RESEARCH ARTICLE
 International Recruitment of Allied Health Professionals
to the United States
Piecing Together the Picture with Imperfect Data
Patricia Pittman, PhD
Bianca Frogner, PhD
Emily Bass, BA
Courtney Dunham, MPH
BACKGROUND: Research on the international recruitment of health professionals to the U.S. has focused
almost exclusively on physicians and nurses; we are
aware of no research on the migration of allied health
professionals. OBJECTIVE: We examined the strengths
and weaknesses of various public and private data
sources on foreign-educated allied health professions in
the U.S. and patched together a picture of these
migrants. We focus on pharmacists, physical therapists
(PTs), occupational therapists (OTs), speech language
pathologists (SLPs), and medical and clinical laboratory
technicians (lab techs). FINDINGS: Based on the American Community Survey, we found that 12% of PTs, 12%
of lab techs, 8% of pharmacists, 4% of OTs, and 3% of
SLPs are foreign-born and entered the U.S. at age 21 or
older. Among foreign-born PTs, about half remain as
non-citizens, suggesting the highest proportion of
recent arrivals among the five professions. CONCLUSIONS: As Congress debates comprehensive immigration reform, one of the much need changes to the
system is better immigration data, disaggregated by
occupation. J Allied Health 2014; 43(2):79–87.
of the employed nursing workforce according to the
2008 National Sample Survey of Nurses.6 Meanwhile,
there has been no systematic attempt to measure the
migration of allied health professionals to the U.S. In
fact, the World Health Organization’s Code of Practice
on the International Recruitment of Health Personnel
only asks governments to track physicians and nurses.7
The current paper combines public and private data
sources to patch together a picture of the migration of
allied health professionals, while acknowledging the
strengths and weaknesses of each source. Specifically, we
examined the international recruitment of five allied
health professions: pharmacists, physical therapists
(PTs), occupational therapists (OTs), speech language
pathologists (SLPs), and medical and clinical laboratory
technicians (lab techs). We describe the credentialing and
licensure requirements these professionals face when
migrating to the U.S., discuss the various visa types they
are using, and then review the numbers of foreign-educated allied health professionals using Census Bureau
surveys, credentialing, and immigration data.
The Supply and Demand of
Allied Health Professionals
RESEARCH on the international recruitment of health
professionals to the U.S. has focused almost exclusively
on physicians and nurses.1–5 International medical
graduates comprise just under a quarter of practicing
physicians, while foreign-educated RNs made up 5.6%
The primary driver of international recruitment of
health care professionals to the U.S. has been the
increased demand for health care due to an aging and a
sicker population.2 Demand is expected to continue to
rise as insurance expands under the Affordable Care
Act, which aims to increase coverage to 32 million
people in 2014.8
The supply of health professionals does not appear to
be keeping up with the rising demand for health care.
Among the five allied health professions that are the
focus of this paper, the stock has remained relatively
steady over the last several years, with a slight uptick in
pharmacists and PTs (data not shown).9 Job growth for
these occupations, however, is accelerating. From 2010
to 2020, the projected rate of change in employment for
PTs (39%), OTs (33%), pharmacists (25%), and SLPs (23%)
Dr. Pittman is Associate Professor, Dr. Frogner is Assistant Professor, Ms.
Bass is Research Associate, and Ms. Dunham is Research Assistant, at the
Milken Institute School of Public Health, The George Washington University, Washington, DC.
RA1315—Received Apr 26, 2013; accepted Oct 6, 2013.
Funding for this research was made possible by the MacArthur
Foundation.
Address correspondence to: Dr. Patricia Pittman, Department of Health
Policy, The George Washington University, 2121 K Street NW, Ste 210,
Washington, DC 20037, USA. Tel 202-994-4295. [email protected].
© 2014 Association of Schools of Allied Health Professions, Wash., DC.
79
FIGURE 1. Projected occupational outlook for allied health professions, 2010–2020. Source: Adapted from: Occupational Outlook
Handbook–Healthcare Occupations (2012–2013 ed).10
is expected to be much faster than the national average
of 14% (Fig. 1). Over the same time period, the projected
rate for lab techs is lower, at an expected 13%.10
One indicator of a worker shortage is a low unemployment rate, with 4% unemployment often cited by
economists as the “natural” rate of unemployment.9,11
Unemployment for these allied health professions is
well below the national average at an average 1.1%
among the five professions in 2012.12
The Immigration Process
Although allied health professionals are currently able
to migrate to the U.S. more easily than nurses, who are
facing a visa (EB3) backlog, the process of obtaining
visas, interacting with international labor recruiters,
and meeting the credentialing and licensure requirements is complex and costly.
VISA TYPES USED BY ALLIED HEALTH
PROFESSIONALS
Allied health professionals use guest worker programs
like H-1B and Trade North American Free Trade Agreement (TN) status, as well as greencards such as EB-2 and
EB-3, to enter the U.S. (see Appendix A for a description of immigration visas). Because of the administrative backlog in processing requests and because the
country caps on permanent EB-2 and EB-3 immigration
visas are quickly filled in major sending nations, greencards can take up to 6 or 7 years to obtain. Most allied
health professionals therefore enter using the H-1B
non-immigrant visa and are subsequently sponsored for
an adjustment of status to the greencard while in the
U.S. H-1B visas are used for jobs that require a baccalaureate degree or higher and have a duration of 3
years with one renewal for a total of 6 years.13
H-1B visas are also subject to a cap, in this case
across all sending countries, with exemptions for notfor-profit institutions of higher education and foundations. Allied health professionals, therefore, compete
for these slots with other high-skilled professions such
as IT techs. The current limit is 65,000 visas per year,
with an additional 20,000 available for those seeking
positions that require advanced degrees. Generally, the
cap is filled within days of the opening of the annual
application process.14 Once the cap is filled, H-1B applications are processed in an order determined by lottery.
As part of an effort to ensure that the H-1B program
does not negatively affect the U.S.-born workforce, any
potential H-1B employer must supply the Department
of Labor with a Labor Condition Application (LCA),
which states that the employer agrees to pay (an
employer-defined and justified estimation of) prevailing
wages and that they are not utilizing H-1B labor in
order to break a strike.13 Canadian and Mexican citizens may enter using the TN status. This is a guest
worker program specific to the North American Free
Trade Agreement (NAFTA) countries for certain highskilled occupations. TN status is also for 3 years, but
unlike the H-1B, TN status is not dual intent. It can,
however, be renewed indefinitely and there are no
limits on the number that may be issued.
INTERNATIONAL LABOR RECRUITERS
Appendix A appears in the online version of this paper, available at
www.ingentaconnect.com/content/asahp/jah, see Volume 43, no. 2,
Summer 2014 issue.
80
International labor recruiters facilitate the migration of
allied health professions to the U.S. In 2007, when visas
PITTMAN ET AL., International Recruitment to the U.S.
TABLE 1. Credentialing and Licensing Requirements for Allied Health Professions
Degree
Requirements
Additional License
and/or Certification
Requirements
PTs
Master’s degree
(minimum)
Doctor of Physical
Therapy (optional)
OTs
Credentialing
Bodies
Screening
Bodies
Required by
National Physical Therapy
Examination offered by
Federation of State Boards
of Physical Therapy (FSBPT)
CGFNS
Foreign Credentialing
Commission on
Physical Therapy16
FSBPT
ICA
ICD
IERF
ICE
(optional)
50 states
DC
Guam
Puerto Rico
Virgin Islands17
Masters degree at
entry-level OT program
recognized by World
Federation of Occupational Therapy*18
Certification from National
Board for Certification in
Occupational Therapy
NBCOT
CGFN
NBCOT
ICA
ICD
IERF
ICE (depends
on state)
50 states
DC
Guam
Puerto Rico†19
Lab techs
Technologist:
bachelor’s degree20
Section 343 screening
required for select nonspecialist categories of
“Lab Technicians”
Pan-Canadian
Framework for
Recognition of
Foreign Credentials‡21
SLPs
Master’s degree from
accredited college or
university
National SLP exam offered
by Praxis Series Educational
Testing Services
Certificate of Clinical Competence in Speech-Language
Pathology offered by
American Speech-Language
Hearing Association (depends
on state/employer)22
Pharmacists
Doctor of Pharmacy
(as of 1990)
Foreign Pharmacy Graduate
Equivalency Exam 24,25
Occupation
12 states
48 states (CO
& SD
excluded)
DC23
National Association of
Boards of Pharmacy
50 states
DC
* Except where NBCOT determines non-WFOT program is professionally comparable CGFNS International.
†Certification or registration accepted in DC, Guam, and Puerto Rico.
‡Lab technicians are also among the 12 professions recently fast-tracked for Canadian immigration under the Pan-Canadian Framework for
Recognition of Foreign Credentials.
ICA, International Credentialing Associates; ICD, International Consultants of Delaware; IERF, International Education Research Foundation;
ICE, International Credentialing Excellence.
for nurses became difficult to obtain due the EB3 retrogression,* many recruitment companies turned to
recruiting allied health profession, in particular PTs.
According to the Alliance for Ethical International
Recruitment Practices (Alliance), in 2007, there were
273 active U.S.-based international recruitment companies, of which only 17 (6.2%) indicated on their website
that they recruited allied health professionals.1 By 2012,
the number of companies active in international
recruitment had declined to 97, of which 40 (41%) were
recruiting allied health professionals (Alliance, personal communication, Mar 11, 2013).
Although some large employers recruit directly, most
recruitment is conducted either by placement companies that charge a fee per professional recruited or
*Visa retrogression occurs when the number of visa applicants in a specific category or country is greater than the number of visas available for
that month, a limit that is set by Congress each year. This creates a backlog of applicants and longer wait times (up to 10 years for India).
Journal of Allied Health, Summer 2014, Vol 43, No 2
staffing agencies that recruit directly or through a placement agency.1 Increasingly, it is the staffing agencies
that dominate the industry and they are a far more
lucrative model. Contracts in either case generally
require professionals to commit to 3 years and include
high penalty fees to prevent migrants from switching
employers.
CREDENTIALING AND LICENSURE
Section 343 of the Illegal Immigration Reform and
Immigrant Responsibility Act requires that PTs, OTs,
SLPs, lab techs, medical techs (as well as nurses, audiologists, and physician assistants) who seek to practice in
the U.S. have their credentials certified by a federally
designated authority.15 In 1977, CGFNS International
(formerly Commission on Graduates of Foreign Nursing Schools) was established to provide a VisaScreen®
certificate for the eight health professions in Section
343. PTs and OTs may also use their own professional
81
FIGURE 2. Immigrants as percentage of total stock of select professions working in the health care industry, 2011. All naturalized
and non-citizen migrants are foreign-born and migrated to the U.S. at age 21 or older. Sample restricted to only those working in
the health care industry. Source: American Community Survey via Ruggles et al.9
bodies. Pharmacists are not included in Section 343.
Table 1 provides a summary of credentialing and licensing requirements for each health profession.
Data Sources for Foreign-Born and ForeignEducated Allied Health Professionals
Data on the migration of allied health professionals to
the U.S. are notoriously scarce.26 For physicians, the
Educational Commission for Foreign Medical Graduates (ECFMG) annually tracks international medical
graduates who enter the U.S.27 For nurses, the National
Sample Survey of Registered Nurses provided a snapshot every 4 years through 2008.28 No central data
source exists for the allied health professions, however.
In this section, we review a variety of proxy data sources
and discuss their strengths and weaknesses, including
Census data, licensure and credentialing data, and three
types of data derived from the immigration process.
AMERICAN COMMUNITY SURVEY
Surveys conducted by the Census Bureau are one
source of data on immigration, although they record
only country of birth, not the more appropriate variable of country of education. The Current Population
Survey (CPS) has been used to analyze immigration for
a large profession like nursing.29 However, CPS suffers
from sample sizes that are too small for allied health
professions. As a result, we explored the use of the
American Community Survey (ACS).
To best capture foreign-born individuals who
migrated (and were potentially recruited) to the U.S. for
82
work, we looked at the total number of people in each
allied health profession in the health care industry in
2011 who immigrated at the age of 21 or older (Fig. 2).
We excluded individuals born to a U.S. citizen. These
migrants either remained as a non-citizen at the time of
the survey or naturalized as a citizen. The category of
non-citizens implies that they are the most recent immigrants, probably having arrived within the last 10
years.†
We found that 12% of PTs, 12% of lab techs, 8% of
pharmacists, 4% of OTs, and 3% of SLPs are foreignborn and entered the U.S. at age 21 or older.‡ Among
foreign-born PTs, about half remain in the non-citizen
category, suggesting the highest proportion of recent
arrivals among the five professions. In absolute numbers, however, lab techs have the most non-naturalized
(13,484) members, followed by PTs (12,220) and pharmacists (1,728).
Figure 3 displays the most recent data on foreignborn professionals over a 4-year period. Consistent
with the changes in the practices of international
recruiters reported by the Alliance for Ethical International Recruitment Practices, we see a sharp increase in
foreign-born PTs after 2010, suggesting that the difficulties in obtaining visas for nurses may have played a role
in increasing the recruitment of PTs.
†Immigrants must have a permanent residency visa for at least 5 years
before applying for naturalization.
‡Among pharmacists working outside the health care industry, the share
of foreign-born and entered the U.S. at 21 or older was 12% in 2011, but
the rates were nearly identical for pharmacists in and out of health care at
10.5% in 2010.
PITTMAN ET AL., International Recruitment to the U.S.
FIGURE 3. Number of foreign-born (moved at age 21 or older) in select allied health professions in the healthcare industry, 2008–
2011. Source: American Community Survey via Ruggles et al.9
Given the limitations of sample surveys and the possibility that some foreign-born professionals were actually educated in the U.S., we also explored other potential data sources.
LICENSURE DATA
Licensure data for allied health professions are
extremely weak and not useful at this time for the purposes of this analysis.
• There are currently only 12 states with licensure for lab
techs.
• The American Speech-Language-Hearing Association
(ASHA) does not collect licensure data for SLPs. They do
have data on the number of ASHA-certified SLPs, which,
according to a 2012 internal analysis, is a 100 % overlap
with state-licensed SLPs. Unfortunately, ASHA does not
register country of education, nor do the data distinguish
between new versus renewed licensed SLPs (Sarah Slater,
ASHA, personal communication, March 7, 2013).
• The National Association of Boards of Pharmacy (NABP)
collects the total number of licensed pharmacists in the
U.S., DC, Guam, Puerto Rico, and U.S. Virgin Islands, but
it does not show newly licensed by year (Lisa Braddy,
NABP, personal communication, Mar 6, 2013).
• The American Occupational Therapy Association
(ACTA) collects licensure data for OTs, but their data do
not differentiate between new and renewed licenses, nor do
they indicate foreign-educated as a variable (Chuck Willmarth, ACTA, personal communication, Feb 28, 2013).
• The Federation of State Boards of Physical Therapy
(FSBPT) collects pass rates as a percentage for first-time candidates for the National Physical Therapy Examination.
This data are collected for graduates of U.S.-accredited and
non-U.S. PT programs. Their website does not provide the
actual number of candidates in each category.30
Journal of Allied Health, Summer 2014, Vol 43, No 2
CREDENTIALING DATA
Credentialing data provide some additional information on migration. Aggregating data from the VisaScreen® certificates issued by CGFNS International, the
FCCPT, and the National Board for Certification in
Occupational Therapy (NBCOT), we show the trends
in the number of credential certificates issued to PTs,
OTs, SLPs, and lab techs between 2005 and 2010 (Fig. 4).
Trends in the credentialing of foreign-educated allied
health professionals suggest that the five professions
examined largely rise and fall together, but that these
fluctuations do not necessarily mirror changes in the
U.S. economy. While there was an abrupt rise in PT credentialing in 2006, credentialing fell between 2006 and
2008. Since the start of the recession in 2008, there has
been a slow increase in the number of foreign-educated
allied health professionals obtaining U.S. credentials.
As previously suggested, it is possible that this increase
reflects international labor recruiters’ increased interest
in allied health professionals, when EB3 visas for
nurses were no longer easily available, rather than a
“real” demand linked to shortages in the U.S.
There are several limitations of these data. First, certification reveals intent to migrate, rather than a measure of whether the person actually was able to obtain a
visa and enter the U.S. Second, certification data are
propriety and therefore subject to the credentialing
associations’ willingness to provide it. CGFNS, which
provides the VisaScreen®, for example, stopped providing public access to its data in 2011. Data from the
FCCPT, NBCOT, and FPGEC were provided to us
upon request, but are not publicly available. Finally, for
those professions that have multiple credentialing
avenues, it is possible that there is some duplication—
83
FIGURE 4. Credential certificates issued to allied health professionals, 2005–2010. Source: Adapted from: 1) VisaScreen® certificates
issued by CGFNS, International; 2) credential review certificates issued by the Foreign Credentialing Commission on Physical
Therapy (FCCPT); 3) Visa Credential Verification Certificates issued by the National Board for Certification in Occupational
Therapy (NBCOT); and 4) certifications issued by the Foreign Pharmacy Graduate Examination Committee (FPGEC).
i.e., an individual has credentials reviewed by both
bodies. Given the cost of credentialing, however, it is
unlikely that many migrants would seek both.
IMMIGRATION DATA
The U.S. Customs and Immigration Services do not
systematically disaggregate visa data by specific profession. As discussed above, most allied health professionals are recruited with an H-1B visa. The H-1B visa data
available to the public differentiate physicians and surgeons (about 8,000/year), from the rest of the health
professions, which in turn are divided into two groups:
therapists (presumably occupational and physical) and
“not elsewhere classified” (NEC). Since for the most
part RNs do not qualify for H-1Bs, it is reasonable to
assume that pharmacists, SLPs, and lab techs comprise
most of NEC. Table 2 presents the total H-IB visas
issued to these two groups between 2007 and 2011.31
LABOR CONDITION APPLICATION DATA
Labor Condition Applications (LCA) are filed by U.S.
employers interested in recruiting workers from abroad
under the H-1B program and is publicly available on the
Department of Labor website. The LCA has been used
as a measure of employer intent to recruit from abroad.32
Among the limitations of this data source is the fact that
employers with multiple worksites may file several
LCAs per worker, such that LCAs filed may over count
the number of foreign-educated professionals being
recruited (Brian Zuccaro, personal communication, Jan
28, 2013; Mike Hammond, personal communication,
Dec 12, 2012). In addition, immigration attorneys suggest that not all filed LCAs are utilized; some may be
abandoned before a foreign worker obtains their H-1B
visa. They say that in the past some companies filed an
LCA for many “workers” so that they would be ready in
the event they had to hire quickly. However, this is no
longer necessary since LCAs are now completed in
about 7 days (Brian Zaccaro, personal communication,
Dec 12, 2012). Thus, the overcount may be slightly less
now than it was a few years ago.
Despite these limitations, the trends over time are a
useful point of reference with regard to the employer
demand side. Table 3 shows the total number of LCA
applications for allied health professions that were certified (approved) by the Department of Labor between
TABLE 2. Initial Employment H-1B Petitions Approved by Occupation, FY 2007–2011
Occupation
2007
2008
2009
2010
2011
Occupations in medicine and health, NEC*
Therapists
1,537
NA
1,634
1,093
2,140
1,485
1,718
925
1,603
869
NEC indicates “not elsewhere classified. Therapists were not listed in 2007. Source: U.S. Citizenship and Immigration Services. Characteristics of
Specialty Occupation Workers (H-1B): Fiscal Year 2007–2011.31
84
PITTMAN ET AL., International Recruitment to the U.S.
TABLE 3. Labor Condition Applications (LCAs) Certified for Allied Health Professions, 2008–2011
Profession
2008
2009
2010
2011
Occupational therapists
Physical therapists
Pharmacists
Speech-language pathologists
Medical and clinical laboratory technicians
TOTAL
905
2,568
1,557
70
46
5,146
797
3,413
1,574
345
38
6,167
816
3,361
1,629
294
40
6,140
747
2,904
1,140
259
57
5,107
Source: U.S. Department of Labor, Employment and Training Administration. Historical Case Disclosure Data, LCA Programs, FY 2008–2011.33
2008 and 2011.33 There were a total of 32,739 workers
listed on the certified LCAs for allied health professionals.33 In Table 3, we see the upward trend in credentialing between 2008 and 2010 reflected in employer
demand as well, although the demand declines in 2011.
PERM DATA
A permanent labor certification (PERM) issued by the
Department of Labor allows an employer to hire a foreign worker to work permanently (greencard) in the
U.S. PERM applications can be filed when a worker is
still in their home country or when they are in the U.S.
with a non-immigrant visa with dual intent, e.g., H-1B.
Most PERMs, however, are filed under the latter situation (Mike Hammond, personal communication, Nov
12, 2012). PERM applications therefore constitute a
measure of employers’ interest in retaining foreign-educated allied health professionals, as well as a proxy for
the volume of migrants who have entered the U.S. over
the course of several years.
PERM regulations state that an employer can legally
file multiple applications for the same foreign worker if
there are multiple job openings, on the grounds that the
additional jobs cannot be filled by available U.S. workers.34 Thus, the number of PERM applications may also
be an overcount. There could also be duplicate PERM
applications when people change employers or when
EB-3 applicants decide to “upgrade” to an EB-2, in order
to shorten waiting time (Mike Hammond, personal
communication, Dec 11, 2012).
Table 4 reports the PERM data for the five allied
health professions included in this study. Paralleling the
credentialing and LCA data, we observe a sharp
increase in the number of PERM applications submitted
between 2009 and 2010, with a slight decline in 2011.35
Like nurses, PTs are not required to submit a PERM
application with the Department of Labor because they
are a “Schedule A” occupation. Schedule A is a U.S.
Department of Labor precertification, which establishes that workers in certain job classifications will not
adversely affect the wages and working conditions of
U.S. workers similarly employed.36
Conclusion
As the shortage of U.S.-educated allied health professionals grows over the next decade, international
recruitment is likely to increase. This paper is the first
to provide a comprehensive overview of the data
sources available to track the migration of allied health
professionals to the U.S.
Quantifying the number of foreign-educated allied
health professionals is difficult as there is no systematic
or national collection of data. The American Community Survey (ACS) provides important background
information on the numbers of migrants in the U.S.,
but it does not indicate country of education. Licensure
data would be an ideal data source, and it is unfortunate that the allied health professionals’ licensure
bodies do not make their data available by year and by
country of origin. Credentialing data viewed over time
are a useful proxy for the level of interest in migrating,
but also have severe limitations because of their proprietary nature and the lack of coordination among credentialing bodies. H-1B data on visas are not disaggre-
TABLE 4. Submitted PERM Applications by Allied Health Professions, 2008–2011
Profession
Medical and clinical laboratory technologists
Occupational therapists
Pharmacists
Speech-language pathologists
TOTAL
2008
2009
2010
2011
1
22
36
11
70
30
12
59
3
105
381
219
628
130
1,369
246
255
340
109
962
Source: U.S. Department of Labor, Employment and Training Administration. OFLC Performance Data, Historical Case Disclosure Data, PERM
Program, FY 2008–2011.35
Journal of Allied Health, Summer 2014, Vol 43, No 2
85
gated by health profession. LCA data are an imperfect
data source for the level of demand for these professionals by employers. Lastly, PERM data reflect employers’ interest in retaining foreign-educated allied health
professionals by applying for permanent visas on their
behalf.
Despite the limitations of each data source, when
examined over time, it is possible to piece together a picture of what has been happening. We find an increase in
migration activity beginning in 2008 for four of the five
professions. While the demand for foreign-educated
nurses dropped during this period, the demand for foreign-educated allied health professionals is consistent
with the general health care workforce trends that show
an increase in jobs even during the Great Recession.
Post-recession, the number of foreign-educated allied
health professions appears to be decreasing slightly. One
possible explanation for this is the reduced availability
of H-1B visas each year since 2010. In 2013, for example,
the cap was reached within 1 week. This is likely because
as the economy recovers, other industries, such as IT,
are competing for these visas.
Improving the quality of data on the international
migration of allied health professionals is important for
several reasons. First, if reliable data were available, a
surge in international recruitment would be a signal to
workforce planners that they need to address domestic
shortages through additional investments in education
or geographic redistribution programs. If, on the other
hand, the data show that international recruitment is
increasing during periods in which there are no shortages, it would be an important signal that the something
is amiss in the immigration system. It could essentially
mean that either 1) the labor certification process,
which is supposed to ensure that U.S. citizens have
been offered these jobs first, is not functioning as
intended or 2) the prevailing wage laws are being gamed
and foreign-educated professionals are being paid less
than their American counterparts.
Better migration data is also important in order to
ensure the protection of professionals being recruited to
work in the U.S. An increase in recruitment should
signal to both state and non-state actors that they need
to be vigilant in their oversight of the international
recruitment industry. Past periods of high international
recruitment of nurses, for example, have been plagued
by unethical international recruiters that take advantage of foreigners eager to make a better life for themselves in the U.S.1,2 In the case of the H-1B visa, this is
the responsibility of the Department of Labor, although
nongovernmental certification efforts, such as the
Alliance for Ethical International Recruitment Practices, can play an important complementary role. In
addition, to the extent that H-1B or other guest worker
programs continue to be used, professional associations
and worker rights advocates will want to track what
86
happens to these individuals: do they stay in they stay
in the U.S. or do they return home?
As Congress debates comprehensive immigration
reform, part of the change needs to be more and better
data on international labor recruitment. As the fastest
growing job sector in the U.S., the healthcare industry
is likely to continue to be reliant on foreign health professionals for some portion of the workforce. Opponents and proponents of international recruitment
alike should agree that, at the very least, we need to
understand who is being recruited, under what conditions, and to what kinds of settings.
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Appendix A appears in the online version of this paper, available at
www.ingentaconnect.com/content/asahp/jah, see Volume 43, no. 2,
Summer 2014 issue.
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Appendix A. Description of Immigration Visas Used by Allied Health Professionals
Visa Type
Eligibility
General Requirements
EB-2
Must be a member of the
professions holding an
advanced degree or its
equivalent, or a foreign
national who has
exceptional ability.
Advanced degree
• Job you apply for must require an advanced degree and you must possess such a
degree or its equivalent (a baccalaureate degree plus 5 years progressive work
experience in the field).
Exceptional ability
• Show exceptional ability in the sciences, arts, or business. Exceptional ability
means “a degree of expertise significantly above that ordinarily encountered in
the sciences, arts, or business.”
National interest waiver (NIV)
• NIVs are usually granted to those who have exceptional ability (see above) and
whose employment in the U.S. would greatly benefit the nation. Those seeking
an NIV waiver may self-petition (they do not need an employer to sponsor them).
EB-3
Must be a skilled worker,
professional, or other
worker.
Skilled workers
• Demonstrate at least 2 years of job experience or training.
• Perform work for which qualified workers are not available in the U.S.
Professionals
• Demonstrate that you possess a U.S. baccalaureate degree or foreign degree equivalent, and that a baccalaureate degree is the normal requirement for entry into
the occupation.
• Performing work for which qualified workers are not available in the U.S.
• Education and experience may not be substituted for a baccalaureate degree.
Other workers
• You must be capable, at the time the petition is filed on your behalf, of performing unskilled labor (requiring <2 years training or experience), that is not of a
temporary or seasonal nature, for which qualified workers are not available in
the U.S.
H-1B
Applies to people who
wish to perform services
in a specialty occupation.*
You must meet one of the following criteria:
• Completed a U.S. bachelor’s or higher degree required by the specific specialty
occupation from an accredited college or university.
• Hold a foreign degree that is the equivalent to a U.S. bachelor’s or higher degree
in the specialty occupation.
• Hold an unrestricted state license, registration, or certification that authorizes
you to fully practice the specialty occupation and be engaged in that specialty in
the state of intended employment.
• Have education, training, or progressively responsible experience in the specialty
that is equivalent to the completion of such a degree, and have recognition of
expertise in the specialty through progressively responsible positions directly
related to the specialty.
TN
Permits qualified Canadian
and Mexican citizens to
seek temporary entry into
the U.S. to engage in
business activities at a
professional level.
You may be eligible for TN nonimmigrant status, if:
• You are a citizen of Canada or Mexico.
• Your profession qualifies under the regulations.
• The position in the U.S. requires a NAFTA professional.
• You have a prearranged full-time or part-time job with a U.S. employer (but not
self-employment, see documentation required below).
• You have the qualifications to practice in the profession in question.
*The job must meet one of the following criteria to qualify as a specialty occupation:
1. Bachelor’s or higher degree or its equivalent is normally the minimum entry requirement for the position.
2. The degree requirement for the job is common to the industry or the job is so complex or unique that it can be performed only by an individual with a degree.
3. The employer normally requires a degree or its equivalent for the position.
4. The nature of the specific duties is so specialized and complex that the knowledge required to perform the duties is usually associated with
the attainment of a bachelor’s or higher degree.
Source: Working in the U.S. Washington, DC, U.S. Citizenship and Immigration Services, updated 26 Jan 2012. Available from:
http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=a39e901bf9873210VgnVCM100000082ca
60aRCRD&vgnextchannel=a39e901bf9873210VgnVCM100000082ca60aRCRD.
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