Initially appeared on doktorko.com 7/4/2007.
...and the subsequent H1B Visa. A lengthy article, so bear with me.
Disclaimer: Some of this information might be context-specific. To describe my circumstances, i am a Filipino graduate (this should be fairly obvious) who specialized in Internal Medicine and was most interested in entering a Hospitalist position.
Looking for a waiver job takes a CONSIDERABLE amount of time. Don't be put off if your batchmates start looking at you funny because you're job-hunting so early. American graduates can sign up for a job the month before they graduate. Foreign graduates looking for waivers need something in the bag roughly six months before they complete residency, mostly because of the interminable processing times.
STEP 0 (before anything else): make sure all your ducks are in a row. Make sure your passport and J1 visa are valid and that you have an active DS-2019. Make sure you have enough saved up (or have enough credit) for legal fees, airplane rides, hotel stays, etc. While good employers will pay for these, you can never be too sure.
STEP 1 (10-12 months before you graduate): decide what you really want to do, and scour the Internet for open waiver positions. Waiver jobs are available on a geographic basis - that is, you need to work in a certain place (or locale), and not necessarily for a certain organization (unless the organization works exclusively in that area).
Places that technically qualify to sponsor waivers are designated "health professional shortage areas" (HPSAs) or "medically underserved areas" (MUAs). How to know if the spot you are considering really qualifies? Go to this website (link updated 7/4/07). At some point, i believe the site might give you data based on "census tracts." To find out which census tract your desired location belongs to, go to this website (link updated 7/4/07) and enter the corresponding address. The census tract number should appear at the beginning of all the data.
Many waiver positions are considered "undesirable" for reasons of geography, patient base, and compensation. Understand that the reason they are offering waiver positions in the first place is that no one else wants to work there. That of course does not mean that you have to settle for just any position that comes your way. Feel free to be a little stringent with your criteria (you can loosen them later if they're too tight); you'll be surprised at how many (relatively) good waiver positions are available out there. There are even some "diamonds in the rough," if you look hard enough.
I myself signed up on a website called "Practicelink" (to which i have no relationship) and managed to come up with a few good leads, mostly in Washington state. I also pored through the classified ads sections of the New England Journal and the Annals of Internal Medicine.
By and large i ignored the "cold calls," wherein recruiters from god-knows-where (i even received a call from a Filipino call center) page you at the hospital (which should be illegal) to offer an "excellent opening" from some random backwater. In my personal opinion - places who hire people to call up random residents for them are probably not worth the time of day.
Sometimes you need to look really hard. Ask your friends in other places whether or not their institutions offer J1-waivers. Some organizations, while they advertise that they do not sponsor waivers, may be willing to make an exception if you are highly qualified. So be persistent and don't be discouraged.
Do your homework. As much as possible, ascertain beyond a shadow of a doubt that your prospective employer (or their lawyer) has had successful experiences with J1-waivers before. It would be horrible if you put all your eggs in one basket only to have your waiver application DENIED by the USCIS because the area didn't qualify right when you have no more time to put together a Plan B.
STEP 2 (8-10 months before you graduate): interview. A review of all interviewing techniques is beyond the scope of this article. Remember all the interviewing skills you honed while applying for residency? You will need all of them, and possibly more. Be on your guard. When it comes to good waiver jobs, it's likely that you will always be in competition with more foreign graduates, so be aware that the employer could be trying to "cherry pick." Be on your guard. Always make it clear that you are willing to go above and beyond the call of duty (as long as you are not being exploited) and that you have no plans of jumping ship. After all, hiring a new physician for (at least) $140,000 a year (a reasonable starting salary for an Internist) is a huge investment for the employer, and they definitely are not interested in a "flight risk."
Try to interview at one "dream job" (the one you really want) and one "failsafe" (the one you would be willing to settle for) at the very least. That is, if you miss your target - at least you'll have a soft place to land.
Unlike residency however, you do not interview at a hundred different places, fill out a rank list, and find out in the end (which could be five months away) who liked whom. Employers are usually working on an abbreviated schedule - they need physicians ASAP - and will expect you to either sign the contract or decline the offer within a few weeks (perhaps up to a month) after interviewing. Try to cluster all your interviews together so that you don't keep anyone waiting while you're considering someone else. They might rapidly lose interest all at the same time, and in the end you'll be left with nothing.
STEP 3 (roughly 8 months before you graduate): review the contract (or have a lawyer review it to make sure that there are no onerous provisions) and sign. There is a wealth of information in the Internet about what constitutes a good contract (salary vs. benefits, types of malpractice insurance, etc.), so i won't go into that at this point. Breathe a sigh of relief, but only a little one.
STEP 4 (immediately after STEP 3): with the contract signed, begin the waiver application process.
There are three little steps you have to go through to get your H1B. I have it on good authority that the first step is the most arduous, and the last two merely consist of "rubber stamping."
STEP 4-A: get your waiver recommendation from the State's health department. If you've done your homework (with HPSAs and MUAs), there should be no issues here, just a few forms to fill up. Take note however that actual recommendation can take months (in my case it took three).
STEP 4-B: get the waiver approved by the USCIS, which takes a few weeks. The second step occurs automatically after the first, unless you receive a "request for information" wherein you will actually need to produce some documentation, and which might delay the processing by up to a month.
STEP 4-C: once the USCIS approves your waiver, your employer will petition you for an H1B, which will take two calendar weeks if they (or you) are willing to shell out an additional $1000 for "premium processing." I do not recommend scrimping on this. After all, what's $1000 versus the projected $140,000 (or so) that you'll be making once the visa comes through?
You might need to pester your lawyer a little bit throughout STEP 4. Don't fret - that's what they get paid for.
STEP 5: your visa approval comes through. Go and celebrate!
As i referenced in a previous blog article, the Philippine government appears to be forbidding waiver jobs, stating that they will not sign any document waiving the two year residency requirement blah-blah-blah. This appears to be an empty threat; none of the steps mentioned require any intervention by any Philippine government agency. More about waivers in the future.∗
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