NMDA Journal Fall 2019

nmdental.org 9 The applicant to your position says, “I need to get an H-1B visa.” Annu- ally, the U.S. Congress sets a limit of 85,000 slots that allow individuals with at least a Bachelor’s degree to enter the country and be em- ployed via sponsorship. On one day each April, all the H-1B visas are allocated to employers (sponsors) for the upcoming year through a lottery. About 7,000 of the H-1B visas are reserved for individuals from Chile and Singapore. Both large and small businesses can participate in the annual lottery. Of the allotted visas, 20,000 fall into the “masters cap,” reserved for the highly educated—including dentists. After the slots are allocated to the cap, the sponsored dental jobs not selected for it may also enter into the second pool of 65,000 giving them two chances, from the in- dividual perspective, to “win the lottery.” Among the challenges for those selected in April are to remain “in sta- tus” and survive economically until the following October, the start of the next Federal fiscal year, when paid employment is first allowed. H-1B visas permit admission to the country for up to six years. This lim- it creates challenges. As time passes, should one return home or move elsewhere in the world; should a “green card” be pursued; should citi- zenship be obtained; and under what conditions can one practice and for which employers? An applicant for your position asks, “Will you sponsor me for a green card?” Expiration of the H-1B visa requires one to leave the country voluntarily or face deportation. A “green card” is a status that allows one to live permanently in the U.S. and permits one to work. Having a “green card” is a step which may be achieved during the six years and it requires the permission of a sponsoring employer to be pursued. If citizenship is desired, it takes between six months to a year to be processed, thus several years are involved after initial permission to enter the country. An applicant for your position asks, “Are you cap exempt?” There is an avenue to avoid the annual 85,000 cap under certain circumstances, and this occurs frequently for dentists with either F-1 or soon to expire H-1B visas. There are“cap exempt”employers: universities, non-profit organizations affiliated with higher education institutions, as well as non-profit and governmental research organizations. Federally Qualified Health Cen- ters, with active written affiliations with schools, are H-1B cap exempt. Some educational institutions sponsor immigrant students under H-1B visas which also triggers the six-year stay limitation. So, if one is required to repeat a two or four-year course of education, a different status and/or employer must be obtained quickly. The applicant for your position asks, “I am a J-1 visa dental student, can you employ me after graduation?”Most international dental students are admitted into the country under J-1 visas. The J-1 visa covers all courses of study at approved institutions of higher education from Au Pairs to Research Scientists and everything in between. In addition, international students may be admitted as J-1’s to den- tal and medical residency and fellowship programs whether or not they previously attended U.S. professional schools. In the latter cases, graduates typically have licensure, board certification, and reimburse- ment obstacles. Often the only remedy to these obstacles is to repeat the missed U.S. professional education, i.e., full completion of dental or medical school. There were 1,446 J-1 visa holders in NM in 2018 according to the U.S. Department of State Exchange Visitors Program. They were of many different disciplines. The U.S. designates educational institutions and other organizations to be sponsors. J-1 visa students are not allowed to work, unlike F-1 students or those with H-1B visas. At graduation, J-1 students must return home, complete additional education, or find employment through the H-1B processes. Certain organizations may be designated to allow temporary J-1 on campus work assignments or short-term work during summer vaca- tions. J-1 students are not allowed to “moonlight” outside of their educational program nor are they allowed to “moonlight”within their training institutions thus displacing U.S. citizens. The applicant to your dentist position says, “I have a doctor friend who got a J-1 waiver. Can you offer that to me?” Dental students and dental employers frequently ask about receiving a “J-1 Visa Waiver” to allow one to change visa type and get around the termination date attached to an active student visa. There is not a waiver of a return to one’s home country for dentists, un- like physicians. This forces job-seeking J-1 dental graduates into the H-1B pool or need to seek employment in cap exempt entities. Under federal legislation, physician employers are allowed to ask for an “interested government party” (in New Mexico, the State Depart- ment of Health) to authorize a waiver of the federal requirement that all international medical school graduates completing residencies return to their home countries for two years before they can enter the country through regular immigration procedures, i.e., H-1B. Each state is allowed to support 30 physicians annually under the “Conrad Visa J-1 Visa Waiver” legislation. New Mexico fills 30 physician slots annually through the waiver procedure. The physicians must also receive a “no objection” statement from their home countries, agree to work for organizations serving residents of “Health Professional Shortage Areas”, and agree to practice for three full-year terms. Dentists do not benefit from the waiver program. The basic language of immigration is complicated and if one is con- sidering hiring immigrant dentists, it is a must to contact both an immigration attorney and a contract attorney to answer the question, “What to do?” Resources TheU.S.DepartmentofStateofferscompressive informationon immigrationonthe internet,especially through the Exchange Visitor Program through whichmany international dentists are allowed to enter the country: travel.state.gov/content/travel/en/us-visas/study/exchange.html ADEAmaintains a list of dental schools participating in international programs: www.adea.org/dental_education_pathways/CAAPID/Pages/CAAPIDDirectory.aspx The U.S. Department of Labor offers information on the H-1B program: www.dol.gov/whd/immigration/h1b.htm For a recent review of state licensing issues see Sergio Varela Kellesarian, “Foreign Trained Dentists in the United States: Challenges and Opportunities,” Dentistry Journal, September 2018: www.ncbi.nlm.nih.gov/pmc/articles/PMC6162558/ NewMexico Health Resources is a non-profit organization that recruits up to 100 or more health professionals annually through two programs in conjunction with the NewMexico Department of Health. NMHR recruits between 15 and 30 dentists each year to NM.