NIW and EAD, hadron others help

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chillchill

Registered Users (C)
i have been told that one can complete NIW in 6 years. i complete three years waiver soon, after that i intend to open own practice. My wife wants to start a new job on EAD( we have EAD and AP and have never used it, i am on H1 and wife on H4 valid till 2009) . When i resign in july my H1 will be null and void and wife will start working for first time on EAD.
my question is that if it takes 2-3 months for me to get letter pf support , and apply for amended 140 , is it still legal for my wife to continue working on EAD( my NIW is self petitioned but based on the 5 year contract from my current employer, whom i am leaving). I do have an approved 140 through NIW.
 
State Dept of health

It all depends on your state dep't of health. Their support is key to you NIW petition. If they continue to support you then you are as safe as gold. If not then it is risky.

Having said that you should be able to guage their view in your conversations with them. You should definitely talk to them to get a feel for their stance.

Sadly the F****** AMA has abdicated that role to those gov't beaurocrats and the answer to your predicament lies in their hands.

In my state the State Dep't of Health has taken the position that you MUST be employed and that you must serve in a setting like a FQHC or CHC. Not the intent of the law but their interpretation as they see fit. I have had but lost options at the altar of this non sense!

In the end this WILL mean. That my services AFTER green card will be in another state. Alas our services are not as valued as they once were!

These are my views. There are more knowledgaboe members in this forum. I welcome ther analysis!
 
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Your wifes EAD is valid as long as her I485 is pending. Unless the state dept. of health went to USCIS to get your I140 nulled, I don't see how the terms of your fulfillment of the NIW affect your wifes I485.

You have 6 years to proove 5 years of service. You could use your EAD to deliver pizzas for one of these 6 years.

Read my disclaimer, but in my humble opinion you should be safe if you leave your current job after the 3 years are up and start a new practice even if you have a couple of months of paperwork gap in between (thats what the 6 year rule is for) At the new location, you will have to proove 2 more years of 'full-time' practice with department of health support so you are eligible for adjustment at the end.

Just be sure to have enough business to fulfill the full-time requirement. There was a poster here who essentially saw 3 patients per week at her hpsa practice and made a living doing moonlight gigs in non-hpsa locations. When time came around to file the final compliance report, there was a lot of anxiety whether USCIS would accept the evidence.

5 cents of unsolicited advice regarding opening a practice:

Opening a practice is a major endeavour. Be sure to do your due diligence regarding the practice location. There is a reason these areas are underserved.
There are essentially two options:

1. Staying where you are.
If you do a waiver job, there shouldn't be any restrictive covenant with your current employer preventing you from remaining in the community. If you have the financial wherewithall to open a practice right accross from your current practice, it can be a good option. You have to be conscious of the fact that your former employer might play dirty if you start competing with him. There are many ways he can hurt your practice. (bogus lawsuits about stealing patient records, challenges to your credentials at the local hospital, sending our rumors in the community about your abilities). Patients tend to be loyal to a physician, not necessarily to a practice. If most of your business is independent from insurance panels (which can be a bitch to get onto if you are a new, single physician practice), most of your patients are likely to follow you. This assumes that you are well liked and trusted in your community.

2. Going somewhere else
If you intend on doing that, be very sure about the practice location. If you have a trusted confidant in the community who has a good understanding of the local market it would be ideal (maybe a colleague in a non-competing specialty). If you are new to a community, you have to anticipate a signinifcant 'ramp-up' phase. In a underserved community, this can be expected to be rather short, but still you have to anticipate that you won't make money for a couple of months until insurance payments start trickling in and your patient numbers are high enough to pay the electrical bill.

End of unsolicited advice
 
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A question on similar line.

I shall complete my first three years of J-1 waiver job in this September. My NIW I-140 was approved in Febryary 2005; ( I-485 applied concurrently is pending because of obvious reasons). So far I have not applied for EAD or AP.

I plan to continue at the present job and complete five years. I do not have plans to moon-light outside my regular job. My question is whether I should renew my H1B or apply for EAD and start working on the basis of EAD on completion of my first three years of H1B?
 
> My question is whether I should renew my H1B or apply for EAD
> and start working on the basis of EAD on completion of my first
> three years of H1B?

Because your I140 is already approved, the EAD/AP is a pretty much 100% deal (different from the usual concurrent filer who still has the chance of his I140 being denied). So letting the H1b is not as risky as it is for people who don't have an approved I140.

One difference to be aware of (which hopefully never applies to you): In the setting of a denied I485 (could be just by mistake of the service), there is a difference whether you entered the country as as 'non-immigrant' or as a 'parolee'. I couldn't tell you what the actual difference is, but it somehow affect the pathways to appeal this kind of decision.
 
Dear Hadron thanks a lot . as always you have been ever so helpful and sincere and detailed about your reply.
well i have thought of all these questions , wife is not getting job in my area but in a city , so i have to move to an MUA near her and do not want to loose or risk loosing my NIW2004 date, even though the second option is to abondon NIW and get PERM( again problems with Retro)
where ever i go in MUA its more likely not to generate money , but if wife's salary can support us , does the USCIS look negatively if i am not able to generate enough revenue ( i am even ready to see pts for $20 so at least i can show the volume) and most money is coming from wife
don't have any specific resources to know which area good or not , but do trust my knowledge , clinical sense so hopefully pts will come.
don't know if can open a "rural designated clinical" , heard that you have to have a physician AND a PA or CMW or NP, would u know if I can show my wife as working as second physician instead of PA.
thanks again
 
> does the USCIS look negatively if i am not able to generate enough revenue
> ( i am even ready to see pts for $20 so at least i can show the volume)
> and most money is coming from wife

They want proof that you work 'full-time' (36 hours/week) in the MUA/HPSA. They look at either an employment contract or at evidence of a full-time practice like affidavits from other healthcare providers, hospital admin, local health director and data about # of patients seen. They will also look at your tax return, and if 10% of your income is from your practice and 90% from W-2s you have from moonlight gigs, things could get dicey.

> don't have any specific resources to know which area good or not ,
> but do trust my knowledge , clinical sense so hopefully pts will come.

Well, optimism is good, just see that you don't loose your shirt on this. Make sure that you incorporate your practice as either LLC or PLC, that way your financial losses are limited to the amount you put in and you don't put your personal assets at risk.

> don't know if can open a "rural designated clinical" ,

Don't know that expression.

>my wife as working as second physician instead of PA.

If your wife is also a physician, you both might be able to get GC through her. Now that you fulfilled your waiver, she is free to pursue a GC (with you as derivative) by her own right.
 
thanks for your reply,
1.if i don't do any moonlighting and spend full time in MUA , but with that if out of the total household income if 10% comes from me working in MUA and rest through my wife's salary ( working independently) can that also cause problem
2. what i meant was ,opening clinic in a area designated as RURAL, in which the reimbursement is at higher rate in Mediaid and medicare. RURAL clinic requires a physician and a PA , so i was asking if i should substitute my wife ( part time ) instead of hiring a PA.
 
> that if out of the total household income if 10% comes from me working
> in MUA and rest through my wife's salary ( working independently) can
> that also cause problem

I don't know. Money is only one aspect they look at.

> ,opening clinic in a area designated as RURAL, in which the reimbursement
> is at higher rate in Mediaid and medicare. RURAL clinic requires a physician
> and a PA , so i was asking if i should substitute my wife ( part time )
> instead of hiring a PA.

I don't know anything about that. There are plenty of little funding methods for 'safety net' facilities like community health centers and the like. But opening something like that really requires a lot of committment. To go through all this just for the GC doesn't sound like a financially sound strategy. Be very careful with a selection of a practice site. Really rural might not be a good location for a full-time practice. You might be better off to go to a couple of different locations and share various offices with people like NPs or PAs who run their own shop.
 
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"share various offices with people like NPs or PAs who run their own shop."

Hadron:
To open a private practice can we share the office of any private practitioner or any of above to help us start. I mean if a physician or allied practices at a particular location only 2 times a week...can I rent the office for rest of the time to start my own practice.Eventually I may have an independent location. What would be some problems involved in this strategy if it is possible?

Thanks a lot as always. wish u all the goodluck in life.
 
> can we share the office of any private practitioner or any of above to help
> us start. I mean if a physician or allied practices at a particular location
> only 2 times a week...can I rent the office for rest of the time to start
> my own practice.Eventually I may have an independent location.
> What would be some problems involved in this strategy if it is possible?

Your 'own practice' can mean a couple of things.
- a place of business (real estate, owned or rented)
- the business itself (corporation, assets)
- the fact that you practice your profession

The goverment wants to know that you are taking care of patients in the HPSA/MUA for 5 years. If you don't have an employment contract, you have to provide them with a reasonable business plan for your own practice. As long as you can proove that you are able to take care of patients, they are not so much interested as to what business arrangments you made to do so. Whether you rent 1 office for the entire month or whether you rent use of office space from 3 different entities for 20 days per month is not so interesting for them. It is a good idea to form the corporation, equip it with some equity and to have a list of CVs for potential staff at hand. Also, you want to get your medicare billing number and ideally your name on a couple of insurance panels before going to the goverment for approval. (I helped a family member to set up a practice this way. It caused some expense initially, but later when he didn't need the NIW after a LC had gone through, we sold of the corporate shell at cost)
 
thank you Hadron! I am planning to go thru this route. I have applied to State DOH for the letter..I would appreciate your help. I dont have much idea about opening a LLC and neither does anyone whom I know. Could I contact you for more help?

Thanks again.
 
First you have to find out from your state medical board whether your state allows medical practice as a LLC (not all do). Then you should talk to a business attorney and an accountant to set up the corporation. It will cost you something like $800 in legal fees. If you haven't really dealt with issues of billing and insurance contracts before, you might want to consider hiring a office management company (such as PerSe) to help you set up a payment scale. There is a whole mountain of paperwork waiting for you.
 
thanks.
the state allows LLC medical practice. Would I need insurance contracts (other than medicare billing number) for uscis application>? in terms of financing, wat do i need to demonstrate?
 
> the state allows LLC medical practice.

Great.

> Would I need insurance contracts (other than medicare billing
> number) for uscis application>?

I don't think that they have any rules on that. I would certainly try to get on medicaid and the various medicare/medicaid hmos. It just makes a better narrative of a viable practice if you have a couple of contracts and you are able to provide services for medicaid / low-income patients. Also, don't forget to have a sliding scale.

> in terms of financing, wat do i need to demonstrate?

Again, I don't think they have firm rules on this.
 
You have a policy on how you will discount your fee for low-income patients. If your normal fee is 225% medicare that would be 100%. Now you come up with a scale of discounts, typically in multiples of the 'federal poverty level'. So if someone only makes 1 FPL you might charge them 25% of your customary fee, if they make 2 FPL 33% and so on. There are medicare rules to take into account. They do allow you to discount your fees, but you have to follow their rules so you don't get in trouble with medicare.
 
Sliding scale applies to low-income 'self-pay' patients. Medicaid you just take what medicaid gives you. Same with medicare or HMO contracts.
The sliding scale is what comes into play if a patient comes and says 'doc, I need my kid to be seen but I can't pay your bill and the kid doesn't have insurance bc my employer doesn't cover family'.
If you just say 'no problem, I'll just take $20 and you won't get a bill' (which would be the reasonable thing to do) you can get into hot water if medicare ever audits you. You are obliged to give the goverment 'your best price'. If they find out that you treat 'private patients' for less than their going rate, they are going to ask you for a gargantuan refund. If you have a properly constructed sliding scale for eligible low-income patients, the goverment won't kill you for discounting your fees.
 
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