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Chris Musillo on Nurse and Allied Health Immigration



    by , 08-11-2014 at 08:52 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo

    New USCIS Chief Leon Rodriguez was nominated for the job shortly after Alejandro Mayorkas accepted the positon of Deputy Secretary of the USCIS. Director Rodriguez was sworn into the role on July 9, 2014. Mr. Mayorkas’ tenure as Director was marked by greater engagement with the public than his predecessors. Mr. Mayorkas regularly attended AILA functions and routinely held “town hall” style meetings with the public.

    Mr. Rodriguez seems poised to continue in this manner. USCIS will be holding a stakeholder teleconference on Thursday, Aug. 14, from 1:30 to 2:30 p.m. ET, with USCIS Director Léon Rodríguez.

    During the teleconference, Director Rodríguez will introduce himself to the USCIS stakeholder community and answer questions. Teleconference registration details are expected shortly.

    Read the Musillo Unkenholt Healthcare and Immigration Law Blog at or You can also visit us on Facebook and follow us onTwitter.


    by , 08-06-2014 at 08:39 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo

    According to a 2012 “United States Registered Nurse Workforce Report Card and Shortage Forecast,” published in the American Journal of Medical Quality,

    “With an aging U.S. population, health care demand is growing at an unprecedented pace . . . The number of states receiving a grade of “D” or “F” for their RN shortage ratio will increase from 5 in 2009 to 30 by 2030, for a total national deficit of 918,232 RN jobs. There will be significant RN workforce shortages throughout the country in 2030; the western region will have the largest shortage ratio of 389 RN jobs per 100,000.”

    The situation is no better in other allied healthcare occupations. According to the Department of Labor’s Occupational Outlook Handbook by 2022, employment of Physical Therapists is expected to skyrocket by 36 percent. The same is true of Occupational Therapists (29 percent), Pharmacists (14 percent), and Speech Language Pathologists (19 percent).

    Contrary to some public perception, International Healthcare Professionals are not undereducated. Prior to issuance of a visa, the International Healthcare Professional’s education, training, past licenses, and experience must be verified and proved that it is authentic and comparable to an American healthcare worker of the same type. International Healthcare Professionals must pass English fluency exams prior to visa issuance.

    International Healthcare Professionals are also not underpaid. Because of strict USCIS and DOL wage requirements, International Healthcare Professionals must be paid the greater of prevailing and actual wages. International Healthcare Professionals cannot have their hours reduced. The employer must pay the guaranteed minimum hours unless the International Healthcare Professional is unavailable for work because of non-work related factors, such as the worker’s own voluntary request for time off, or in other circumstances where the worker is unable to work.

    The PERM labor certification process guarantees that there are no US workers ready, willing, and able of performing the position before any International Healthcare Professional is granted an immigrant visa. Employers cannot make International Healthcare Professionals sign onerous contracts, including those contain penalty clauses.

    Recent studies are pointing to the high quality of care provided by International Healthcare Professionals and the added value that they bring to the US healthcare industry. Patricia Cortes, Assistant Professor, Markets, Public Policy and Law, Boston University, authored a 2012 study, Relative Quality Of Foreign Nurses In The United States.

    She found that,

    "foreign nurses, in particular Filipinos, tend to work in more demanding settings and maintain less desirable schedules - they are more likely to work in hospitals, work full-time, and do shift work, as compared to their native counterparts.

    Natives are more likely to work part-time and choose jobs with standard schedules - for example, they tend to work in physicians’ offices and schools, etc. In terms of educational background, the majority of foreign nurses have at least a bachelor’s degree, whereas a larger fraction of natives have an associate degree. A more educated nurse workforce (as measured by the share of nurses in a hospital holding a bachelor’s degree) has been associated with better patient outcomes and higher nurse productivity."

    Read the Musillo Unkenholt Healthcare and Immigration Law Blog at or You can also visit us on Facebook and follow us on Twitter.

    by , 07-28-2014 at 03:23 PM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo

    Musillo Unkenholt LLC turned five years old on July 1, 2014! It would have been impossible to have our five years of success without the hard-effort and talent of our Legal team. In celebration of our fifth birthday and in recognition of everyone's hard work, we will closing the office at 12 noon (ET) on Wednesday July 30. We are having a group outing at the Cincinnati Reds baseball game. If you contact us during the afternoon of July 30, rest assured that we will promptly return your call or email on Thursday.

    Read the Musillo Unkenholt Healthcare and Immigration Law Blog at or You can also visit us on Facebook and follow us on Twitter.

    by , 07-24-2014 at 10:12 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo

    USCIS has just published and released an updated H-1B Memorandum which purports to provide guidance to USCIS officers in their adjudication of H-1B petitions for Registered Nurses. This Memorandum updates the long-standing 2002 Johnny Williams USCIS Memorandum on the same subject. The new Memorandum does not break new ground. It is not expected that the Memorandum will result in a significant increase in approved H-1B petitions, although its Background section helpfully reminds USCIS officers that “there are some situations, however, where the petitioner may be able to show that a nursing position qualifies as a specialty occupation”.

    USCIS officers presently deny nearly all H-1B petitions for Registered Nurses, regardless of the specific facts of the petition. The fundamental problem for RNs seeking H-1B status is that few US Registered Nurse positions in the US require a Bachelor’s degree in Nursing for entry into the position. In order to have an H-1B approved it is not enough that the applicant holds a Bachelors’ degree; the position itself must require a Bachelor’s degree. The Memorandum makes this clear: “Registered nurses generally do not qualify for H-1B classification” (Page 2).

    Even nurses who work in units where 100% of the nurse workforce holds Bachelors of Science in Nursing (BSN) have seen H-1B denials. These denial opinions dismiss the employer’s facts, and simply cite to the Occupational Outlook Handbook, which generally says that nursing positions do not require Bachelor’s degrees.

    As the Williams Memorandum explained, the new Memorandum confirms, there are exceptions to this general rule. For instance, the new Memorandum favorably recognizes that hospitals with magnet status, “indicates that the nursing workforce within an institution has attained a number of high standards relating to quality and standards of nursing practice” (Page 3). The Memorandum then buries in footnote 9 a very important fact: “For example, as of January 1, 2013, 100% of nurse managers of individual units/wards/clinics must have at least a baccalaureate degree in nursing upon submission of the Magnet application.” This Memorandum would have been improved if the author had plainly stated that Nurse Manager positons at Magnet hospitals qualify for H-1B visas. Nonetheless, this acknowledgement should be helpful in future H-1B petitions for Magnet Hospital Nurse Managers.

    Beyond this section on Magnet hospitals the new Memorandum offers little guidance for USCIS officers. In several places the Memorandum tells officers to analyze cases on the facts of the petition and on a case by case basis, which is apparent.

    The new Memorandum mirrors the Williams Memorandum in that it reminds officers that Advance Practice Nursing position are generally specialty occupations and approvable for H-1B visas. It also helpfully recognizes that some specialties, such as critical care and peri-operative (operating room) may qualify for the H-1B.

    While USCIS HQ missed an opportunity to be clearer about which RN positions were approvable for H-1B visas, the Memorandum shows that the USCIS is aware of the issue.

    Read the Musillo Unkenholt Healthcare and Immigration Law Blog at or You can also visit us on Facebook and follow us on Twitter.

    by , 07-21-2014 at 09:51 AM (Chris Musillo on Nurse and Allied Health Immigration)

    by Chris Musillo

    All foreign-educated Physical Therapists must be issued a Healthcare Worker Certificate prior to receiving a temporary (e.g. H-1B or TN) or permanent visa, as per 8 CFR 212.15(c):. Two originations are permitted to issue these HWC’s. CGFNS issues the Visa Screen, which is also issued to qualified Registered Nurses, Occupational Therapists, and several other healthcare occupations. FCCPT issues the FCCPT Type I Certificate. The FCCPT Type I is only issued to Physical Therapists.

    The HWC verifies that the foreign educated Physical Therapist has (i) qualifying education, training, licensing, and experience; (ii) passed a qualifying English fluency exam; and (iii) passed the actual licensing exam (NPTE exam).

    The FCCPT recently published an update about their verification of Indian distance education. At issue is whether the educational experience is post-Secondary education and is not continuing education. Several criteria are now considered by FCCPT.

    - Verification that the study center does not violate the jurisdiction territory as outlined by the University Grants Commission (UGC).
    - Evidence that the study center is not franchised. This means that it cannot be affiliated to more than one university.
    - Verification that the University is in charge of admissions to the distance education program. Admissions cannot be done by study centers as per UGC regulation.
    - That the program is authorized to be offered through distance education by the Distance Education Council (DEC). Even though the DEC has been disbanded by the UGC, the regulations stay in effect until the UGC publishes new standards.

    Read the Musillo Unkenholt Healthcare and Immigration Law Blog at or You can also visit us on Facebook and follow us on Twitter.
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