The most common program by which foreign nationals enter the U.S. to work as physicians is the professional workers visa, or H-1B visa.  To obtain an H-1B visa, the foreign born physician must be sponsored by an employer.  This visa is good for up to six years. An important requirement is that the employer must have the ability to hire, fire, or otherwise control the physician's work.  Self-employed physicians can qualify for the H-1B visa, if the physician's practice has a board of directors that can control the employment terms of the the physician.  Moreover, if a physician's work location is not owned or controlled by the employer, e.g. a hospitalist working at a hospital but employed by a private practice, the petitioning H-1B employer must provide additional evidence that it is the actual employer.

In order to qualify for an H-1B visa to practice patient care medicine, the foreign born physician must pass all parts of the United States Medical Licensing Examination (USMLE), National Board of Medical Examiners (NBME) or FLEX, and the English language proficiency test given by the Educational Commission for Foreign Medical Graduates (ECFMG).  In addition, the physician must be licensed to practice medicine in their intended state of employment.  Usually, except for physicians who trained in Canada, this means that the physician must have completed a medical residency in the U.S.  However, this does not apply in the case the physician obtains an H-1B visa to complete a U.S. medical residency program.

Not all foreign born physicians are subject to the test requirements.  These requirements only apply to foreign medical graduates (FMGs).  For purposes of the H-1B visa, the following foreign born physicians are not considered FMGs:

• Physicians of national or international renown;
• Graduates of U.S. medical schools;
• Physicians not practicing patient care (e.g., medical researchers).

It is important to take note of the costs and fees associated with the H1-B visa. In general, legal fees for H-1B visas start from $1,000 to $2,000, depending upon the expertise, experience, and location of the attorney.  Generally, the government application fees depend upon the size and type of employer.  Currently, an employer with more than 25 employees will likely pay $2,325 of which $2,000 cannot be reimbursed by the physician.  An employer with 25 or fewer employees will likely pay $1,575 of which $1,250 cannot be reimbursed by the physician.  Application fees for petitions filed by post-secondary schools and non-profit organizations affiliated with post-secondary schools are lower, currently at $825.  Also, for payment of an additional “premium processing” fee of $1,225, the government guarantees processing of the H-1B petition within 15 days of application acceptance.