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DOL Appeals Body Limits Hospitals in Filing PERM Applications for International Medical Graduates


According to a recent decision by the Board of Alien Labor Certifications Appeals (BALCA), the Department of Labor’s appeals body, hospitals wishing to retain International Medical Graduates in their medical residency programs will likely not qualify for foreign labor certification during the residency. On November 21, BALCA issued a consolidated decision with regard to seventeen PERM applications filed on behalf of medical residents by  Albert Einstein Medical Center and Abington Memorial Hospital.  In BALCA’s view, the decision whether to approve or deny the applications turned on whether, in general, medical residency programs may still be considered offers of “permanent employment,” as they have been for the last 25 years or more.

In reaching its decision, BALCA first reviewed prior regulations, DOL memoranda, and caselaw, and found that to date, DOL consistently approved labor certifications for positions in medical residency programs. However, BALCA went on to note the absence of a definition of “permanent employment” in the regulations or prior caselaw – including caselaw specifically approving medical resident labor certification — and chose to fashion a new test for whether any position may be considered “permanent employment” and thus eligible for labor certification.  BALCA announced a three part test for a position to be considered “permanent:”

  • There must be an agreement – not necessarily a written contract, but at least an intention on the part of the employer to offer, and of the employee to accept, employment of indefinite duration;
  • The position need not be guaranteed to last forever – that is, a position may be “permanent” even if it can be ended by the employer and the employee at some point in the future; and
  • To be “of indefinite duration,” the position must have two characteristics.  First, it must be “of lasting duration,” meaning that the person will fill the position for an indefinite period of time – certainly expected to last more than a year, but with no specific ending date, even one that is three or more years away.  Second, there must be an “assurance of continuation of employment,” meaning that the employer must have the capability and intention of providing lasting and continuous employment.

In BALCA’s own words, “[T]he regulatory requirement of an offer of permanent employment is focused on a snapshot of the good faith intention of the employer at the time the labor certification is filed to make an offer of permanent employment – that is, indefinite employment of a lasting and continuous nature – within the expectations of any typical job offer.  An employer that has no intention to continue the employment of the immigrant beyond a set term of years cannot have the requisite intent.” (Opinion at page 72, footnote omitted).

Applying this definition to  medical residencies generally, BALCA found that the employers of medical residents do not generally have the intent to offer permanent employment, but instead only employment for the duration of the residency term. BALCA explained that its newly-adopted definition of “permanent” contemplated the expectation of indefinite employment at the time of the filing of the labor certification.  BALCA then concluded that resident positions do not fit the newly adopted definition of “permanent employment” because medical residency positions are not of “lasting duration” and do not offer an “assurance of continuation.”

Though BALCA ruled that medical residency programs in general may not qualify for foreign labor certifications, it did note that the specifics of the residency programs at Albert Einstein Medical Center and Abington Memorial Hospital were not in the appellate record.  BALCA remanded the labor certification denials back to the Certifying Officer for review of the evidence submitted by the Hospitals that related specifically to these two medical residency programs and for new decisions consistent with the Board’s general findings.

Though the full impact of BALCA’s decision is unknown at this point, it will likely limit medical facilities’ ability to sponsor their International Medical Graduates for permanent residence during their residency.  Abington Memorial Hospital and Albert Einstein Medical Center asserted to BALCA that their intention in recruiting resident physicians was to obtain the services of physicians who would continue on an indefinite basis with the Hospitals after their residencies; BALCA left that issue for the Certifying Officer to address on remand, but in doing so, asserted (with no basis in the record) that post-residency positions were “distinct positions” from the upper year resident positions offered in these applications.

Even prior to this decision, many hospitals were rethinking their strategies for retaining International Medical Graduates in light of the Department of Labor’s reluctance to approve labor certifications during the residency period.  This BALCA decision will cause foreign born physicians to have to rethink their career paths and plans, and hospitals their recruiting and retention strategies.  For further information or consultations on the effect of this decision, please contact your attorney at the Firm.

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