The Current Therapist Shortage in the U.S.

The current shortage of qualified Occupational Therapists in some regions of the United States has caused many health care providers to recruit foreign Occupational Therapists.  Fortunately, U.S. Immigration laws provide several employment visa options for U.S. employers seeking to hire foreign Occupational Therapists.

Overall there are two main options for employing foreign Occupational Therapists in the U.S:

1. temporary work visas; and
2. permanent work visas (green cards).

TEMPORARY WORK VISAS FOR OCCUPATIONAL THERAPISTS

Most foreign Occupational Therapists have bachelor’s degrees in occupational therapy and thus qualify for the versatile 6-year H-1B status.  Canadian and Mexican Occupational Therapists can be employed in the U.S. in H-1B status or TN status under the NAFTA treaty.

• H-1B Status for Occupational Therapists
  
  Most foreign Occupational Therapists qualify for professional H-1B status.  Occupational Therapists with bachelor’s degrees (or equivalent) in occupational therapy qualify.  The H-1B status authorizes a total stay of 6 years and is issued in increments of 3 years.  INS processing time is generally 15 to 120 days.
  

• TN Status for Canadian Occupational Therapists
  
  Canadian Occupational Therapists can work in the U.S. in TN status pursuant to NAFTA.  Occupational Therapists are one of the many professional occupations listed on the NAFTA Annex. TN status is valid for one year and may be extended each year.  The TN status can be obtained upon the day of entry into the U.S.  The TN Therapist’s spouse and children may reside in the U.S. in TD status.  Of course, the TN Occupational Therapist must also meet all state licensure requirements. The H-1B status is superior to TN status and most U.S. health care providers should pursue H-1B status.  However, there is no $1000 H-1B filing fee associated with the TN status.
  
• TN Status for Mexican Occupational Therapists
  
  Mexican Occupational Therapists can work in the U.S. in TN status pursuant to NAFTA.  The TN status is valid for one year and may be extended each year.  The Mexican Occupational Therapist’s dependents may reside in the U.S. in TD status.  The procedure for obtaining the Mexican TN status differs from the Canadian TN status.  Employers must offer Mexican TN Occupational Therapists the higher of the “prevailing wage” or actual wage.  Also, the U.S. employer must first petition the INS Service Center and obtain TN approval before the Mexican Occupational Therapist can obtain the required TN visa in the passport.  Processing time can range from 15 to 90 days. Canadians are visa-waived and do not have such requirements.

Permanent Visas (Green Cards) for OCCUPATIONAL THERAPISTS: A  3-Step Process

Foreign Occupational Therapists may obtain employment-based immigrant visas (lawful permanent resident status) through a 3-step process that takes approximately 24 to 36 months to complete. Unlike Physical Therapists and Registered Nurses, Occupational Therapists must undergo a 3-step process that includes an arcane and time-consuming “labor certification” process through the U.S. Department of Labor.  Occupational Therapists are not “Schedule A” employees and thus are not “pre-approved” for labor certification by the U.S. Department of Labor.

• Step One: Filing the Application for Labor Certification (Form ETA 750 with the DOL)
  
  The immigrant visa process for Occupational Therapists commences with the preparation and filing of the Form ETA 750 application for permanent alien labor certification with the state’s Department of Labor in the state of intended employment.
  
  Alien labor certification is a procedure that employers must undertake in many cases to establish that there is not a qualified and available U.S. worker as an alternative to employing the alien in question on a permanent basis.  In the past, the employer has normally been required to conduct a supervised recruitment and prove to the satisfaction of the DOL that a minimally qualified U.S. worker cannot be located and recruited to the employment.
  
  A separate form ETA 750 Part A and B (in duplicate original) must be filed for each therapist.  The total processing time for these applications is a range between six and eighteen months (depending upon the state).  The INS Service Centers, when operating efficiently, process I-140 petitions for Occupational Therapists in two to six months.  For more information about the labor certification process click here.
  
  

• Step Two: Filing the Immigrant Visa Petition (Form I-140 with the INS)
  
  Upon approval of the application for permanent labor certification by the US DOL, the next step is to file the immigrant visa petition. The petition contains information about the sponsoring employer and the foreign occupational therapist.
  
  A separate I-140 immigrant visa petition must be filed for each therapist. The INS filing fee for each application is $115.00.  In addition, a company support letter and the Occupational Therapist’s credentialing documentation must accompany the form I-140 petition.
  
  The INS Service Center processing time for I-140 Immigrant Visa Petitions is a range between two to seven months.  The INS Service Centers, when operating efficiently, process I-140 petitions for Occupational Therapists in two to six months.
  
  Upon approval of immigrant visa petition, the Occupational Therapist may apply for adjustment of status (Form I-485) if he or she is working in the U.S. (e.g. in H-1B or TN status). Alternatively, the Occupational Therapist may apply via “consular processing” in which case the INS Service Center will forward the file to the National Visa Center for further processing at the U.S. Embassy or Consulate in the foreign therapist’s home country or country of residence.
  
  

• Step Three:  Adjustment of Status or Consular Processing
  
  Upon INS approval of the I-140 immigrant visa petition, the file is forwarded to the National Visa Center (NVC) to initiate “consular processing”. The NVC is a clearinghouse and serves as the liaison between the INS and Department of State (U.S. Embassy or Consulate).  In some cases, the Therapist is currently in the U.S. and thus eligible to “adjust status” and complete the green card process inside the U.S.   Many Occupational Therapists working in the U.S. with H-1B or TN status elect to adjust status by filing Form I-485 with the INS Service Center.  Processing time of the I-485 application may take 8 to 15 months.
  
  Consular processing is often quicker but requires the Therapist to appear at a scheduled interview at the U.S. Consulate/Embassy in his or her home country. It usually takes a few weeks ( three to six ) for the INS to forward the case to the NVC. Once the NVC receives the approved I-140 petition from the INS, it issues “Packet 3", a group of State Department forms including the visa application (Form DS-230, Part I) and a checklist (Form DS-169) of documents the Occupational Therapist will need to present to the consular officer at the required Embassy interview.
  
  The Form DS-230, Part I should be completed immediately and forwarded to the U.S. Embassy or Consulate. Once the Occupational Therapist has obtained all of the necessary documents (see below) listed on the Form DS-169 checklist, the checklist must then be mailed to the U.S. Embassy or Consulate. Upon receipt of the Form DS-230, Part I and the checklist, the Embassy or Consulate will then issue “Packet 4" including the scheduled interview appointment letter.
  
  “Packet 4" contains the visa appointment letter (time/date of interview), Form DS-230, Part II, IRS Form 9003, the medical examination form and the affidavit of support form (Form I-864). The Therapist must appear at the designated physician’s office for the required medical examination. The Therapist should present his or her vaccination records (if available). Upon completion of the examination, the physician will seal the results in an envelope. With respect to the I-864 affidavit of support, the Therapist must complete one for his or her accompanying immediate family members (spouse and children under 21). The affidavit is submitted as evidence that the accompanying family members will have adequate means and support.
  
  At the required Embassy interview, the Occupational Therapist (and accompanying immediate family members) will present their Forms DS-230, Part II, completed medical examinations, the visa processing fees (approximately $400 per person), employment support letters and the required documentation (e.g. police clearance, OT licenses and certifications) listed below. If the consular officer is satisfied that the Occupational Therapist meets the qualifications for the immigrant visa, an immigrant visa stamp will be placed in the Therapist’s passport at the close of the interview. The accompanying family members will also be issued their visa stamps. Accompanying family members may opt to apply later in a “following to join” case.

DOCUMENTS REQUIRED FOR APPROVAL OF I-485 APPLICATION TO ADJUST STATUS

•  Visa Screen Certificate

All foreign health care workers (including Occupational Therapists) are required to obtain a Visa Screen certificate from an approved credentialing agency. The approved agency for Occupational Therapists is the National Board for Certification in Occupational Therapy (NBCOT). The Visa Screen certificate verifies that the foreign Occupational Therapist’s education, training, license and experience is comparable to a U.S. Occupational Therapist and that the foreign Occupational Therapist is fluent in English and has the appropriate license.

One of the requirements for obtaining the Visa Screen certificate for Occupational Therapists from countries in which English is not the official language is passage of the Test of English as a Foreign Language (TOEFL).

Although the INS Service Center will accept the filing of an I-485 application without the required Visa Screen Certificate, the I-485 application will not be approved unless and until the Occupational Therapist submits the required Visa Screen Certificate.

• Occupational Therapy License

The foreign Occupational Therapist must be registered in the country where he or she is practicing or received occupational therapy education. Proof of the foreign Occupational Therapist’s licensure/registration (if required for practice) must be submitted with the I-140 immigrant visa petition.

With respect to U.S. licensure (state of intended employment), temporary or interim licenses (if required by the state) may be obtained once the foreign Occupational Therapist enters the U.S.  Each state has its own requirements for obtaining temporary and permanent licenses, some states having no licensure requirements to practice.

DOCUMENTS REQUIRED AT THE EMBASSY INTERVIEW

• Visa Screen Certificate