Hiring International Physicians—Knowing the Terminology Is Half the Battle -- Part 1

With the estimated shortage of physicians in the United States over the next decade ranging anywhere from 90,000 to 200,000 fewer physicians than needed to meet the health care needs of our growing and aging population, most health care organizations are likely to find themselves having to recruit more and more internationally born and educated physicians. Navigating the federal government's complex immigration rules and regulations in order to successfully and legally hire international physicians can be daunting. Part 1 of this article covers some basic terms commonly encountered while recruiting and hiring such physicians. Familiarizing yourself with these terms will make them sound a little less "foreign" and will alleviate some of the hesitation you may feel when considering hiring internationally born physicians.

Basic Terms

International Medical Graduate (IMG)

An IMG is a person who has graduated from a medical school located outside the United States, Puerto Rico, or Canada,¹ or who is otherwise qualified to practice medicine outside of the United States. All IMGs wishing to enter the United States to provide direct patient care must be "credentialed," that is, must have passed the National Board of Medical Examiner's (NBME) credentialing exams or their equivalent. The Educational Commission for Foreign Medical Graduates (ECFMG) currently administers NBME's credentialing examinations in the form of the United States Medical Licensing Examination (USMLE). The credentialing requirement is waived for IMGs who are of national or international renown in the field of medicine; were licensed and practicing medicine in the United States before January 9, 1978; or who are coming to the United States to teach or to conduct research in which no direct patient care is involved.

Immigrant

An immigrant is a person authorized to live and work in the United States generally without limitation as to duration of admission or scope of lawful activity within the United States. This classification does not include persons with temporary visas or statuses.

Nonimmigrant

A nonimmigrant is a person who has been issued a temporary visa by a United States consular officer (if overseas), as well as a person who has been allowed into the United States by an authorized United States official for a limited duration and purpose, and who is often restricted as to what activities they may engage, (i.e., an H-1B nonimmigrant admitted into the United States for temporary professional employment with a sponsoring employer).

Visa

A visa is an official document issued by the U.S. Department of State that is affixed to an individual's passport or other travel document that signifies a consular officer believes the individual to whom the visa was issued is eligible to apply for admission into the United States in a particular nonimmigrant or immigrant status. Initial issuance of a visa can only be issued by a United States consular officer outside the United States. A visa does not guarantee admission to the United States. Even with a visa, admission can be denied if the government officer inspecting the visa holder at the border believes the individual is not eligible to be admitted in the status for which the visa was issued. The period of validity of a visa establishes the time during which the alien may present himself or herself at a United States port of entry. However, a visa?s period of validity is not the same as the authorized period of temporary stay in the United States. The authorized period of temporary stay granted to a visa holder may be less than the visa?s period of validity, or it may be longer. The admission document (Form I-94) issued to the visa holder at the border, and not the visa itself, is the document that determines an individual?s status in the United States, as well as for how long and what type of activities in which the individual may lawfully engage while in the United States.

Admission

Admission is the lawful entry into the United States after inspection and authorization by an official from the United States government.

Status

When a foreign national arrives at the border of the United States, he or she must be inspected by an immigration inspector at the port of entry. The inspecting officer will date stamp admission, write or print the class of admission and the period of authorized stay on a Form I-94 Admission/Departure Record before stapling it into the individual's passport, and will then place the same annotation in the passport next to the admission stamp. This act grants the admission status to the individual. Overstaying or violating status, such as working illegally, is a removable offense.

Lawful Permanent Resident

Lawful permanent residency is the status of having been lawfully accorded the privilege of residing permanently in the United States as an immigrant in accordance with the immigration laws of the United States. Lawful permanent residents are often referred to as “green card holders” because one former version of the document that served as proof of lawful permanent resident status used to be primarily green in color. Interestingly, most of the other prior versions of the document used to be more blue in color. The current version of the document, the Permanent Resident Card Form I-551, is a sophisticated personal identification document that contains holograms and other imbedded security measures.

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¹ However, Canadians who graduate from non-Liaison Committee for Medical Education accredited schools are considered IMGs.