Hiring an Associate Dentist Who Requires Visa Sponsorship

Long a part of medical doctor staffing, dentists requiring visa sponsorship have come to represent a much larger segment of the available work force. Often these associate candidates bring extensive training and geographic flexibility that is not easily found in the domestic applicant pool. Also, they often offer a longer-term associate solution, as the visa process discourages the kind of “job-hopping” that is more routine with traditional early career dentists.

Whether a practice is considering sponsoring a new Visa or transferring an existing Visa, the process is not as intimidating as it may appear. Our friend Ken Gauvey of The Law Practice of Ken C. Gauvey (http://www.gauveylaw.com/) provides the following overview of the Visa sponsorship process from the employer’s perspective. For more information or to consult with an immigration lawyer, please contact Ken Gauvey at www.gauveylaw.com.

Hiring Doctors in the Era of Health Care Shortages

The U.S. faces a national shortage of doctors. In fact, the Association of American Medical Colleges released a report indicating that the U.S. shortage of qualified physicians is at 20,000 now with half of the nation’s doctors being over the age of 50. As a result, that shortage, even before the introduction of the Affordable Care Act, is expected to grow exponentially in the coming years. A study in the Annals of Family Medicine projects that the country will need 52,000 more primary care physicians by 2025. According to the Journal of the American Medical Association, only one in five graduating medical residents plan to go into primary care. In the face of this shortage, it is clear that hospitals in the U.S. will have to rely more on qualified foreign doctors to fill this gap.

Unfortunately, the means to hire foreign nationals are limited and complex. In general, when hiring a foreign national doctor, the immigration timeline follows a predetermined schedule. In many cases, a doctor will need a J-1 waiver, followed by an H-1B visa, followed by some form of permanent residency sponsorship. Doctors who come to the U.S. to finish their studies commit to a two-year period of practicing medicine in their home country. The J-1 waiver is required to waive that two-year commitment. In exchange, those doctors agree to work for three years in the U.S. in a medically underserved area. However, once the waiver is approved, the doctor still needs an H-1B visa to actually work in the U.S.

The J-1 Waivers are limited. At present, each state only gets 30 of them. Moreover, each state has its own processes and procedures developed by the state department of health in place to determine who gets one of the waivers. Some states require the putative employer to demonstrate six months of recruiting efforts. Other states have few actually requirements outside of an application. Some states process the waivers at no cost to the employer; others have large fees associated with waiver requests. Having knowledgeable counsel who is familiar with the requirements for multiple states is of significant benefit to the employer. Once the state approves the request, the U.S. Department of State has to approve it. This process generally takes six to ten weeks. Following this, the Department of Homeland Security (DHS), through USCIS provides the final approval.

Concurrent with the review, the employer can file for the H-1B, which is the visa that actually allows the doctor to work. With premium processing, the H-1B can be approved, along with the final waiver, two to three weeks after the Department of State issues its approval. The H-1B is valid for three years, and permits one three year extension. During this period, the employer has to make a determination on whether to sponsor the employee for permanent residency.

There are many ways to obtain permanent residency through an employment relationship. The two most prominent ways are the National Interest Waiver (NIW), and Labor Certification. If a doctor subject agrees to work for five years (two in addition to the typical J-1 service requirement) in a medically underserved area, the doctor can immediately apply for a NIW. Additionally, assuming an immigrant visa is immediately available; the physician can also file for permanent residence, though the final approval of permanent residence is granted only upon proof of five years of service. An additional benefit afforded by the NIW and concurrent application for permanent residence is that the immediate family of the physician may apply for work authorization. Moreover, this process avoids the Labor Certification process which is time consuming and expensive.

The Labor Certification process requires the employer to conduct a specific test of the labor market to determine whether there are any qualified, ready, willing and able U.S. physicians to fill the position. The employer must conduct, at minimum, a two month recruiting effort using methods dictated by the U.S. Department of Labor. The employer must conduct a good faith recruiting campaign using five different types of recruitment efforts such as newspaper advertisements, web advertisements, etc. The employer has to interview minimally qualified candidates and if one candidate meets the qualifications the Labor Certification process fails. Therefore, this process requires an in depth review of the job description, and strict adherence to the regulatory requirements for the recruiting campaign. At the end of the recruiting effort, assuming no minimally qualified candidates are found, the employer, through their attorney, can file the Labor Certification application asking the DOL to certify the position. The DOL can request an audit, approve or deny the application, or have the employer redo the recruitment process under DOL supervision. Once approved, the employer can file the employment-based visa application. Following approval of the visa, and the completion of the three-year waiver requirement, the doctor can then file for permanent residency, subject only to the per country limitations in this process.

The process for hiring foreign national doctors is complex, but manageable with competent legal counsel. Employers should not shy away from engaging in this process especially as the shortage of doctors in this country continues to grow. However, employers do need to know the options when seeking to hire doctors who are subject to the J visa requirements. Competent legal counsel can manage the J waiver process and the H-1B process; and provide legal guidance throughout the Labor Certification process; and can prepare the remaining immigration filings. Therefore, while hiring doctors can be complex, employers cannot afford to shy away from the process in this era of health care shortage.

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

Electronic Cover Letters

Attached you will find my resume. I have 7 years of Medical Receptionist experience but no dental office experience.  I read that you need to have dental office experience and I don not have that but still feel that I would be a good choice for the job. Thank you for looking at my resume.

Writing a cover letter can be tough.  However, it is an important to getting your foot in the door.  Above is a cover letter that I recently received.  Yes, that is it, spelling error and all.  Honestly, I did not even open this individual’s resume, but it did get me thinking about what other individuals need to do to improve their chances at getting the attention of a potential employer.

In this day and time, the cover letter is especially crucial since communication is electronic.  When your resume is an attachment, this is your first chance to make an impression on a potential employer.  Unless you are copying and pasting your resume into the emails, which I do not recommend, your resume is not staring the reader in the face.

So, what can you do to stand out and get the reader’s attention?

First, address the reader.  Now, in this person’s defense, she was applying to a blind ad.  She could have, however, addressed the email to the hiring manager or with a “Dear Doctor”.

Next, let the reader know which position you are interested in.  They could have more than one opportunity available.

Then, focus on the positives.  The phrase that jumps out at me in this letter is “no dental office experience” a requirement for the position.  She even goes on to say that she read that it is a requirement.  Focus on what you have. 

A few other points to hit on in the body of this email, spell out simple numbers.  Spell check is a wonderful thing-use it.

Finally, there is no way to contact this individual in the email.  What if the attachment does not work?  Always, always, always include contact information! 

Below is a simple letter that would have made a much better impact for the job seeker.

Dear Doctor or Hiring Manager,

Attached you will find my resume for the opening you have available for a dental receptionist.  I have seven years of experience working in the medical field as a receptionist.  I am computer savvy and have strong customer service skills; I believe that my skills would transfer well into your practice and would welcome the chance to interview for your opening.  Please feel free to call me at (xxx)xxx-xxxx if you have any questions or would like to schedule a time to meet.

Thank you for your time and consideration.

Regards,

Your Name

A few extra minutes and minimal work can mean the difference between your resume getting deleted or you scoring the interview.  Take your time!  Happy job hunting!


Tiffany Worstell is a nationwide Recruiter for Dental Staff at ETS Dental. She can be reached at tworstell@etsdental.com or 540-491-9112. 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

Recruitment in 2014 - Employers Look for Unique Ways to Compete for Top Talent

As we kick off the New Year, the candidate-driven market that MRINetwork has been observing in the executive, managerial and professional sector is projected to become an even greater challenge in 2014. The media is increasingly making note of this trend, referenced as "overwhelmingly candidate-driven" in the most recent MRINetwork Recruiter Sentiment Study, as exceptional candidates with specialized skills gain more leverage due to a shrinking talent pool. The reality is that employers must compete like never before to bring in the best people to lead their organizations into the workforce of 2020 and beyond.

Click to enlarge.

"2014 has been slated as the Year of the Employee, due to global economic growth that is increasing demand for top candidates with specialized skills," says Nancy Halverson, vice president of global operations for MRINetwork. "As 'A' players gain more control over the hiring process, employers will need to develop innovative processes to recruit and retain exceptional talent."

The following are some suggestions for how employers can make themselves more attractive to the professional workforce:

• Create an employee experience that is engaging and motivating. Confidence is growing in the economy, providing more candidates with the incentive to leave less than desirable work arrangements. As companies become more vulnerable to losing key talent in 2014, they will have to seek ways to provide an employee-centric work environment that is fun, motivating and focused on the things the employees within the organization value most.
   
• Include millennials in succession planning. As succession planning and executive searches are becoming a priority for many companies who need to replace retiring baby boomer executives, employers should not forget to include millennials in these plans. Millennial professionals, who are in their mid-twenties and thirties, possess the skills and experience needed to grow into mid and senior management roles, if provided the appropriate support and guidance.
   
• Provide continuing education opportunities to avert skill gaps. Finding qualified candidates that have the specialized skills that employers need is becoming a global dilemma, with skill gaps in the workplace at an all-time high. Companies that invest in their staff by providing ongoing learning opportunities, create added value to current employees while also attracting desirable talent into their organizations.
   
• Keep technology simple. New human resources and recruitment technology are emerging every day. No matter what platforms or solutions your organization uses, the key is to make sure the technology facilitates a user-friendly experience that engages employees and candidates, instead of creating a frustrating or tedious process that diminishes the organization’s ability to attract and retain talent.

"The candidate-driven market in our post- recessionary economy presents some unique challenges, given mounting skill gaps in our professional workforce," states Halverson. "Companies will have to assess whether their branding and recruitment practices are attractive and engaging enough to allow them to compete for the best talent."

Associate Agreements

Associate Agreements (contracts) can suffocate us at a time we should be reveling in a new opportunity.  However, many dentists don’t understand what is in their contracts, in turn complicating the process and turning this joy of new opportunity into a whirlwind of anxiety and trepidation.

This article is not intended to be legal advice.  ALWAYS consult an attorney or legal expert in your jurisdiction.

Here are a few points to pay attention to when reviewing your Associate Agreement:

1. Employee or Independent Contractor:  Regardless of the debate on what is technically legal or acceptable by the IRS, make sure you know which status you are agreeing to.  If taxes on income are not paid correctly, it could come back to bite both the associate and the practice.   Consult a CPA or Attorney on what is correct for your situation.

2. Compensation: Are you going to be paid on collections or on production?  These two do vary, but don’t get stuck in the mindset that production-based income is the only way you will accept to be paid.  Keep in mind that even if you are paid on production, many practices will adjust your future paycheck if there are any unpaid patient balances or write-offs.  In essence, you are being paid on collections anyway.

3. Notice Period: The length of termination periods are widely becoming 30 or more days long.  We’re seeing more and more asking for 60 to 90 days notice.  Understand what is required of you to terminate your employment with a practice. 

4. Restrictive Covenants and Non-Compete Clauses: Dental practices will protect their interest by requiring you to agree to some sort of restrictions upon the termination of your employment.  They will restrict you from practicing dentistry in any capacity within a certain distance for a specified length of time.  There will be other language that restricts you from soliciting patients or staff for a specified time period.   Distance varies upon geography.  For example, rural areas can have 20 miles or more of a restricted zone, while a metro area will be 2 to 5 miles.

5. Lab Expenses:  Most practices are paying these costs; however, make sure to ask if you will be paying for any lab expenses.  There is no real standard on this in the industry.  Practices will have associates pay for half or an amount equal to the Associate’s percentage of pay.  Also, make sure you understand the formula for calculating your pay with lab expenses.  You want the lab expense to be deducted from the total production prior to calculating your percent of pay.  {Pay = % of production * (Production – Lab expense)}

These are just a few of the “biggies” that develop in contract negotiations.  Again, refer to your attorney for precise legal advice.

Posted by Carl Guthrie, Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Carl at (540) 491-9104 or email at cguthrie@etsdental.com.

The Top Twelve Mistakes Dentists Make Filing Their Taxes

The following is a guest post from our friends at the Dental CPAs

Lance Jacob of the Dental CPAs has compiled a list of the top twelve most common tax filing mistakes that he sees his dental clients making. If you don't have a dental CPA, contact Lance.    

Filling out tax forms with an incorrect Social Security number. The IRS computers will automatically reject your deductions and credits if your Social Security number is wrong.[i] This mistake seems careless and trivial, but it is paramount to have the right Social Security number when filing your taxes.  Your social security number is your tax ID number, which is linked to numerous transactions such as income statements, savings account interest, and retirement plan contributions. It is also vital to claiming tax credits. Since the majority of returns are now being filed electronically, a correct social security number is paramount. An incorrect social security number will result in the reject of an e-filed return.   

Double dipping on dependents for divorced taxpayers. Ill repercussions could result such as additional taxes, penalties, and interest charged.[ii]  A child can ultimately meet the rules to be a qualifying child of only one person.[iii] Once divorced, your children do not duplicate out of thin air; therefore they cannot be claimed twice in taxes.  The IRS does not allow both divorced taxpayers to claim a child as a dependent. 

Not reporting non-deductible IRA contributions.  Any contribution to an IRA, whether it is deductible or non-deductible, should be reported on Form 8606, so when you withdraw it you are not taxed on it.  Plain and simple, all contributions to an IRA must be reported.

Incorrectly reported estimated tax payments.  If your accountant instructed you to make quarterly estimated tax payments, be sure to let him or her know the details of the payment for each installment.  Provide the check numbers, dates of payment, and the amount of each payment.  What often happens is people claim they made the payments as their accountant told them, but did not keep any records and inadvertently forgot a payment or two.  If the accountant includes all of the estimated payments on the return when they all were not really made, the IRS or state government will send a notice of tax due with penalties and interest.

Incorrect Federal ID number used on 1099 MISC.  Although your accountant can easily fix this, the less the IRS has to contact you, the better it is. The IRS matches 1099MISC and the Social Security number or Federal Identification number used. If you provide services, and the client you did the work for issues a 1099MISC, be sure they know to use the federal identification number of your business and not your social security number.  If they use the wrong number the IRS will send you a notice that you did not report income on your personal return, when in fact it was reported correctly on your business return.

Exceeding the mortgage interest deduction limit on Mortgage and home equity debt in excess of $1.1million.  This error commonly falls as the fault of both the taxpayer and accountant.  They only deduct the amount reported of the mortgage interest statement, Form 1098, and do not bother to check the amount of mortgage the taxpayer has.  The tax laws limit the amount of deductible interest to the interest on the first $1,000,000 of home mortgage debt and $100,000 of home equity debt [iv].  So if you have a mortgage of $2 million, you can only deduct mortgage interest related to the first $1.1 million in total debt.   

Standard mileage vs. actual expenses.  Mistakes in this area come from inconsistent use of methods.  If your car is for business purposes only, then the entire cost of its operation can be deducted.  However, if the car is used for both business and personal use, only the cost of its business use can be deducted. The amount of your deductible car expense can be found using either the standard mileage rate method or the actual expense method. [v] Some people will qualify for both methods but you must choose only one method when you start using the vehicle and continue with that method until you replace the vehicle.  Be sure to figure your deduction with both methods initially to see which gives you the larger of the deductions.

First-Time Homebuyer Credit recipients unaware of the fine print.  Those who received a First-Time Homebuyers’ Credit towards their purchase of a home settled on prior to 12/31/08 must begin repaying that money on 2010 tax returns. Now is the time to take a good hard look at the details of this credit. Many who accepted the $7,500 credit may not realize that it was in fact a loan, and the government will begin not-so-politely asking for the money back over the course of the next 15 years starting with 2010 individual tax returns. As with any federal money however, there is a lot of fine print to read into on this one. Use form 5405. [vi]

Forgetting to tell your tax preparer you took an early distribution on an IRA; therefore, failing to calculate the early distribution penalty of 10%.  If you are under the age of 59.5, a distribution on an IRA (including employer matching and profit sharing) is considered early, and subject to a 10% additional tax.  This tax is in addition of other taxes that apply to the distribution. [vii]

Forgetting your signature on your return! If you were an artist, you wouldn’t forget to sign your masterpiece upon its completion, would you? You must sign your taxes for the IRS to process your taxes.  Filing your taxes electronically is a foolproof way to ensure your taxes will not go unsigned.  These software packages do not allow documents to be sent unless every step is completed.

Incorrect bank account information for refund. If you are having your accountant file your returns electronically and want your refunds directly deposited (or payments automatically) withdrawn from your checking or savings account, provide the correct account information including name of bank, bank routing number, and account number. This will avoid delays in processing your refunds and/or payments

Forgetting to file a Form 1099 for rental property or a business as a sole proprietor.

The IRS now requires you to answer the following questions

1. Did you make payments during the tax year that would require you to file Form(s) 1099? (these are forms used for rents, non-employee compensation, interest, and other income).

2. “If yes have you or will you file all required Form(s) 1099?

It is important for your accountant to ask this question of the client and also important for the taxpayer to be aware when a 1099 is needed. You can see the problem you might have if you answer yes to the first question and no to the second.

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[i] http://www.walletpop.com/taxes/most-common-taxpayer-mistakes/

[ii] http://taxes.about.com/od/dependents/a/Dependents.htm

[iii] http://www.irs.gov/individuals/article/0,,id=218767,00.html

[iv] http://www.irs.gov/publications/p936/ar02.html

[v] http://www.irs.gov/taxtopics/tc510.html

[vi]http://money.cnn.com/2009/09/24/pf/expert/home_buyer_credit.moneymag/index.htm

[vii] http://www.irs.gov/faqs/faq/0,,id=199762,00.html