It constantly amaze us how many physicians with visa and immigration issues get advice from sources that either unscrupulous or unknowing.  Some of these soures are even family members, thinking that they know what the right answer is, but actually dont.  Or former colleagues, or current colleagues, or attorneys, or placement and recruiting agencies (yes, even in our industry).  And the worse of all, the internet. 

Immigration law is constantly changing, and even if the laws dont change, people change and the interpertation of the law changes.  So for example, what might have been acceptable for a waiver petition in California last year, might be a bit different this year.  And that doesnt just happen with immigration law, it happens in licensing, facilities, insurance, etc.  We live in a world that changes constantly and to rely on someone that might have gotten a waiver two years ago is not valid.

Also, our best recommendation is to get advice from experts in the particular field.  For example, with recruiting agencies, the largest in the country know very little about the nuances of the waiver process.  In fact, they know very little about it at all.  Why?  Because that is not their strength.  Their strength is to get a job in Phoenix for example, for the American physician that is currently working in Atlanta.  And they are very good at it.  The way to find an expert is to ask questions and to see what their expertise is.  Do they spend time with you on the phone telling you and explaining to you the entire J1 process and are they able to tell you about the current situation in most of the states.  Do they have good references and testimonials and are they willing to give you the contact information so you can speak directly to them.  Do they try to “hard sell” you, or do they offer their services if you want to take advantage of them.

For attorneys it is the same process.  A recommendation from somone else works best.  If not, do they have testimonials and references that you can check out.  Are their fees reasonable (please note, I said reasonable, not the cheapest - just like you would not necessarily want to go to the cheapest physician, you do not want to go with the cheapest attorney necessarily).  Remember if they screw up, the only person hurt is you.  And you might ask what is reasonable for fees for a J1 waiver -  The total process should cost anywhere between $6500 and $7500 not including filing fees.  That is reasonable.  If an attorney is charging you allot less, or allot more, then there either should be a very good reason or something is wrong and I would recommend not using them.

Friends, relatives and colleagues all think they might be doing you a favor, but believe me they are not.  We run into so many people that believe whatever they say and yet they are not in the industry, or they went through the process and their information is not timely.

Talking about not timely.  Information on the internet.  I am sometimes reading something on the internet and I look at it was published in 1999.  9 years ago.  The Conrad State 30 program was the Conrad State 20 program then, and it was only for primary care.  It has nothing to do with reality of todays situation. 

Do not believe anything unless it comes from someone you have faith in and know has experience and the experience is current.  We have seen so many physicians actually hurt their careers because they have taken a family members advice or from a colleague.  And the advice was wrong.  I am sure that they did it with the best intentions, and the physicians would almost get hostile when we told them that the information was wrong, but the simple fact is , the physician was hurt about it.

And getting the wrong attorney or the wrong advice from an attorney can be devestating and can end up costing you a career in the US and a new life for you and your family.

There is alot of information out there.  We are bombarded with it every day.  We trust none of it.  We go to either experts or the source.  We do not rely on information to make decisions that might be outdated, or from family members or colleagues that might simply be wrong.  You should be careful too.  It could mean the difference from working here and moving your career forward or not.

It is that time of year again that residents and fellows that will be finishing in 2009 are contacting us in droves.  We probably get over 100 phone calls and emails a week from physicians in every specialty and sub specialty.  The J1 Physician Network takes on a limited number of clients at any one time to insure that each physician is afforded a priority search and has personal service.

There is always a question about what a placement and recruiting agency does.  Here are just some of the things we do for each client.  Hopefully this will help you when deciding whether or not to use a recruiter or to seek a job for yourself.

1.  Insure that all J1’s get their State Department Case Number.  We help in filling out the form DS 3035.

2. Reveiw and rewrite the candidates CV.  We never change the content, but we do change the format to make it more “user friendly” and more presentable.

3.  Get an understanding of the physicians needs and the needs of their family.  We want to know each physicians needs in terms of schools for children, employment for spouses, religious needs, etc.  This information all goes together to get a profile of the physician to aid in making a good match with a facility and practice opportunity.

4.  If there are any unique immigration issues, have the physician speak with our on staff immigration attorney.  We want no suprises and make sure that all issues are covered.

5.  Find out each physicians expectations.  What they are expecting in regards to salary, call, geographic area, etc. and let them know what is probably the reality of the market place and what they can realistically expect.

Think about it, that is what happens even before conducting a search or presenting an opportunity.  We have all heard of nightmares for J1’s.  Do you know why?  Because all of these issues were not considered.  Physicians that only care about going to a particular city, or making a particular amount of money, or having a particular call schedule and not care about anything else, opens them up to problems and bad situations.

6.  Begin a search.  Find potentially appropriate opportunities.

7.  If a potentially appropriate opportunity is found, we insure that it is in a qualified area, we make sure there are still slots available in the state for a J1 waiver, we insure that the facility will offer a guarenteed income and not an income guarentee, we get a job profile that tells us the salary, call, vacation, whether or not they will pay for legal expenses, whether or not they will pay for site visits, etc.  Then, and only then do we present the candidate and tell about their background, their family, their hobbies, etc.

8.  If the facility is interested, we then arrange an initial phone interview. 

9.  If the facility is still interested, we help in arranging the site visit for the physician and his family ALWAYS paid for by the facility.  If they are not willing to pay, we do not present the candidate.  Just a quick note as well, if the facility is not willing to pay relocation we do not present the candidate.

We do not work with any facility that wont pay interview expenses or relocation expenses.  If they wont pay those, how do we know that they will pay the physician?

10.  After the site visit, we then insure that a contract, if going to be offered, will be offered within 5 days (typically).

11.  We reveiw the contract, and send a copy to our immigration attorney to insure that it meets all the requirement for the J1 waiver.

12.  We help each candidate negotiate any points of the contract that might need to be negotiated.  We also give advice on if we feel the facility is being reasonable and/or the candidate is being reasonable.

13.  We then expect the candidate to either accept or reject the contract with 5 days unless still negotiating changes.

14.  If the candidate rejects the opportunity, we start the entire process again.  If accepted, we help the immigration attorney with all the filings for the waiver petitition.

15.  We monitor the J1 petition until the candidate gets their H1 and then insure that them moving, getting housing, and starting their new career goes smoothly.

16.  From the time that a site visit is scheduled until the waiver petition is filed, we are in contact with the state insuring that the waiver will be approved.  We have never had a waiver petition denied.  We only allow the process to go forward if the waiver is going to be approved.

17.  We make sure that the facility will not take advantage of the physician.  The placement is important but we insure that the physician is going to be treated fairly and honestly.

That is a basic overview of what we do and what you should expect from a recruiter.  EVERY TIME.  Their are many that want allot of money and then present opportunites that do not match the physician in any way.  They dont vet the facilities and that leads to the nightmare situations that we have all heard of.  We know when a facility has the potential of abusing a physician and we have never had a situation that that has occurred.

We always give advice to every physician.  When using a recruiter, make sure that they do all of these items.  If they dont it will be the physician that suffers.

Also, because we are insuring a match, the number of interviews and such is not important.  I know many physicians call us and want us to get them 3 interviews and get them 3 offers and they already have 2 offers.  We decline and would not work with these type of physicians.  We want to make a good match.  One that meets the needs of the physician and their family.  That can take a bit of time and that is not always easy but that is our obligation.

And that should be the obligation of any physician recruiter that you work with

We try to get out as much information as possible to help you in your job search.  As a physician on a J1 it can be very difficult and sometimes daunting.  We have given examples of real life experiences so our readers can see maybe a different perspective and hopefully can learn and be helped by it.

Here is a a situation that happened very recently.  We had a J1 Internal Medicine candidate show interest in a Hospitalist job in a major city that we were representing.  He stated that he was available in August or September of this year, and we immediatly sent him a candidate profile to fill out.  We wanted to see if he could be a good match. 

He also sent his CV.  On the CV it was stated that in late in 2009 he was going to start a fellowship.  We asked him to clarify this.  He wrote back saying that he was starting a fellowship but needed a job from this August until next June.

We wrote back and said that it was impossible.  He could not get a waiver if he wasnt willing to sign AND fulfill a 3 year contract and that he could not work on a J1 visa.  He wrote back and here is his reply:

“I already have two offers and I dont think you know what you are talking about.”

Please remember, an offer or even a contract is NOT a waiver, it is NOT a change in visa status and it is NOT anything but a piece of paper with a  job description on it.  He cannot work as a J1.  If he signs a contract for 3 years, knowing that he will break it in 12 months, then he is just dishonest and has a lack of character (also, any credit for working in an underserved area will not be counted.)

Chances are that the facility does not even know his visa status yet, and they might not find out until the final steps of trying to hire him.  And then any potential deal will fall apart.  Why?  Because of his dishonesty.

Please Please Please remember:  A contract is only good if it will lead to a waiver.  If it does not, it is just a piece of paper. 

And being rude to us in his email just means that we would never work with this guy EVER.  We also get calls from many facilities and ask about candidates, even if they have not been presented by us.  We would never recommend this candidate for any opportunity anywhere.  And we also realize that if he was rude to us, he is probably just a rude individual that is rude to many people.  And those type of people dont get far in life and will find it difficult to work in a team environment.

We contemplated for quite awhile on how we should respond.  Should we set him straight?  Should we quote chapter and verse both immigration law and the US State Department and the USCIS guidelines?  Should we just be rude back?

We decided against all of those things and here is our reply:

“Congratulations on your offers and good luck in the future.”

We think he will need all the luck he can get.