By Farhad Sethna, Attorney, Adjunct Professor of Immigration Law, The University of Akron, School of Law
Have you ever wondered why the immigration process takes so long? It is a very involved and complex process, with many steps that must be followed completely to ensure compliance with immigration laws and regulations.
International Medical Graduates (IMGs) must first be hired by an organization in a work-authorized status, typically the H-1b. In some cases, especially when the H-1b quota is met, an “outstanding” IMG may be hired on O-1 status. However, this is a status reserved for very elite individuals and is difficult to obtain. Once an IMG is hired and a visa is obtained, the physician will often ask the organization to commence with the “Green Card” (permanent resident card) process, which involves three main steps:
- Labor Certification
First, the employer must petition for Labor Certification with the US Department of Labor. The “PERM” process requires an extensive search of the US labor market to prove that employment of the IMG will not deprive or displace a US physician. (In National Interest Waiver (NIW) cases, the PERM process can be bypassed provided the physician commits to at least five years of service in a Medically Underserved Area or Health Professional Shortage Area.)
- PERM application approval
Next, within six months of the PERM application approval, the employer must file an “Immigrant Petition for Alien Worker,” (form I-140) with the US Citizenship and Immigration Service. When the I-140 is approved, the IMG is granted a “Priority Date” – essentially a spot in line that determines when the final step in the Green Card process may be completed.
- Permanent resident status
Finally, when the Priority Date for the IMG becomes current, the IMG may apply for “Adjustment of Status to apply for permanent resident status.” At this stage, the IMG’s spouse and non-US-citizen children may also file applications for lawful permanent resident (LPR) status.
At any time during the Green Card process, if the IMG’s work-authorized visa status runs out, it is important that the non-immigrant status be renewed so the IMG may remain in the country and continue to work legally.
As illustrated in Image 1 below, the entire process from start to finish, including obtaining an H-1b visa, can take from three to six years. Patience and attention to detail is required at each step to ensure that approval is granted.
Retaining the IMG long term requires more than just promises. The employer has to deliver on a complex series of steps. Each of these requires prompt, committed action to be able to move to the next stage. If done right, a physician will appreciate the employer’s efforts and stay just as committed to the employer over the medium to long term.
Image 1: Timeline for various immigration processes. Some steps may be completed concurrently, while others depend on approval of a prior step.