Finding the Right Job.

It is very important to find a ‘good fit’ when job hunting. For International Medical Graduates, this becomes even more important. This is because visa sponsorship is involved. If you are on a J1 visa, geographical location will be rather important as well. In addition, it will be difficult to change jobs while awaiting your green card sponsorship.

Options for getting your green card:

There are 2 big options to consider when job hunting: many physicians working under J1 training visa would qualify for J1 waiver jobs. One of the popular options are for employer sponsored green card (PERM). Just make sure there is an exact timeline for when the green card sponsorship will occur. Remember to have this in your employment contract. This can either in your main contract or as an addendum. If it is in writing, it may never happen.

Another common option would be a self-sponsored green card, under the EB-2 National Interest Waiver Program.

There are pros and cons to these 2 different options, which I will cover in another article.

Check your contract!

Case of the never-ending wait for green card sponsorship.

Jan, a medical subspecialist, had her pick of job offers even as an International Medical Graduate. She completed her residency and fellowship in one of the top hospitals in America. Jan had plenty of academic and non-academic job offers. After reviewing her options, she decided to work as an employer physician at a hospital based practice.

In her initial job offer, she was a green card sponsorship after 6 months of ‘trial period’. This was verbally promised to her by her employer. After a year, she contacted human resources, as the process was never initiated by the hospital. After another year of waiting, she was finally told they will no longer consider sponsoring her green card due to costs involved. This is due due to management changes and hospital budgeting issues. As she did not have any of this in writing, she had no recourse legally.

Fortunately, due to her extensive research experience and links to her prior training, and after some legal wrangling, Jan managed to get a new position where she trained and was eligible for EB1 self-sponsored green card.

According to physician recruiters, an average of 70% of physicians in both medical and surgical specialties change jobs within their first 1-2 years of practice. Be it due to location, job challenges, social issues, this rate has not changed in the past few years. It is important to find a place that will sponsor your green card if you need one. Make sure to read your job contract carefully, it is normally worthwhile to have a contract negotiation team review your contract as well.

Be picky, be very picky…

When hunting for ‘a job with good fit’ as a visa candidate, it becomes even more important to be selective of the right professional and personal opportunity. I have been on both sides of the equation. As a job hunter and now as employer, I have seen great physicians changing jobs and constantly moving to find the all elusive ‘perfect job’. I have friends who are stuck on their 3 year job contract who have ‘sucked it up’ and continued working in rather adverse conditions. Personal anecdotes of working 25 days a month, 12 hour days, seeing 30-40 hospital patients a day. This, and without any extra reimbursement! This is why is is important to have a good job contract going into the job.

As a physician, and particularly as an international medical graduate, we are used to accepting rather crazy schedules and expectations. However, it is important not discount the well-being of our family and ourselves. The burnout rate among physicians are already among the highest among various professions. The toll of working under poor conditions can be harmful not just to ourselves, but it often affect our spouses and children as well. I have a friend who ended up going back to his home country, after spending over 30K in USMLE fees, travel expense, 3 year residency, burnt through 2 visa waiver jobs.

Consider professional contract review:

Often times, despite the costs, it is helpful to have a contract lawyer or healthcare practice management such as Contract Diagnostics review your contract before signing on the dotted line. The average costs for these reviews (not to directly negotiate the contract for you) is around 200/hr to 300/hr. Contract Diagnostics also offer a more detailed legal, a benefit, and a compensation review. They can also directly negotate with your employers. They offer an all-in-one human resources, legal team that will help you negotiate the best compensation possible.

Here are some employment terms you should check out as well.

JB, hospitalist: With 80 hour work weeks, unequal weekend and night coverage.

JB is a new graduate in Internal Medicine, who requires a J1 waiver sponsorship. He was initially looking to match into fellowship, but did not get a position in a highly competitive sub-specialty. Due to time constraints, he only interviewed at 2 different locations, and picked the one with the higher pay – guaranteed first year pay of 210,000 in a traditional internal medicine practice. He was the only employee, and worked for the physician-owner, who is also the scheduler, in a rural location. As he did not explicitly ask about the work schedule, he was scheduled to work all 3 major holidays the first year (Thanksgiving, Christmas, New Year) and disproportionate weekends.

After his initial salary guarantee for the first year, he was changed to a wRVU only compensation model with high overheads. As he still did not have many established patients, he took a 30% pay cut and still had to work long hours. 18 months into this, JB could no longer tolerate such adverse conditions. He quit, and went back to his home country.

Will you be happy living here for at least 3-5 years?

For physicians who are relocating along with their family, the location becomes even more important. When we recruit new physicians, we are particularly interested to meet their family as well. There was a very well trained physician, impressive CV, had lived in the States for several years doing research and MBA prior to residency. He was newly married and brought his wife along for the job interview.

During the meet and greet dinner, his spouse had a lot of issues with the food that was served. She also commented on the lack of traditional grocery stores and places of worship, and made disparaging comments about the population and city where our practice is located. Needless to say, our ‘perfect candidate’ did not get a job offer.

On the other hand, it is important to ensure the location of the job works for your family.

Various practice options:

Back when I was looking for my J1 waiver position, I had different options presented to me: work as a hospital-employed physician, a private practice group, in an academic center inner-city hospital, or with a national hospitalist group. After years living on the East Coast, I was mainly interested in living on the West Coast, so that was where I concentrated my job search on. I finally decided to work with a private practice group, with partnership track within 3 years. I am still working with the same group, almost 10 years down the road.

To recap, here are the steps to consider when searching for a visa waiver job:

  1. Work with a reputable recruiter, preferably with the ones who understand the visa waiver requirements. Contact your seniors who have already started working – they may have good recommendations!
  2. Start your job hunt at the 12-18 months before you complete your training. Some states fill their J1 waiver spots quickly. Some states do not offer J1 waiver spots to non primary care specialties (family medicine, pediatrics, general surgery, internal medicine, psychiatry, ob/gyn).
  3. Contact the J1 waiver co-ordinators in the state you are interested in. They can provide contacts for waiver jobs and also confirm that the location and job you are interviewing with qualifies for a waiver job. If you want to apply for the National Interest Waiver, you can apply once you have received your job offer and even before you start working with the help of the J1 visa co-ordinator. This is especially helpful if your spouse needs work visa as well.
  4. Interview in as many places as you can see yourself living in. Speak to current employees and ancillary staff.
  5. Consider hiring Contract Diagnostics to review your contract (starting at $200 for a basic review – up to more detailed legal, a benefit, and a compensation review. They also offer direct negotiation with your employers. They have an all-in-one human resources, legal team that will help you negotiate the best compensation possible.
  6. Negotiate the sign on/relocation bonus, has important tax implications – see this article:
  7. Fill up required paperwork in a timely manner.
  8. Congratulations with the new job!

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