Recruit Foreign Healthcare Workers: Short-Term and Long-Term Strategy
Short-Term Strategy – Focus on Our Nearby Neighbors
American hospitals, clinics, and doctors’ offices facing healthcare worker shortages and seeking to recruit foreign workers to fill their need should think nearby neighbors then distant-neighbors. That means, employers should consider looking to Canada and Mexico before looking to recruit foreign healthcare workers from, distant neighbors such as India, Ethiopia or the Philippines. The United States-Mexico-Canada Agreement speeds up the process and is likely cheaper! The other visas discussed in the short-term section below are also likely to be faster too and possibly cheaper than the H1-B option discussed at the end of this presentation.
TN Visas for Canadian and Mexican Healthcare Professionals
TN visas represent the fastest and most cost-effective option for recruiting healthcare professionals from Canada and Mexico. Under the United States-Mexico-Canada Agreement (USMCA), Canadian and Mexican citizens in qualifying healthcare professions can obtain TN status for temporary professional work 8 CFR § 214.6. TN visa applicants must provide documentation in the form of a letter from the prospective employer in the United States confirming the qualifying profession, job description, anticipated length of stay, professional qualifications, and compensation arrangements 8 CFR § 214.6.
TN visas offer significant advantages over other visa categories. TN visas under USMCA are not subject to annual numerical limitations, unlike the restrictive H-1B cap 8 USCA § 1184. Canadian citizens can apply for TN status directly at a port of entry, enabling same-day processing, while Mexican citizens must obtain TN visas at U.S. consulates abroad 8 CFR § 214.6. The visa category covers physicians (requiring unrestricted state licensure) and other healthcare professionals listed in the USMCA appendix 8 CFR § 214.6.
J-1 Exchange Visitor Program with Conrad 30 Waivers
The J-1 Exchange Visitor Program provides a pathway for foreign medical graduates to enter the United States for graduate medical education or training 22 CFR § 62.27. Foreign medical graduates on J-1 visas are automatically subject to a two-year home country physical presence requirement under section 212(e) of the Immigration and Nationality Act 22 CFR § 41.63. However, the Conrad 30 waiver program allows J-1 physicians to waive this requirement by committing to practice medicine for three years in a Health Professional Shortage Area 8 CFR § 212.7.
The Conrad 30 waiver eligibility requires that physicians “have entered into a bona fide, full-time employment contract for 3 years to practice medicine at a health care facility located in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals” 8 CFR § 212.7. Each state is limited to 30 Conrad 30 waivers annually, and state departments of public health coordinate the waiver application process 8 USCA § 1182.
Schedule A Permanent Residence for Nurses and Physical Therapists
Schedule A Group I designation provides the most efficient permanent residence pathway for registered nurses and physical therapists. The Department of Labor has predetermined that “there are not sufficient United States workers who are able, willing, qualified, and available” for these occupations 20 CFR § 656.5. This pre-approved labor market determination provides an expedited pathway for labor certification applications 20 CFR § 656.5.
Professional nurses qualify for Schedule A if they (i) have received a Certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS); (ii) hold a permanent, full and unrestricted license to practice professional nursing in the state of intended employment; or (iii) have passed the National Council Licensure Examination for Registered Nurses (NCLEX–RN), administered by the National Council of State Boards of Nursing” 20 CFR § 656.5. Physical therapists must “possess all the qualifications necessary to take the physical therapist licensing examination in the state in which they propose to practice physical therapy, 20 CFR § 656.5. Applications for Schedule A labor certification must include specific documentation requirements, and “labor certifications for professional nurses and for physical therapists shall not be considered” under regular PERM processing 20 CFR § 656.15.
National Interest Waivers for Physicians
Physicians serving in shortage areas or Veterans Affairs facilities may qualify for National Interest Waivers (NIW) under the EB-2 classification 8 USCA § 1153. The Nursing Relief Act created this “non-discretionary national interest waiver of the labor certification requirement for doctors who agreed to work in federally-designated health professional shortage areas” Schneider v. Chertoff, 450 F.3d 944 (2006). Physicians must agree to “work full-time (40 hours per week) in a clinical practice for an aggregate of 5 years” in designated shortage areas or VA facilities 8 CFR § 204.12.
The Schneider v. Chertoff decision clarified important timing requirements for physician NIW applications. The Ninth Circuit held that regulations “preventing time worked in designated shortage area prior to approval of doctor’s immigrant visa petition and national interest waiver from counting toward aggregate medical practice requirement was in conflict with, and ultra vires to” the Act Schneider v. Chertoff, 450 F.3d 944 (2006). This ruling helps physicians who begin working in shortage areas before their NIW petitions are approved.
O-1 Visas for Extraordinary Ability Professionals
O-1 visas are available for individuals with extraordinary ability in the sciences, arts, education, business, or athletics pursuant to the INA. The statute requires “extraordinary ability in the sciences, arts, education, business, or athletics which has been demonstrated by sustained national or international acclaim” and “whose achievements have been recognized in the field through extensive documentation. Individuals in O-1 status must continue work in their area of extraordinary ability pursuant to the INA.
The extraordinary ability standard typically requires healthcare professionals to demonstrate international recognition through published research, major awards, leadership positions, or other evidence of sustained acclaim in their medical specialty. This visa category is practical only for truly exceptional healthcare professionals with extensive documentation of their achievements. The O-1 Visa is for the best of the best healthcare workers. It is critical to speak with a qualified business immigration lawyer when contemplating hiring physicians under the O-1 Visa category to help assembling the documentary evidence, marshaling credible evidence and presenting substantial proof of the physician’s extraordinary abilities. Perhaps, another visa category is more appropriate!
Recent Developments in the Legal Framework
State legislatures are taking real and concrete actions to address medical worker shortages in their states. For example, in 2025 Texas legislature enacted Texas House Bill 2038, “Doctor Act”. When introducing the legislation, the author informed the committee some starling facts: 1) at least 30 counties in the State did not have a single primary care physician, 2) 39 percent of Texas’ physician are over 65 years old and are likely to retire within five years, and 3), Texas is projected to have 10,000 deficits in qualified doctors to serve in Texas’ hospitals, clinics and doctors offices throughout the State. The Doctor Act was passed into law in 2025. The Doctor Act sought to address the physician shortage in Texas by reducing regulatory barriers that prevent physicians from serving Texans and tapping into three underutilized physician groups to get more doctors to Texas: international physicians, veteran physicians, and physician graduates. The Doctor’s Act has been the law in Texas since September 1, 2025. It creates new provisional licenses for international medical graduates and unmatched U.S. graduates. The Doctor Act permits Texas hospitals, clinics, doctors offices and other healthcare employers hire eligible physicians who meets the following credentialing requirements:
- Foreign physician passage of the USMLE Step 1 and 2;
- Foreign physician with valid Job Offer from an American hospital, clinic, doctors office or other medical service provider;
- Foreign physician working under the supervision of an American licensed physician
The Doctor Act envisions issuance of provisional licenses where after two years the foreign physician can apply for full licensure as a physician in the State of Texas. Texas is not alone among States when passing legislation to address various aspect of the healthcare worker shortages. Today at the writing of this blog, more than 18 states have relaxed their regulatory requirements and eased licensing requirements to expand their physician pool. Some States have pending legislation to address the nationwide healthcare worker shortage. The states are taking various different approaches to the problem; those hiring healthcare workers to fill shortages should examine the approach of the state where they operate or seek to hire. Business Immigration lawyers can counsel and help navigate American hospitals, clinics and doctors’ offices in examining how best to comply with applicable laws when recruiting and bringing in qualified foreign physicians. Moreover, our readers must understand that national and perhaps even international laws are also in play when considering hiring international physicians. Contracts with physicians could be covered under cross-border laws and state specific contract laws. As for U.S. immigration laws which are contained in 8 U.S.C., commonly referred to as the Immigration and Nationality Act (INA) which gives the Executive Branch broad discretion in enforcing. Note that recently the Executive Branch announced up to $100,000 fees on certain visa category(s). Hospitals, clinics and others may offer to pay full costs to bring in foreign healthcare workers. Sometimes American law demands that the employer foots the cost of hiring and recruiting foreign workers. Lawyer counsel is critical to make sure things are done in accordance with all laws. An experienced business immigration and tax lawyer can help navigate these difficult issues. The basic point is that international, federal, state and local laws apply when hospitals, clinics and doctors’ offices bring in international physicians and other health care workers. Failure to comply with applicable laws could be costly, create long delays, potentially create legal jeopardy and present hardship and disappointment for the foreign healthcare worker, their families and others. American hospitals, clinics and doctors’ offices must do this right consistent with applicable laws.
Key Takeaways – Short-Term Strategy to Bring in Medical Workers within six months: A North American Regional Approach
For American hospitals, clinics, and doctors’ offices facing healthcare worker shortages and seeking to recruit foreign workers within six months, the most practical visa options in 2026 are: (1) TN visas for Canadian and Mexican healthcare professionals, offering same-day processing with no annual cap; (2) J-1 visas with Conrad 30 waivers for international medical graduates willing to serve in Health Professional Shortage Areas; (3) H-1B visas with premium processing for specialty healthcare occupations; and (4) Schedule A permanent residence applications for registered nurses and physical therapists. Canada and Mexico are our near neighbors where American hospitals, clinics and doctors’ office think in a broader way on North America pool of trained and equipped medical workers for better health outcomes for all of North America—the United States, Mexico and Canada. A pooled recruitment, training and deployment of qualified healthcare workers in unity with our close neighbors is likely to best to supply healthcare workers for North American patients and employers. Finally, as is pointed out—international, federal, state and local laws are implicated when American hospitals, clinics and doctors’ offices are contemplating hiring and hiring international healthcare workers.
Long-Term Strategy – Focus on Our Distance Neighbors
Now that we have examined some of the possible ways to quickly bring in physicians and other healthcare workers, let us turn to the old and tried H-1B visa category which requires labor certification. Note that with the exception of the TN visa category which is limited to citizens of Canada and Mexico— the other visa categories discussed above are available to health workers recruited from other countries. But for now, let’s look at the H1-B visa option.
Current Legal Framework:
H-1B visas apply to workers in specialty occupations requiring a bachelor’s degree or higher pursuant to provisions of the Immigration and Nationality Act (INA). Healthcare workers can qualify for H-1B visas if they meet the specialty occupation requirements, including physicians, nurses with bachelor’s degrees, and other healthcare professionals meeting the specialty occupation requirements 8 USCA § 1184. However, H-1B visas are subject to an annual cap of 65,000, plus an additional 20,000 for workers with advanced degrees 8 USCA § 1184.
The H-1B application process requires multiple steps that can extend processing times. Employers must first obtain a certified Labor Condition Application (LCA) from the Department of Labor, then file Form I-129 with USCIS 20 CFR § 655.700. Premium processing service is available for an additional fee, providing 15 business day processing of the I-129 petition 8 CFR § 106.4. The regulation prohibits employers from requiring H-1B workers to pay the filing fees paid by the employer” under section 214(c) of the Immigration and Nationality Act 20 CFR § 655.731. The fact is, American hospitals, clinics, doctors’ offices and others hiring foreign healthcare workers cannot pass any of the cost associated with complying with labor certification process to the foreign workers. It is not legal to pass these costs to the employee either directly or indirectly. As for the $100,000 penalty fee mentioned previously, it is not clear whether employers can pass this fee along to the foreign healthcare worker. Consultation and help from a Business Immigration Lawyer is prudent and possibly seeking guidance and counsel of a U.S. Tax Lawyer or both should be sought since U.S. tax laws increasingly present where migrants are involved. Pre-immigration tax planning, estate planning and asset protection are essential to protect the American employers’ interest and the interest of the foreign physician. Other international and federal laws could also be implicated when hiring foreign healthcare workers.
For example, the Philippines, India and Ethiopia have established healthcare education systems that produce qualified healthcare workers. But international laws in these countries could restrict or otherwise limit hiring of healthcare workers from the country. Often times the government has all but selected and paid for these gifted individuals’ education. Case law demonstrates the significant presence of Filipino healthcare workers in the U.S. healthcare system, with courts noting that “the issue of the exploitation of Filipino nurses has been the subject of attention” and discussing how healthcare organizations recruit nurses from the Philippines Anilao v. Spota, 27 F.4th 855 (2022). The Commission on Graduates of Foreign Nursing Schools (CGFNS) provides certification services for foreign healthcare workers, including those from Ethiopia, India and the Philippines countries 8 CFR § 212.15.
Healthcare workers from these countries must meet the same visa requirements as other foreign nationals. For nurses, CGFNS certification can facilitate visa applications and credential recognition 8 CFR § 212.15. The specific visa pathway depends on the worker’s qualifications, the employer’s needs, and timing requirements rather than country of origin. But country of origin laws could restrict, limit or somehow modify who and how healthcare workers from the country is recruited and hired by American hospitals, clinics and doctors’ offices. These insights could be explored with and explained by lawyers with foreign law firm friends and contacts within the origin country.
This law blog is written by attorneys at Coleman Jackson, P.C., which is located at 6060 North Central Expressway, Suite 620, Dallas, Texas 75206 for educational purposes; it does not create an attorney-client relationship between this law firm and its reader. You should consult with legal counsel in your geographical area with respect to any legal issues impacting you, your family or business.
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