Many foreign-born physicians are just as interested as anyone else in the benefits of locum tenens — but is working locum tenens on an H-1B visa possible?
The short answer is yes! With the right help and guidance, foreign-born physicians can work locum tenens and enjoy 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 there for up to seven years for medical training. At the end of seven years, the physician must 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 getting a J-1 waiver isn’t simple, once approved, a physician can apply for an H-1B visa and stay for another three years.
An H-1B visa can be renewed once for another three years. So, a physician on an H-1B visa has six years to work in the U.S. before obtaining a more permanent residence status, 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.
To apply for a J-1 waiver, you must first obtain a job offer from a practice or hospital willing to sponsor you and help you receive an H-1B visa. This means you must know where and who you want to work for 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 is that United States immigration laws only allow a certain number of J-1 waivers to be issued yearly in each state. The chances of getting a waiver vary, depending on which state you plan to work in (for example, underserved areas need more doctors but have a more challenging time attracting them). Some federal agencies also issue J-1 waivers for primary care doctors and a few physician specialties, but only when specific requirements are met. Whether you hope to work in a non-profit, for-profit, or government setting, applying for a J-1 waiver can be long and extensive, so beginning early is essential. The sooner you start, the better your chances of getting one. This means starting your job search early and deciding on something as quickly as possible.
As you can imagine, a fair amount of stress will be involved here. Any corrections you must make to the paperwork will cost you time, money, and maybe even the opportunity itself.
Want to dig deeper? Here’s more information on how to work locums on a J-1 visa (CompHealth)
Locum tenens for foreign-born physicians
Only some foreign-born physicians 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 last as little as a few days, months, or even years. If you’re a foreign-born physician, you could use locums to experience different regions of the country and try out different work scenarios before zeroing in on where you might want to stay long-term.
Another benefit? Schedule flexibility. 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 unlimited time off to visit them.
Qualifying for locum tenens employment on an H-1B visa
Suppose you’re understanding how visas work for foreign-born physicians. In that case, you should see the problem with going locums right away: 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. However, in most cases, locum tenens physicians work as 1099 independent contractors, not W-2 employees.
One way to solve this problem as a foreign-born physician is to form a corporation. Your corporation would hire you full time and sponsor 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 lunch break. You’ll need to create a board of directors to validate your credentials and meet other organizational or structural requirements. Understanding the waivers and visas accompanying 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 the 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 company owner.”
The financial side of locums: Hear one experienced locum physician’s financial strategy (Weatherby Healthcare)
Working locum tenens on a H-1B visa
Once your corporation is in place, you can work as a locum tenens physician. Of course, you’ll also want the support and guidance of a locum tenens agency that has worked with foreign-born physicians and knows 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 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 allows a foreign-born physician to work in locums. The process takes time, effort, and even some money upfront. However, many physicians say that.
Many foreign-born physicians who work locum tenens do it on the side to supplement their primary employment. This is especially true for physicians working 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 certain work hours, so these physicians typically set up their practice and do a concurrent H-1B. They have their primary H-1B through their employer and a part-time H-1B through their company.”
Other considerations for foreign-born physicians
It’s important to note that hiring yourself through your corporation could make it more complicated, 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, especially if permanent residence in the United States is your long-term goal.
Finally, there are at least four different types of business visas that a foreign-born physician could apply for. The J-1 waiver, followed by the H-1B visa, is the most common pathway. The requirements for the other visas are for doctors in more specific circumstances. Still, these visas are worth learning about.
Have more questions about locum tenens? We have the answers
Other physicians have done it. So can you.
As a foreign-born physician, I find the benefits of locum tenens to be beautiful. Is locum tenens the right option for you?
Getting the opinion of an experienced locum tenens agent might be an excellent place to start. They’ll answer your questions and give you important advice that could improve your chances of obtaining the necessary waivers and visas. With the growing shortage of doctors, those chances are getting better yearly. 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!