Immigration Options for Dentists

by Ken C. Gauvey
www.gauveylaw.com

There are many associate dentist hiring cycles throughout the year. December through February is the busiest time of year for US-trained foreign nationals who will need to navigate the immigration process in order to work in the country.

With that in mind, we recently invited Ken Gauvey of www.gauveylaw.com to contribute. Ken has experience advising dentists and dental practice owners through the visa and permanent residency processes.

Dentists are placed in a strange position in U.S. immigration laws.  While being recognized as health-care professionals, dentists are precluded from applying for the same types of immigration benefits offered to other health-care professionals.  Therefore, with few exceptions, United States Immigration and Citizenship Services (USCIS) treat dentists more akin to engineers than doctors.  However, there are exceptions to this treatment that dentists can take advantage of that can either shorten the time it takes to get Lawful Permanent Residency (LPR), known as a Green Card, and remain in the U.S.

We hope that this overview will answer questions and ease concerns of those preparing to seek sponsorship:

Temporary Work Authorization

The standard immigration process involves working under some form of temporary visa status before gaining LPR status.  This temporary visa can be one of several visa options for professionals and include the H-1B, TN, and E visa categories.

The primary temporary visa status for working in the U.S. is the H-1B visa. The H-1B is a visa limited to professionals requiring at least a Bachelor’s degree and who are working for a specific U.S. employer as stated in the H-1B petition.  The H-1B is approved for a period of three years, with one three-year extension permitted, unless an application for LPR status was filed 365 days prior to the end of the 6th year of H-1B status, in which case the H-1B can be extended until the LPR status is finalized. However, there are only 65,000 H-1B visas available every year.  These visas are used by everyone from models, to IT and engineers, to doctors and dentists.  There are an additional 20,000 H-1Bs available for those who received a Master’s degree in the U.S. In 2013, USCIS received 124,000 H-1B petitions within the first five days of the application period, which starts every year on April 1. The H-1B therefore is fairly dependent on timing and luck.

The H-1B process involves two steps. Once the employer wants to hire a dentist on an H-1B, the employer, through counsel, files a Labor Condition Application (LCA).  The LCA is filed with the U.S. Department of Labor.  The DOL then certifies the LCA within, typically, 5-7 business days.  The LCA is then filed with USCIS, along with the I-129, evidence and supplements, to apply for the H-1B.  If the application is filed on April 1, if approved, the dentist can begin working on October 1 of that same year.

H-1B transfers work in a similar way with one important exception.  An H-1B transfer occurs when the dentist is already in the U.S. on an H-1B and wants to change employers. The new employer must sponsor the H-1B transfer.  The LCA, I-129, evidence and supplements are still required.  However, the dentist can begin working for the new employer as soon as the transfer application is sent to USCIS, rather than waiting for an approval.  

Dentists from Canada and Mexico have additional options for working in the U.S. These dentists can work under a NAFTA visa as a TN.  The TN is a visa that permits certain categories of workers, including dentists to work in the U.S. for a specific U.S. employer. The TN can be renewed without limitation as long as the dentist is employed by the employer.

Dentists from Australia can enter on the E-3 visa.  This visa is essentially an H-1B specifically for individuals from Australia. Importantly, the E-3 has its own numerical limitation of 10,500.  The E-3 may be renewed every two years.

Lawful Permanent Residency

Once a dentist is employed in the U.S., there are several ways to remain in the U.S. as a Lawful Permanent Resident.  The most used is the Labor Certification process, or PERM.  However, dentists and employers can avoid this lengthy and costly process in a couple of ways including demonstrating extraordinary ability or demonstrating acclaim as an outstanding researcher.

The Labor Certification process, or PERM, is the most often used avenue to Lawful Permanent Residency. In PERM, the employer engages in a specified three-month recruitment effort as dictated by the U.S. Department of Labor to try to fill the dentist’s position.  If no U.S. qualified applicants apply for the position, the employer then asks the DOL to certify the PERM application.  That certified application is then used to file for the immigrant petition and eventually Lawful Permanent Residency.  The entire process can take from one to ten years depending on how the DOL treats the PERM application and the country of origin of the dentist.

Individuals who have a record of research and publication in highly ranked journals can avoid PERM. Depending on the level of publication, international acclaim, and accomplishments, PERM can be avoided through the filing of a National Interest Waiver or Outstanding Researcher petition.  The National Interest Waiver is a petition to USCIS to be relived of the PERM requirements because it is in the national interest for the dentist to remain in the U.S.  The dentist has to show that the dentist’s continued presence and work in the U.S. would benefit the nation as a whole.  The Outstanding Researcher has similar criteria.  In these petitions, the dentist must demonstrate that the dentist has risen to the very top of their field.  This is often done through awards, references to published works, and the like. Either the National Interest Waiver or the Outstanding Researcher petition would permit the dentist to skip the PERM process.

Dentists have a plethora of immigration options available to them.  As with any major legal decision, it is always best to contact an experienced attorney familiar with the immigration needs of health-care professionals before going forward. U.S. immigration provides very few second chances, so it is always best to know the pitfalls and hurdles that stand in the way.

For more information or to consult with an immigration lawyer, please contact Ken Gauvey at www.gauveylaw.com

What Does Your Interviewing Process Say About Your Company?

Grabbing the attention of top candidates can be challenging for employers trying to court their first picks in the executive, managerial and professional job market. These applicants are typically interviewing with multiple companies and have additional options at their disposal. Employer branding and a streamlined recruitment process are just a few of the strategies companies are using to make themselves more attractive in this candidate-driven market. While these strategies can help make the recruitment and hiring process more efficient, many employers forget to consider the subtle messages they could be conveying about the company, through the interviewing process itself. This oversight can create a lasting impression that turns candidates off before an offer is ever made.

With a shrinking talent pool and increased competition for top candidates, employers have to not only sell the company well, but also conduct an interviewing process that presents the company and its corporate culture in the best light possible. "When companies approach the interviewing process from the candidate's perspective, they are much more likely to create an experience that is mutually engaging and appealing to the 'A' players in their markets," says Rob Romaine, president of MRINetwork.

The interviewing process should be an opportunity for both parties to evaluate a professional and cultural fit with the company. Yet, consider as an employer that perhaps you are additionally sending out unintended messages about weaknesses in the company culture or work practices.

Have you reflected on the following?

1. Is your process executed in an organized, seamless manner?
2. Are the company representatives experienced at interviewing candidates, or are they just winging it?
3. Are the interviewers polite and sincerely interested in learning more about the candidate's background, or are any of them annoyed that the interview is taking them away from their work?
4. Does the company do its best to follow-up with top applicants and keep them engaged or do several days or weeks go by without any feedback from the interviewer?
5. Is the interviewing process lengthy or is it respectful of candidates' time?

If you answered no to any of these questions, it may be time to re-evaluate what the company's interviewing and recruitment practices say about the organization. "Just as employers are concerned about making a bad hire due to poor cultural fit or lacking skillsets, candidates are equally concerned about working for companies that seem disorganized, unprofessional, unreliable or inconsiderate of their employees' needs," notes Romaine. "Even the slightest glimpse of poor work practices can send top candidates away from your organization and straight to a competitor."

At the end of the day, the interviewing process is as much about candidate discovery as it is about employer branding. It is therefore important for employers to evaluate whether their practices are attracting or detracting key talent from their organizations.

Hiring an Associate Dentist – Experience vs. Potential

When we start working with a practice, we collect a lot of information about the owner, practice, and the position. Some details are quantitative, but many crucial points are open for interpretation. Most practice owners tell us they need an experienced dentist for their position. In most cases, that is the best option. In fact, over 90% of the doctors we place have over one year of experience in practice or residency. But what are the tradeoffs to experience? When should an office consider hiring a doctor a year or two out of school rather than five to seven years out?

Experience

 Pros-

• Production: Dental School is just the beginning. It takes several years, lots of CE and thousands of chair side hours for most dentists to hit their stride. An experienced dentist should be better able to handle a full schedule.
• Known quantity: A seasoned dentist brings credentials, a work history, and track record of past successes that will allow a new employer to project reasonably accurate results
• Less Babysitting: With experience comes independence and the ability to handle

Potential

Pros-

• Malleable: While an experienced dentist will come to your practice with his or her own idea on how an office should operate or with a well-defined clinical philosophy, a less-experienced dentist will be open-minded and receptive to guidance.
• Less up front needs: This is true of patient load as well as guaranteed income. While many recent graduates have huge student loan debts to consider, they typically have less expense in the rest of their lives. They also come to your practice without the burden of trying to reach previous income levels. They typically are better able to handle a growing practice than a dentist who needs to maintain a higher standard of living
• Superstars are still available: Most practices would love to hire a dentist who is motivated, great with patients, can keep procedures in house and who will be a boom to the practice for years to come. Dentists like that are rarely available long. These are the dentists who are partners or practice owners within a few years of practice.

Posted by Morgan Pace.

Morgan Pace is the Southeastern U.S. Account Executive and Senior Recruiter for ETS Dental. He can be reached at mpace@etsdental.com or 540-491-9102. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com

Is Your Quest for the Perfect Candidate Hampering Your Company's Recruitment Goals?

Until a few years ago, prospective Google employees had to endure a hiring process that could involve more than 10 interviews. The resulting length of the hiring process created a time-intensive ordeal for hiring managers, causing the company to frequently lose top talent to its competitors. Two years ago Google overhauled its process and limited each candidate to five interviews, recognizing that the longer candidates are on hold, the more time they have to get another job offer or accept a counteroffer.
While Google's previous 10-interview process is atypical, many companies employ a lengthy interviewing and hiring process. Some organizations recruit in this manner because of lingering practices developed during the recession when companies focused on filling only the most vital roles, incorporating lengthy interviewing processes to avoid making hiring mistakes. Other employers simply argue that their process has historically proven to be successful in ensuring great hires within their organization. In either scenario, these companies don’t realize that lengthy interviewing processes are no longer effective in today’s executive, managerial and professional job market. In this space, which is largely candidate-driven and where the talent pool is small, top candidates are being courted by several companies and have many options at their disposal. A prolonged search not only hampers companies’ ability to recruit the best candidates, it also keeps employers from seeing the potential of well-qualified individuals who may be missing some of the job requirements.

Employers frequent look to recruiters to help them locate talent that are a perfect match to job descriptions, however the purpose of all new hires should be not only to match job requirements but also to bring in people that have the growth and leadership potential to help companies move their businesses forward.

"It's important to learn to recognize potential in candidates who can become 'perfect' employees through guidance and leadership," advises Rob Romaine, president of MRINetwork. "Don't focus only on how closely they match your job description, but also consider whether they can evolve into the current role and beyond."
MRINetwork recruiters typically offer the following advice to companies trying to evaluate whether they should streamline their hiring processes:

1. Determine if your interviewing process is time-efficient and considerate of candidates’ time. The best candidates are typically employed and are interviewing with multiple companies.
    
2. Review whether you struggle to hire your top picks or if you are losing them to counteroffers and other job offers.
    
3. Keep the lines of communications open. Explain each step of the interviewing process to the candidate up front. Provide feedback within 24 hours of the interview and explain next steps to keep them engaged in the process.
    
4. Consider what your interviewing process says about your company culture and brand. A lengthy process could give the impression that there is always a lot of red tape with getting things accomplished or approved. It can also give the wrong impression that you are no longer interested in the candidate.

Adds Romaine, "The most successful companies realize that recruitment is not about finding candidates that perfectly match job descriptions." "It is about matching talent that have the experience, skills, maturity and cultural fit to impact the company and lead it into the future. Most job-related skills can be taught within three to six months, but intelligence and leadership skills are something candidates either have or they don't. It is up to hiring managers and highly-skilled recruiters to be able to discern whether talent have the potential to not only fit into a given role, but also become strong leaders in the company."

What Does a Graduating Pediatric Dentist Earn?

So you have done well in college and were accepted into dental school. During this time you have realized that you have a special talent and interest in working with kids. You apply and are accepted into a pediatric residency and spend a couple of more years earning your pediatric dental certification.

Finally, after many years of study and devotion, you are a pediatric dentist! You are now ready to enter the market and find that first job and wonder what is fair and what you can expect to earn. You probably have heard figures from your residency director, co-residents and others in the specialty and the numbers may vary widely. Who is right? They are probably all correct in what they are telling you and the differences can be explained by understanding what they have experienced.

I am an independent recruiter who works exclusively with dental specialists and I spend most of my time with private pediatric dental practices and those looking to hire a pediatric dentist. I work nationally and see daily what practices are offering and new graduates are getting in different areas around the country.

What am I seeing? Nationally, on average, I see base guarantee of around $200,000 which is vs. a % of collections. Most practices pay on a % of collections rather than production since most are participating in a few PPO’s or discounted plans.

To break this down further, the daily guarantee averages between $800 and $1,200. The daily guarantee should become a moot point after one is up and running with a practice and it is there as a floor. With the guarantee, the practice is saying that they are going to have a schedule that will allow you to be productive and, if they do not for a particular day, you will still be paid for your time.

What % are practices paying? Typically it will be between 35% and 45%. A % approach is recommended rather than a flat salary because it allows the associate to be in control of their destiny and they know what they need to produce and then collect in order to reach a certain earnings level. With the % approach vs. a salary, practice owners are not wondering if they are overpaying and associates are not wondering if they are being underpaid and are incentivized to work rather than surfing the internet or other non productive distractions.

Why would one work for 35% when others are getting 45%? I see a good number of graduating pediatric dentists who evaluate a practice opportunity based on the % alone and anything less than 40% or 45% are not of interest to them. What they really need to look at is the nature of the practice to include the patient flow, whether they will be doing a good amount of restorative and the ability to do hospital dentistry and sedations etc. A pediatric dentist can do much better financially in a busy practice paying a lower % vs. a higher end, slower practice paying 45% where they are relegated to hygiene checks and little restorative dentistry. 

Location, Location, Location: That said, the biggest factor in what a new graduate pediatric dentist can and will earn is where they decide to live and practice. This is a simple supply and demand economics equation with some of the best earnings opportunities being in areas that you and I may have never heard of.

What I see is that most of the major metropolitan areas across the country tend to be fairly saturated with pediatric dentists and it can be more challenging for the new graduates to find truly good private practice opportunities. I recommend looking at areas where people are not going and take a position there for a couple of years. You can earn a great deal, gain very valuable experience and make yourself much more marketable and you will find it much easier to get into the market where you really want to be for the long term.

If you have any questions about earnings or the state of pediatric dentistry in certain areas of the country feel free to call me. I will be happy to share with you what I know.

 

Gary Harris is a nationwide Recruiter for Dental Specialists at ETS Dental. He can be reached at gharris@etsdental.com or 540-491-9115. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com