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What foreign-born physicians need to know about working locum tenens

Illustration - locum tenens H-1B visa

Locum tenens is a great career option for doctors who want more freedom and flexibility than a regular, permanent job usually affords. It’s also a smart option for those who aren’t ready to settle down in one location and a great way to supplement your income. Many foreign-born physicians are just as interested as anyone else in the benefits of locum tenens — but is working locum tenens on a H-1B visa really a possibility? 

The short answer is yes! With the right help and guidance, foreign-born physicians can work locum tenens and enjoy all of the same lifestyle benefits as other locum physicians. However, the key phrase here is, “with the right help and guidance.” This isn’t a route you’ll want to travel alone! But if your personal circumstances line up well, working locum tenens could be a rewarding part of your medical career.    

What are J-1 and H-1B visas?

Most foreign-born physicians begin their careers in the United States on a J-1 visa, which allows a foreign-born medical graduate to live in the United States for up to 7 years for medical training. At the end of seven years, the physician is required to return home for at least two years before applying for another visa.

However, there are exceptions. If a physician wants to stay in the United States, the most common solution is to apply for a J-1 waiver. While the process of getting a J-1 waiver isn’t simple or easy, once approved, a physician can apply for a H-1B visa and stay for another three years.

A H-1B visa can be renewed one time for another three years. So, a physician on a H-1B visa has a total of six years to work in the U.S. before they need to obtain a more permanent residence status to stay, such as a Green Card.

Applying for a J-1 waiver

If you’re a foreign-born physician looking for your first post-residency job, let’s be honest: The immigration process in the United States is complicated.

In order to apply for a J-1 waiver, you have to first obtain a job offer from a practice or hospital willing to sponsor you and help you obtain a H-1B visa. This means you have to know where and who you want to work for right from the beginning. Later, if you change your mind, you probably won’t be able to transfer the J-1 waiver to a new sponsoring organization.

Another challenge: United States immigration laws only allow for a certain number of J-1 waivers to be issued each year in each state. The chances of getting a waiver vary, depending on which state you’re planning to work in (for example, underserved areas need of more doctors but have a harder time attracting them). Some federal agencies also issue J-1 waivers for primary care doctors and a few physician specialties, but only when certain requirements are met. Whether you hope to work in a non-profit, for-profit, or government setting, the process of applying for a J-1 waiver can be long and extensive, so it’s important to begin early. The sooner you start, the better your chances will be of getting one. This means starting your job search early and deciding on something as quickly as possible.   

As you can imagine, there’s going to be a fair amount of stress involved here. Any corrections you end up having to make to the paperwork will cost you both time, money, and maybe even the opportunity itself.

Locum tenens for foreign-born physicians

Not every foreign-born physician interested in working locum tenens will be able to meet all the legal requirements, but those who do and choose to go that route will enjoy significant control over their lifestyle and career.

For example, locum tenens physicians don’t have to know what city or state they want to spend the rest of their careers in. Assignments are temporary and can be as short as a few days or last months or even years. If you’re a foreign-born physician, you could potentially use locums to experience different regions of the country and try out different types of work scenarios before zeroing in on where you might want to stay long-term.

Another benefit? Locum tenens physicians can schedule as much time off between assignments as they need. This is huge for physicians with family and friends living elsewhere. As a locum tenens physician, you’ll have virtually unlimited time off for visiting them.

Qualifying for locum tenens employment on a H-1B visa

If you’re understanding how visas work for foreign-born physicians, you should see the problem with going locums right away: In order to obtain your J-1 waiver and H-1B visa, you need the sponsorship of the hospital or practice that’s hiring you as their permanent employee. But in most cases, locum tenens physicians work as 1099 independent contractors not W-2 employees.

As a foreign-born physician, one way to solve this problem is by forming your own corporation. Your corporation then hires you as a full-time employee and sponsors you for your J-1 waiver and H-1B visa.

Of course, it’s not as simple as that. Creating a corporation to hire yourself for locum tenens contract work isn’t something you do during your lunchbreak. You’ll need to create a board of directors to validate your credentials and meet other organizational or structural requirements as well.  And understanding all of the waivers and visas that accompany the process can be equally daunting.

This is where an experienced immigration attorney comes in. Ann Badmus, principal attorney of Badmus & Associates, a firm that specializes in immigration issues, says, “If you are going to do an entrepreneurial H-1B visa, you will need to structure your company so that there are others, typically physicians, involved in the organization as part of board of directors or board of managers. Then the government is comfortable that you’re not the only person that can control your work, even though you’re 100% the owner of the company.”

Working locum tenens on a H-1B visa

Once your corporation is in place, you can then begin working as a locum tenens physician. Of course, you’ll also want the support and guidance of a locum tenens agency who has worked with foreign-born physicians before and knows well the challenges you’ll be facing. 

When it comes time to get paid, the locum tenens agency or healthcare facility you’re working with will pay your newly formed corporation and issue all of the relevant 1099 forms directly to the corp.

But as the corporation’s only employee, all that money is typically yours to disburse — as a paycheck, benefits payments, retirement investments, and other expenses as needed.

This legal arrangement makes it possible for a foreign-born physician to work locums. The process takes time, effort, and even some money up front. But many physicians will say the flexibility is worth it.

Many foreign-born physicians who work locum tenens, do it on the side to supplement their primary employment. This is especially true for physicians who are work in the U.S. on a J-1 waiver, which requires that physicians work at least 40 hours a week. “They still need an established practice and work for that practice at least 40 hours a week,” Badmus says. “A locums company can’t usually guarantee a certain number of hours of work, so these physicians typically set up their own practice and do what’s called a concurrent H-1B. They have their primary H-1B through their employer, and they have a part-time H-1B through their own company.”

Other considerations for foreign-born physicians

It’s important to note that hiring yourself through your own corporation could make it harder, in time, for a foreign-born physician to obtain a Green Card when your H-1B visa expires. Be sure to consult with your lawyer and the locum agency you work through about this, especially if permanent residence in the United States is a long-term goal for you.

Finally, there at least four different types of business visas that a foreign-born physician could potentially apply for. The J-1 waiver followed by the H-1B visa is the most common pathway. The requirements for the other visas seem to be for doctors in more specific circumstances. Still, these visas are probably worth learning about.

Other physicians have done it. So can you.

As a foreign-born physician, the benefits of locum tenens can be especially attractive. Is locum tenens the right option for you?

Getting the opinion of an experienced locum tenens agent might be a good place to start. They’ll answer your questions and give you important advice that could improve your chances for obtaining all of the necessary waivers and visas. With the growing shortage of doctors, those chances are getting better every year. They may even present you with an option you didn’t know about.

You’ll never know until you talk to someone. As the saying goes, information is power. Don’t wait — start the conversation today!

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