Green cards enable you to live and work in the United States permanently and allow you to apply for citizenship after minimum 5 years of residency, with exceptions made for those who marry U.S. citizens or come to the country as refugees. A permanent resident (PR) does not hold the same status as a US citizen, but the major difference is in right to vote and live outside the country without restrictions.

Green cards can be obtained through employment, family, investment, refugee status, and other special conditions. Green card through employment is the most common path taken by foreign dental graduates who have completed a US dental program, so I will be discussing the employment-based options in detail.

Normally, you can apply for a green card (even from your home country) once you are assigned an immigrant visa number which is linked with your approved work visa. This is for people who can work immediately after moving to the US. Since foreign dentists have to equalize their degree/undergo additional training, in most cases they will be on a student visa (F1) or dependent visa (L2/H4). In these cases, you can apply for the green card only after you have a work visa/are employed. The green card application must be one of the most important negotiating terms in your employment contract.

The most commonly used employment-based green card types are:

EB1/First Preference: Individuals with special abilities, distinguished academics, professors, and researchers, and international executives are eligible for First Preference Permanent Residency or an immigrant visa. Evidence can range from Pulitzer or Nobel Peace Prizes and Athletic Awards to Professional Associations and Publications.
EB2/Second Preference: Professionals with an advanced degree (masters) or workers with exceptional talent. This also includes foreign nationals interested in a National Interest Waiver.
EB3/Third Preference: Skilled workers and professionals are eligible for Third Preference EB-3 green cards. Workers are required to have at least two years of experience and professionals usually require degrees from accredited universities.

Less commonly:

EB4/Fourth Preference: Individuals under special circumstances like Translators, Armed Forces Members, NATO-6 employees, certain religious workers, and Employees of global organizations.
EB5/Fifth Preference: Immigrant investors who are willing to invest between $500,000-$1,000,000 in a venture that creates at least ten new jobs for U.S. citizens, or other lawful permanent residents are eligible for fifth preference green cards.

Dentists generally fall in the EB2 or EB3 category which are employment based. Green cards can also be obtained through investment (invest $500,000 in a rural area or $1,000,000 in an urban area to set up a clinic/business that employs 10 US citizens or Green card holders) or self-petitioned (meeting a minimum of 3 out of 10 criteria to prove extraordinary ability in your field), both of which do not require an employer to file on your behalf and can be filed concurrent with your employment based green card.
Application Process:

1. PERM Labor certification: The sponsoring employer must obtain an approved labor certification from the U.S. Department of Labor (DOL) (which verifies that there are insufficient available, qualified, and willing U.S. workers to fill the position being offered at the prevailing wage, and hiring a foreign worker will not adversely affect the wages and working conditions of similarly employed U.S. workers).
2. Form I-140 (Petition for Alien Worker): Once the labor certification is approved by the DOL, the sponsoring employer must file a Form I-140 demonstrating among other things, that the employer has the ability to pay the offered wage and that the foreign national dentist satisfies the minimum qualifications required to fill the position that is being offered to him or her. An I-140 Approval Notice is a document that grants an employer the option to employ a foreign national on a permanent basis.
3. Form I-485 (Application to Register Permanent Residence or Adjust Status to remove any conditional requirements from their status): This is the actual green card application and can be filed only if your priority date is current as per the Visa Bulletin. The priority date is generally the date the labor certification application was received by the Department of Labor (DOL). If the priority date for the foreign national is current, they are able to file the I-485 and the I-140 concurrently. There are only 140,000 immigrant visas available each year for all the employment-based categories and there is a further 7% cap for each country. It is based on your country of birth, not the country your passport is from. Currently, Indian and Chinese applications are so backlogged that they have to wait for 8-10 years for their priority dates to become current. During this time, you could change jobs but your new employer would have start the process again with a new PERM but your priority date from the initial PERM application would be saved and you will not lose your spot on the queue.

With a valid Green Card, a foreign national dentist can stay and work in the U.S. as a permanent resident. The spouse and minor children of a Green Card holding dentist are also eligible to apply for a Green Card but each individual must file their own application. Once the I-140 is approved, you can apply for an Employment Authorization Document (EAD) for yourself and your spouse. The EAD will enable your spouse to study/work without restrictions that were placed on them while on their dependent status.

The dependent statuses do have certain restrictions:
*Student F-1 dependent F-2 spouses cannot work/study unless the study is “vocational or recreational in nature.” Recreational classes may include things like language, cooking, or writing courses, but cannot lead to academic objective or degree.
*Work J-1 dependent J-2 spouses can study, and work if they first obtain work authorization (EAD).
*Work H1b dependent H-4 spouses are allowed to study, but they cannot work until the EAD is approved.

Cost and time involved in the green card process:

• PERM Labor certification: Typically takes 4 to 6 months but this process may take longer if your application is selected to be ‘audited’ (about 30% of applications are audited with requests for additional information/documents). If audited, it goes back in the processing queue which may take an additional year to be processed by the Department of Labor (DOL). The costs for this step only involves lawyer fees around $3,500 (no government filing fee) which depends on the employed firm/lawyer plus the advertising/recruiting costs ($700-$2,500). The employer is responsible for the costs of this step and has to pay it on your behalf.
• Form I-140 (Petition for Alien Worker): I-140 must be filed within 6 months of the PERM approval and takes typically 4 to 6 months. However, for an additional $1,225 filing fee, the USCIS will fast-track the petition via “premium processing” (15 calendar days). The cost involved is around $2,750 lawyer fees plus $580 government fee for the EB2/3 category. This can be paid by the employer or the employee. So an employer may pass all or part of the expenses on to you either at the time of filing the I-140 Petition or as part of a “payback” agreement if you leave the job within a specified period of time after obtaining permanent resident status.
• Form I-485 (Application to Register Permanent Residence or Adjust Status to remove any conditional requirements from their status): In this step, you file for your dependents (spouse and children) as well. The time frame involved is dependent on your priority date. The USCIS currently charges a $1,070 filing fee per I-485 application ($635 for children under the age of 14). This fee, as well as any attorney fees or other expenses, may be paid by the employer or employee. For certain countries like India and China, the applications are severely back-logged (currently on 2008) and so you may have to wait 8-10 years for your priority date to become current. Your H1b work visa is valid for an initial 3 years plus 3 years extension but if you file your PERM step of the green card within this time frame, the work visa can be extended until your priority date comes up.

The Green Card Lottery Program
The annual green card lottery program is an opportunity for foreign nationals to obtain “green cards” through a randomly selected in a lottery process – known as Green Card Lottery. To be eligible to apply for the green card lottery, you must be a native or a country with a low rate of immigration to the US. There is no cost to enter the lottery, but the only way to apply is to complete and send a form electronically at the US Department of State’s Website during the registration period.

I know this seems like a lot of information to digest and you do not need to know all this to get it right. Once you are employed, your employer will have an immigration lawyer that will take care of this for you.

Please leave comments or additional information you wish to share below in the comments. Also, go over to the forums and pose your inquiry to like-minded people or discuss information in relevant groups.

Disclaimer: I am by no means a lawyer or an immigration specialist. All the information I have put together in this post are reflective of my own understanding and experience. Please do not hold me liable for any misinformation although I have tried my best to make sure that any information relayed to you is true to the best of my knowledge.