Every immigrant comes to the US to realize their American dream….to come to the land of opportunities, to study and/or work and make it big! But somewhere along the way, you realize that the financial debt that comes with a foreign dentist going through a US Graduate program is accompanied by the fact that we are limited to certain jobs because of our immigration status. Attaining the freedom to practice freely can be achieved only once you receive your Green card or become a US citizen. While that sounds simple, depending on the country you were born in, this can be the biggest block to achieving your dream.

Generally, foreign dentists come to the US on a student/work visa and then apply for their green cards under their employer (in the EB2/EB3 category). Applicants from most countries will get their green card in a year (give or take) but the longest wait is for Chinese/Indian applicants (because of the sheer number of applicants). For example, USCIS is currently processing 2008 EB2 Indian applications..that is a wait of 8-10 years!! Hopefully, that will become current soon (it will take a miracle!) but until then, these applicants will be able to apply to extend their work visa if they have reached a certain point in their green card application. Once you get your Green card, you are issued with an Employment Authorization Document (EAD) which allows you to work as an independent contractor or own your own practice.

How does U.S. immigration affect my work as a dentist?

This is a topic that most foreigners do not think about when they are planning to move to the US. The freedom to work is limited under certain immigration conditions. I want to share what I know regarding this topic…

1. On a student visa (F-1)

Although there are several visa categories for international students in the United States (including J and M categories), the majority of international students enrolled in US colleges or graduate schools are under the F1 visa program. You have to be a full-time student but you can work part-time on campus as a research assistant/resident assistant etc. You are not allowed to work outside (not even minimum wage jobs). Check with your international student advisor on what on-campus jobs you are eligible for. Any off-campus employment for F-1 or J-1 students must be authorized! Work that is unpaid may still be considered employment for  F-1 or J-1 status holders. Without proper work authorization, off-campus employment would be considered a violation of your F-1 or J-1 requirements. The consequences would most likely include loss of legal immigration status in the US, possible deportation by the US Department of Homeland Security and great difficulty in any future attempts to acquire a visa to enter the U.S.

Once you are close to graduating, you will be able to apply for the F-1 OPT (Optional Practical Training), which will permit you to work for any employer in the US (subject to all of the rules of OPT) for 12 months. The 12 month period must be used within 14 months of completion of the study. The U.S. Citizenship and Immigration Services (USCIS) will accept applications for OPT up to 90 days prior to program end date and within 60 days after program completion. One twist to OPT is that students who have graduated from a US college or university with a specific degree in the STEM fields – science, technology, engineering, and mathematics – can apply to extend their OPT for an additional 17 months, bringing their total post-graduation OPT available time up to 29 months. Unfortunately, Dentistry is not considered under the STEM provision.

You do not need an offer of employment in order to apply for OPT. Students on OPT may not remain unemployed for more than a total of 90 days out of a 12 month OPT period. Any changes in your employment status should be informed to your International Student Advisor as they have the responsibility to report information in SEVIS. After completion of OPT, you are allowed to remain in the U.S. for 60 days to prepare to leave the U.S., change your status, or transfer your F-1 to a new school. You may not work during this grace period. To learn more about student visas and how to apply for one, check out this post.

2. On work visa (H-1B)

You will probably apply for the H-1B work visa when you have found a suitable and willing employer while still on your OPT. The H-1B work visa only permits you to work as an employee under someone else, not as an independent contractor. This means you will get a W2 form to file your taxes as an employee whereas independent contractors file the Form 1099. For a foreign dentist, this means owning your own practice will prove difficult until you get your Green card. This was a huge disappointment for us because as dental specialists, most dental offices expect us to work as independent contractors who pay our own taxes, but since we needed sponsors who would consider employing us as employees, finding jobs became difficult.

Timing is a critically important factor to keep in mind when applying for an H-1B. Current immigration law allows for a total of 85,000 new H-1B visas to be made available each government fiscal year. This number includes 65,000 new H-1B visas available for applicants with at least bachelor’s degree, with an additional 20,000 visas available for those with an advanced degree from a US academic institution. The applications must be submitted by April 1 (six months before the start of the fiscal year on Oct 1). In recent years the H-1B visa cap has been heavily oversubscribed and so the USCIS holds a lottery for the available H-1B visas. There are some exemptions to the numerical cap. Foreign nationals who are employed in nonprofit or government research organizations and educational institutions like universities and colleges (including two-year technical schools) are exempt.

Once you have been approved for your primary H-1B visa, you can apply for supplemental work visas for any additional employers. There is no limit to the number of employers or the minimum number of work hours needed. Supplemental work visas are ‘cap’ exempt.

You are allowed to invest in businesses or have passive income as a shareholder. As long as someone else runs the business and your role is limited to shareholder participation such as meetings and voting. You can buy a house or any other real estate in the US and can also invest your money in stocks, mutual funds, bonds etc. To learn more about H-1B work visas and how to apply for one, check out this post.

3. On Green card

This is the ideal scenario as you are allowed to work as an independent contractor or even own your business. Your employer will apply for your EB2/EB3 employment based Green cards. Most companies will have conditions that will need to be fulfilled for them to start your Green card process – either work for a certain period of time before applying on your behalf or have a contract where you work with them for a set number of years. This is something to keep at the forefront when negotiating your employment contract. Make sure you read the fine print before signing your employment contract and that both you and the employer are on the same page regarding this matter. Typically H-1B work visas are 3-year visas that can be renewed once resulting in a 6-year term unless the Green card has been filed and your position in the queue has been determined. Then the work visa can be indefinitely renewed until your Green card priority date becomes current. Once you get your Green card, you can apply for US Citizenship after a minimum of 5 years.

As of 2015, H4 visa holders (spouse/dependent on an H-1B work visa) will be eligible for an Employment Authorization Card (EAD) once the green card reaches a certain point in the application (pending Immigration Petition for Permanent Residence or I-485). On the EAD, they can work and even start/own a business. The H4 EAD is tied to the H-1B visa and so if the primary H-1B visa holder loses his status, the H4 EAD is invalid too.

Investor visa or green card: The “immigrant investor visa”, also known as the EB-5 visa, is an investment-based opportunity to obtain U.S. permanent resident status (a “green card”). Generally, one may obtain a green card through the EB-5 category by meeting two requirements: (1) invest $1,000,000 (in metropolitan areas) – $500,000 (in rural areas) of legally obtained capital in a U.S. commercial enterprise and (2) create 10 jobs for U.S. workers. To learn more about Green cards and how to apply for one, stay tuned for my upcoming post on it.

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.