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Judith
Judith, Immigration Lawyer
Category: Immigration Law
Satisfied Customers: 24416
Experience:  34 years as practicing immigration attorney, with non-immigrant and immigrant visa experience.
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** This Message is for JUDITH **Dear Judith,I was reading

Resolved Question:

** This Question is for Judith **


 


Dear Judith,


 


I was reading about the National Interest Waiver (NIW) for Physicians here:


 


http://www.uscis.gov/portal/site/uscis/menuitem.5af9bb95919f35e66f614176543f6d1a/?vgnextoid=e39718a1f8b73210VgnVCM100000082ca60aRCRD&vgnextchannel=a695a6c515083210VgnVCM100000082ca60aRCRD


 


I have doing a lot of research about this because, as I am sure you know, the labor certification requirement can be waived with this NIW method of applying for the Green Card.


 


Here are my questions about this, please:


 


 


Q1)


 


It says I must agree to work as a general practitioner for five (5) years in a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA).


 


I am a physician that does house calls. My employer sends me to the inner city of Detroit to see senior citizen patients in their homes. 


 


I did a search of this website: http://www.hrsa.gov/shortage/


 


and Detroit is listed as an HPSA and MUA.


 


Now I read at the Michigan department of health website: 


http://michigan.gov/mdch/0,1607,7-132-2945_47635-244768--,00.html


 


that


 


Documentation indicating that the employment site is in a federally designated shortage area  (HPSA or MUA/P). In the case of multiple work sites, please list them separately.



 


But how would I demonstrate this for my job, since I do house calls to senior citizens?


 


My office is located in Farmington Hills, Michigan. I go to the office in the morning and then head out by car with the medical assistant to the homes of patients who live in Detroit.


 


So, would I list the addresses of all my patients one by one here: 


http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx


 


Yes? Or some other way to prove my job is in a HPSA / MUA?


 


(We have a physician who did residency on J-1 and is now using this house call job with my new employer to complete here J-1 waiver. She also was working with me at my previous employer Mobile Doctors for one year, also doing house calls and that job also qualified for her as a J-1 waiver job. So it is possible to prove that this type of house call job to Detroit is a HPSA / MUA. I just don’t know how.)


 


 


 


 


 


 


Q2)


 


I read that ‘The doctor must work for five (5) years at the designated medically underserved area prior to obtaining permanent residence’.


 


So I would not get the Green Card until AFTER I completed 5 years of working in the HPSA / MUA?


 


If this is true, this NIW method is actually longer that the regular PERM method, yes?


 


Sure with the NIW you may save time by not having to apply for PERM, but you have to wait 5 years to get the Green Card.


 


With the PERM method, you can get the green card after the PERM, I-140 and I-485 are approved, which can take about 12 - 18 months on average.


 


Is this a correct comparison of the the two methods (NIW vs PERM)?


 


 


 


 


 


 


Q3)


 


It says that I need to work in a HPSA or MUA for 5 years.


 


So do I have to agree to work in the HPSA / MUA for 5 years and apply, or do I have to first complete working in an HPSA / MUA for five years and then be eligible for this NIW?


 


 


 


As you know, my previous employer Mobile Doctors used to send me to Detroit for the exact same type of job - doing housecalls for Senior Citizens. Which I did for nearly three years - November 2010 to August 2013.


 


My new employer will be doing the same. 


 


Can the three years I worked in Detroit with Mobile Doctors count in this NIW application?


 


 


 


 


 


 


Q4)


 


I also read that:


 


“Along with the filing of a national interest waiver the physician may also apply for adjustment of status. Once in adjustment of status the physician will be issued an employment authorization document (EAD) and a travel document, which will replace the physician's H-1B visa. 


 


The physician will remain in adjustment of status, renewing the EAD and travel documents annually, until such time as the physician has completed 5 years of required employment in an underserved area. 


 


Once the required 5 years of employment has been established to the USCIS the physician will be issued a green card.”


 


So it sounds like this is really a faster way of getting the EAD.


 


Are there are pitfalls to having an EAD and not getting the Green Card for years?


 


 


 


 


Q5)


 


Also will my wife get an EAD and Green Card also if I choose to go this NIW route?


 


 


 


The NIW does not sound like a very good option. At first I got all excited, but then the more I read the less enthusiastic I became about this NIW route.


 


Unless I have misunderstood the NIW route, it sounds like the regular PERM route is better. 


 


But I will await your replies before making a final decision.


 


Thank you so much


 


Asad


 

Submitted: 10 months ago.
Category: Immigration Law
Expert:  Judith replied 10 months ago.

Thank you Asad for increasing the value.

Let me ask you:

1. Since Mobile Docs went out of business is there any former officer of the corporation whom you have maintained contact with? It would be essential to show proof of your HPSA work through contracts they held with Detroit Office of Seniors or Dept of Health, who ever was funding the program for home visits. Those contracts would specify the locations where the physicians would be sent in terms that could be acceptable evidence.

2. The same holds true for the current employer. I am sure their contract only provides for reimbursement eligibility if the services are provided to residents of a HPSA/MUA or other narrow criteria than can be used to show you worked in the shortage areas.

3. What evidence did your J1 friend use to get her waiver through Mobile Docs? That same evidence is what is needed for you petition to get credit for that time.

4. At the current employer you report to FH in the am. Do you have clinical hours there or just report to do your records and then head out to Detroit homes? How many hours a day do you treat patients? You have to show 40 hours a week of clinical care.

5. Do you admit patients to hospitals in HPSA areas? Do you have to make rounds?

 

Judith

Customer: replied 10 months ago.

Hi Judith, here are the answers to your questions:


 


1. Since Mobile Docs went out of business is there any former officer of the corporation whom you have maintained contact with? It would be essential to show proof of your HPSA work through contracts they held with Detroit Office of Seniors or Dept of Health, who ever was funding the program for home visits. Those contracts would specify the locations where the physicians would be sent in terms that could be acceptable evidence.


 


Yes, the woman who was the branch manager of Mobile Doctors in Detroit is now the branch manager of my new employer Pineview! Yes this is true.


 


Because when Mobile Doctors shut down because of Medicare upcoding fraud by the head office in Chicago, everyone lost their jobs. So she started a new company and hired some of us.


 


The home visits were all funded and paid for my Medicare.


 


 


2. The same holds true for the current employer. I am sure their contract only provides for reimbursement eligibility if the services are provided to residents of a HPSA/MUA or other narrow criteria than can be used to show you worked in the shortage areas.


 


 


The way it works is that we physicians do house calls and the services we bill Medicare.


 


We sometimes deal with other insurance companies, but the main fuding source is Medicare.


 


 


 


 


3. What evidence did your J1 friend use to get her waiver through Mobile Docs? That same evidence is what is needed for you petition to get credit for that time.


 


 


Yes, I can ask my colleagues immigration attorney to touch base with my immigration attorney.


 


 


4. At the current employer you report to FH in the am. Do you have clinical hours there or just report to do your records and then head out to Detroit homes? How many hours a day do you treat patients? You have to show 40 hours a week of clinical care.


 


 


I have no clinic hours. I do one hundred percent house calls. I just go to the FH office in the morning to do paperwork.


I see patients from 8am to 4pm. 5 days per week.


 


 


5. Do you admit patients to hospitals in HPSA areas? Do you have to make rounds?


 


I can send a patient to a hospital, but I don't have any hospital privileges and I do not make any hospital rounds.


 


Thanks


Asad

Expert:  Judith replied 10 months ago.

Here are my questions about this, please:

Q1)

It says I must agree to work as a general practitioner for five (5) years in a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA).

I am a physician that does house calls. My employer sends me to the inner city of Detroit to see senior citizen patients in their homes.

I did a search of this website: http://hpsafind.hrsa.gov/

and Detroit is listed as an HPSA and MUA.

Now I read at the Michigan department of health website:

http://michigan.gov/mdch/0,1607,7-132-2945_47635-244768--,00.html

that Documentation indicating that the employment site is in a federally designated shortage area (HPSA or MUA/P). In the case of multiple work sites, please list them separately.


But how would I demonstrate this for my job, since I do house calls to senior citizens?

My office is located in Farmington Hills, Michigan. I go to the office in the morning and then head out by car with the medical assistant to the homes of patients who live in Detroit.

So, would I list the addresses of all my patients one by one here:


http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx


Yes? Or some other way to prove my job is in a HPSA / MUA?

I am not sure the HIPPSA laws would allow you to list patient addresses. Generally, I would approach this from the very first time a doc client comes into my office for the H1B and make sure that the contract between the employer and the doc states that the doctor agrees that his work will be making patient house calls within the HPSA/MUA and list the geo codes for the areas of Detroit where he would be sent to see patients.

I would suppose that you would get an Affidavit from the former manager of Mobile Docs attesting to the same thing in past tense.

This is less than ideal, but it would be all you could get.

(We have a physician who did residency on J-1 and is now using this house call job with my new employer to complete here J-1 waiver. She also was working with me at my previous employer Mobile Doctors for one year, also doing house calls and that job also qualified for her as a J-1 waiver job. So it is possible to prove that this type of house call job to Detroit is a HPSA / MUA. I just don't know how.)

I would suggest to have your attorney talk to her attorney and ask what documentation they used for the waiver.

 


Q2)

I read that ‘The doctor must work for five (5) years at the designated medically underserved area prior to obtaining permanent residence'.


So I would not get the Green Card until AFTER I completed 5 years of working in the HPSA / MUA?


Correct. The adjustment of status is held until you have evidence of completion of the 5 years under contract.

 


If this is true, this NIW method is actually longer that the regular PERM method, yes?


Correct

 


Sure with the NIW you may save time by not having to apply for PERM, but you have to wait 5 years to get the Green Card.

With the PERM method, you can get the green card after the PERM, I-140 and I-485 are approved, which can take about 12 - 18 months on average.


This is correct. Generally for those who obtained a J1 waiver the NIW is an easier route because those are already established as in the HPSA. A lot of the ground work is done for the waiver. And they have to serve a minimum amount of time anyway.

 


Is this a correct comparison of the the two methods (NIW vs PERM)?


Yes


Q 3)


 


It says that I need to work in a HPSA or MUA for 5 years.

So do I have to agree to work in the HPSA / MUA for 5 years and apply, or do I have to first complete working in an HPSA / MUA for five years and then be eligible for this NIW?

You need to file the I-140 within 6 months of signing your contract with the employer agreeing to work in the HPSA/MUA.

As you know, my previous employer Mobile Doctors used to send me to Detroit for the exact same type of job - doing housecalls for Senior Citizens. Which I did for nearly three years - November 2010 to August 2013.

My new employer will be doing the same.

Can the three years I worked in Detroit with Mobile Doctors count in this NIW application?


Yes, if you are able to come up with proof of your full-time work in the HPSAs making house calls.

Q4)

I also read that:

"Along with the filing of a national interest waiver the physician may also apply for adjustment of status. Once in adjustment of status the physician will be issued an employment authorization document (EAD) and a travel document, which will replace the physician's H-1B visa.

The physician will remain in adjustment of status, renewing the EAD and travel documents annually, until such time as the physician has completed 5 years of required employment in an underserved area.

Once the required 5 years of employment has been established to the USCIS the physician will be issued a green card."

So it sounds like this is really a faster way of getting the EAD.


Yes, but it is still an EAD to work for the HPSA employer full time. You can use the EAD to moonlight, however.

 


Are there are pitfalls to having an EAD and not getting the Green Card for years?

USCIS can always revoke the I-140 up to the approval of your green card. So suppose the adjudicator reviewing your 485 at the 5 year mark doesn't think the HPSA work is documented well enough................they could request proof of your work in the HPSA and if they don't like it...........they could deny the 485 and revoke the I-140.

It is more risky for you than for other docs b/c of your situation not having all this documented for a waiver.
Q5)

Also will my wife get an EAD and Green Card also if I choose to go this NIW route?

Yes, this is correct. That is another advantage.

The NIW does not sound like a very good option. At first I got all excited, but then the more I read the less enthusiastic I became about this NIW route.

Unless I have misunderstood the NIW route, it sounds like the regular PERM route is better.

I don't like it for you. It could turn out to be a waste of time and $ because if the I-140 is denied....6 months down the line, maybe more, you have lost this time when you could have had the PERM approved. Let's face it, Detroit is not a place docs would love to relocate to and work in, especially making house calls to patients in the hood. The street I grew up on is burned out. We got scared just driving down it 2 years ago to see what it looked like.

So getting a PERM approved for your job shouldn't be difficult because not a whole lot of applicants want to do what you are willing to do .

I would say go for the PERM again and get it over with.

 

Judith

Judith, Immigration Lawyer
Category: Immigration Law
Satisfied Customers: 24416
Experience: 34 years as practicing immigration attorney, with non-immigrant and immigrant visa experience.
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