USCIS officials there to help him with some of the details that the director of a huge agency could not possibly know.

The new site has some very nice features. The most immediate improvement is that the site is clean and user-friendly. The updates to the Case Status section are commendable. Looking ahead, the Director explained that in May 2010 the site will alllow for interactive email service queries.

The site is still buggy. Many of the new links are not operable at this time; USCIS expects to fix the bugs in the next few days/months. Curiously the webpage URL’s are still unusually long. In the future, USCIS expects simplified URLs (e.g. www.uscis.gov/forms instead of http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=db029c7755cb9010VgnVCM10000045f3d6a1RCRD&vgnextchannel=db029c7755cb9010VgnVCM10000045f3d6a1RCRD. This URL is not a joke!).

The Director showed a self-deprecating sense of humor. After acknowledging that the link to the Leadership Biography page was not yet fully operable, he coyly remarked that the reason for the delay was because his biography was lengthy and he had not yet finished it.

But the best message that I heard is that the USCIS took the time to reach out to the community. In the past, USCIS announcements often come with a simple Press Release. This “new” USCIS approach to community outreach is laudable. The Director and his team deserves kudos.

Fewer International Nurses Interested in the US

During most of the 2000s, internationally trained nurses made up about 10-15% of all new RNs that came on-line in the US. These numbers disappeared with the onset of retrogression in January 2008. In spite of the retrogression, internationally-trained and educated nurses remained faithful to the US, as evidenced by the fact that internationally-trained RNs continued to take the NCLEX in great numbers.

In 2006, about 20,907 internationally educated RNs passed the NCLEX exam. In 2007, the volume jumped; 22,827 internationally educated nurses passed the NCLEX exam. With the onset of retrogression, 2008 saw a slight decline; 18,905 internationally educated RNs passed the exam.

But the latest numbers point to a massive drop in the numbers of internationally educated nurses passing NCLEX. Through June 30, 2009, only 7,236 have passed the exam, which annualizes to 14,472.

While the US nursing shortage certainly has eased in recent months, economists and government officials all agree that this is a temporary condition. By the end of the next decade the US could be short 250,000 to 1 million nurses, depending on whose estimates you read.

It is obvious that reasonable visa opportunities for international nurses must happen or else the US is going to find that it has a massive nursing shortage and international nurses are no longer there to fill the gap.

All statistics in this posting are from the NLCEX Fact Sheets, which are published on NCSBN’s webpage.

The Most Optimistic Scenario

I was recently asked by a client to offer my opinion on the most optimistic scenario of when we might see healthcare visa reform in the US.

Sen. Schumer (D-NY) is one of the Senate’s leading members and has long made immigration reform a legislative priority. With Sen. Kennedy’s passing, the Democratic leadership informally has tapped Sen. Schumer to draft the Comprehensive Immigration Reform (CIR) bill. Earlier this summer, he listed his principles for comprehensive immigration.

Sen. Schumer has long been a proponent of sensible immigration reform, including liberalized visa numbers in occupations that have been in short supply. In 2005 he helped pass the EX visa, which offered 50,000 visas for applicants holding Schedule A occupations and their immediate family members. Schedule A occupations are those occupations that have been certified in short supply by the Department of Labor (DOL). The DOL takes its role seriously and looks long-term before it lists and delists occupations from Schedule A. Schedule A presently includes Physical Therapists and Registered Nurses.

Democratic leadership already has decided that CIR will not be on the agenda until 2010. Whether that happens largely is dependent on President Obama and the Democratic leadership’s popularity ratings at the end of 2009. Both ratings have slipped in recent months.

If the Democrats and Pres. Obama can stabilize or improve their popularity, then it seems likely that they will be able to pass CIR in early 2010. US mid-term elections will take place in November 2010, and so any CIR bill must be done by the spring. No politician will want a CIR bill to drag into the summer of 2010.

Given that Sen. Schumer’s historical position on employment based immigration, it seems more likely than not that the CIR bill will include nurse visa reform. But there still are many hurdles to clear before we get to spring 2010.

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.