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Immigration: Tools for long-term retention
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Tools for long-term retention

By Farhad Sethna, Attorney, Adjunct Professor of immigration law, The University of Akron, School of Law

In August, I was privileged to speak at the ASPR Annual Conference in Tucson, AZ. What a unique experience that was! It was the first time that I had ever seen a forest of saguaro cacti. It reminded me of western movies, with Clint Eastwood squinting out into the blazing sun! Those thorny cacti got me comparing the harsh desert environment with immigration challenges, especially in the context of recruiting international medical graduates (IMGs). Just as the saguaro cacti have evolved to survive, we too can learn how to recruit and retain IMGs for the long-term in a seemingly bleak environment utilizing creative immigration options.

The immigration process for IMGs has many potential pitfalls, but many rewards. In my session at the ASPR conference (materials for which can be found at the ASPR conference website), I suggested several strategies for the long-term retention of IMG physicians. I have also authored other articles on the topic of physician recruitment, which can be found at

Research indicates that retaining a physician for more than three years significantly reduces the odds of losing that physician. The rate of attrition plunges from a whopping 14 percent to a single-digit 8 percent!
Unique challenges facing IMGs include lengthy immigration processes for H-1B waiver positions; mandatory three-year service in H-1B status for the waiver to vest; lengthy processing time for labor certifications; and a backlog in the visa priority dates, especially for physicians born in India and China. These obstacles create a regulatory jungle that requires careful navigation. Skirting the shoals of immigration law to earn the green card’s safe harbor in the US is perhaps the uppermost priority of any IMG, especially those with families.

Through discussions with clients, I have come to realize that the most important commitment an employer can offer an IMG is sponsorship for immigration benefits. Given the IMG’s desire, it is necessary for employers to go forward boldly with hiring, knowing that there are solutions to most immigration obstacles. Keep in mind that every obstacle gives birth to an opportunity!

The benefit of time
The total time from start to finish of the J-1 waiver or H-1B employment process, ending ultimately with the issuance of a green card, could take as much as eight to ten years! During that time, the physician works for the practice and makes professional and personal ties, while their family integrates in the community. The ramifications of these relationships: a higher retention rate once permanent residence (green card) is received.

Creative option: choose the Conrad 30 waiver if possible
As a result of the Conrad 30 Program which began in 1991, every state has a total of 30 J-1 waiver slots it can allocate for physicians practicing in medically underserved areas. Up to 10 of these slots (Flex 10) may be reserved for specialty physicians, even those serving in areas that are not Health Professional Shortage Areas (HPSAs). Unfortunately, the program has been severely underutilized by most states. On average, only 10 to 13 states fill their Conrad 30 slots each year! Some states use less than 10 per year! As a result of the Affordable Care Act, recruiters will be challenged with finding even more physicians in the coming years — so it makes sense to hire as many physicians as possible through the Conrad 30 program.

Using creative immigration options, such as the Conrad 30 Program, everybody wins: the IMG, the medical practice, and above all, the patient.

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