Physician Perm February 6, 2018

By Carl Shusterman

International Medical Graduates and the H-1B Lottery

For physician recruiters who are working with candidates on H-1B visas, April really can be the cruelest month, as T.S. Eliot said.

This is because each year on April 1, thousands of employers throughout the country submit petitions on behalf of foreign-born professionals whom they hope to hire on H-1B visas. This includes hospitals, medical groups and healthcare facilities, which submit H-1B petitions on behalf of international medical graduates (IMGs).

In 2014, over 172,000 H-1B petitions were filed on behalf of a wide range of foreign professionals, including physicians. However, only 85,000 visas were available. This year, there will likely be over 200,000 petitions filed, while the H-1B cap will remain stuck at 85,000. Who gets an H-1B and who does not then becomes a random lottery. Win and your candidate is in. Lose and he or she may have to go back to the drawing board and wait for next year.

One strategy physician recruiters can employ to enhance their odds of success is to submit petitions in the cap-exempt category, when possible. This includes positions with academic medical centers and facilities affiliated with academic medical centers.

However, IMGs coming out of residency who trained on H-1B visas often are recruited to non cap-exempt hospitals, medical groups and other facilities. Because the H-1B is employer specific, these facilities must file for an H-1B on the candidate’s behalf in order to employ them. When they do so, they are subject to the lottery, and their chances of obtaining an H-1B in this year’s lottery are less than 50%.

An alternative, where possible, is to skip the H-1B lottery and sponsor the IMG candidate for a green card. Provided the employer is located in a federally designated Health Professional Shortage Area (HPSA), and the candidate commits to practice in the location for five years, the candidate can qualify for a National Interest Waiver (NIW). Going through the NIW process, the candidate can qualify for work permission 90 days after the green card petition has been filed, which is faster than going through the H-1B lottery, even if you are fortunate enough to win it. Keep in mind, however, that this strategy does not apply to physicians born in India or China, due to per-country quotas for green cards.

Though you may wish to try your luck in the H-1B lottery, it’s good to have alternatives, because the odds are lengthening. If you have had an interesting experiences with the H-1B lottery, or if you have any questions about alternative strategies, please feel free to share them. I can be reached at or at 213-623-4592, ext. 0.


Carl Shusterman served as a Trial Attorney with the U.S. Immigration and Naturalization Services and is principal of the Law Offices of Carl Shusterman ( a firm specializing in obtaining work visas for healthcare professionals and in other aspects of immigration law.

Latest Blogs

Take the first step to starting your new career.

Authorized to work in the US? *
Job Type Interest *
Have you been on an Interim engagement with AMN before? *
Are you currently employed or on an active Interim engagement? *

How much notice would you have to give? *

What date are you available to start an Interim engagement? *

* Indicates Required Fields


I agree to receive emails, automated text messages and phone calls (including calls that contain prerecorded content) from and on behalf of AMN Healthcare, and affiliates. {{show_more}} I understand these messages will be to the email or phone number provided, and will be about employment opportunities, positions in which I’ve been placed, and my employment with AMN companies. See privacy policy or cookie policy for more details.

Complete Your Application!
AMN Healthcare NurseFinders logo
Continue to NurseFinders to complete your application and profile.