Physicians face a version of the immigration problem that is distinct from most other H-1B holders. The training timeline is longer, the employer dependency runs deeper, and the visa category most physicians train in comes with a restriction that can take years to resolve. For physicians who want permanent residency on their own terms and on their own timeline, the standard employer-sponsored pathways are often a poor fit.
The EB-5 investor visa program offers an alternative that sidesteps many of these constraints. Under the EB-5 Regional Center Program, a physician can invest $800,000 in a qualifying U.S. project through a licensed regional center and, upon meeting job creation requirements, obtain a green card independently of their training program, their residency employer, or any future employer’s decision to sponsor them. Critically, the 2022 Reform and Integrity Act (RIA) introduced concurrent filing, which allows eligible investors to file for work authorization and adjustment of status at the same time as their investment petition, providing immediate practical benefits while the green card process works through the system.
This post examines the specific immigration challenges physicians face and how EB-5 addresses them.
Most Physicians Train in J-1 Status
The majority of international medical graduates complete their residency and fellowship training in J-1 exchange visitor status. J-1 status carries a two-year home residence requirement, meaning that upon completing training, the physician is expected to return to their home country for two years before being eligible for most U.S. immigrant or non-immigrant visas. Waivers of this requirement exist, but they come with their own constraints.
Waiver jobs are competitive to secure. The Conrad 30 program, the most commonly used waiver pathway, requires physicians to practice in a federally designated underserved area for a minimum of three years in exchange for the waiver. The number of waivers available per state is limited, and competition for positions in desirable locations is significant. The process of obtaining the waiver itself is time-consuming, adding further delay before the physician can begin pursuing permanent residency through conventional channels.
EB-5 is not subject to the J-1 two-year home residence requirement. A physician in J-1 status cannot use EB-5 concurrent filing while in J-1 status, as J-1 is not a qualifying non-immigrant status for that purpose. However, EB-5 becomes a viable and powerful strategy for physicians who transition to H-1B status during or after training, which is a path a meaningful number of physicians do pursue.
The H-1B Clock Problem for Physicians
Some physicians complete their training in H-1B status rather than J-1, either by choice or because their program supports it. Public hospitals affiliated with colleges or universities are typically exempt from the H-1B lottery, making H-1B an accessible option for many residency programs. However, H-1B status is capped at six years, and specialist physicians in particular face a real risk of exhausting that cap before completing training.
A three-year internal medicine residency followed by a three-year subspecialty fellowship consumes the full six years of H-1B time. At that point, the physician needs an approved I-14
0 or an active green card process already underway to obtain an extension. If neither is in place, the clock runs out.
This is where starting EB-5 early in a residency program changes the outcome. An I-526E petition filed near the beginning of residency can, depending on processing times and the physician’s country of origin, result in permanent residency before the residency or fellowship program ends. That outcome eliminates the six-year cap problem entirely: the physician exits training as a permanent resident rather than beginning a fresh search for an employer willing to sponsor a green card.
Employer Sponsorship Is Not Guaranteed
A residency program that employs a physician in H-1B status does not typically sponsor that physician for permanent residency. Residency programs are training programs, not long-term employment arrangements, and most do not initiate PERM or I-140 processes for residents. That means a physician completing residency in H-1B status must find a post-training employer willing to take on that sponsorship, often from the beginning of the PERM process.
Even when a post-training employer is willing to sponsor, sponsorship is not unconditional. Many employers impose tenure requirements or performance milestones before initiating the green card process. The physician may be required to work for one or two years before any filing is made on their behalf. During that period, their immigration status remains entirely dependent on the employer maintaining their H-1B petition.
EB-5 removes this dependency. The investment is made by the physician, not the employer. The green card process proceeds regardless of where the physician works, whether they change employers, or whether any employer agrees to sponsor them. For physicians who want to choose their post-training position based on clinical fit and compensation rather than immigration considerations, this independence is a significant practical benefit.
Spousal Work Authorization: Three Years Earlier
For physicians with spouses who want to work in the United States, the H-4 work authorization pathway presents a significant practical problem. H-4 spouses are only eligible to apply for work authorization once the H-1B holder has an approved I-140 petition, the penultimate step in the employer-based green card process. Reaching that step requires at minimum two years of active employer sponsorship, and only if the employer agrees to initiate the process at all.
For a physician in a three-year residency program whose program does not sponsor for permanent residency, a spouse under H-4 status would be without work authorization for the full duration of residency, and potentially longer if the post-training employer imposes a waiting period before initiating sponsorship. That is a meaningful financial and professional constraint for the physician’s household.
EB-5 concurrent filing provides a materially faster path to spousal work authorization. When a physician in H-1B status files concurrently for adjustment of status and an Employment Authorization Document, their spouse can file for work authorization at the same time. The spouse does not need to wait for an I-140 or for an employer’s decision to sponsor. For a physician beginning residency, this can mean spousal work authorization years earlier than the H-4 pathway would allow.
When to Start
For physicians in H-1B status, the answer is as early as possible in the residency program. Starting the EB-5 process near the beginning of a three-year residency creates the realistic possibility of reaching permanent residency before the program ends. Starting midway through residency still provides meaningful protection against the six-year cap and delivers spousal work authorization faster than the H-4 pathway. Starting after residency is still viable, but the clock pressure increases and the window for concurrent filing narrows as visa availability in the EB-5 categories may tighten.
There is also an immediate deadline to be aware of. Grandfathering provisions passed under the RIA expire on September 30, 2026. Physicians who file before that date are protected from any future program lapse. Beyond that, an inflation-adjusted price increase is expected in January 2027, likely adding $130,000 to $140,000 to the current $800,000 investment amount. Both deadlines make the case for beginning the process this summer rather than after residency ends.
The EB-5 process requires an immigration attorney, documentation of a lawful source of funds, and selection of a qualifying project through a licensed regional center. Four months is enough time to complete all of those steps before the September 30 deadline. The right approach is to begin all three tracks at once rather than sequentially.
Ready to Explore EB-5?
CanAm Enterprises has raised $4.1B+ in EB-5 capital, facilitated 9,400+ permanent green cards, and maintained a 100% USCIS project approval rate across 75+ projects spanning more than 30 years. Contact our team to learn more about current projects and whether EB-5 fits your immigration strategy.
Contact us at info@canamenterprises.com or +1 (212) 668-0690.
About the Speakers
Watch the full conversation “EB-5 for H-1B and J-1 Visa Holders” here.
Peter Calabrese, CEO, CanAm Investor Services
Peter Calabrese is CEO of CanAm Investor Services, the FINRA-registered broker-dealer affiliate of CanAm Enterprises. He works closely with prospective investors navigating the EB-5 process and advises on project selection and investment structuring.
Nicolai Hinrichsen, Managing Partner, Miller Mayer EB-5 Practice
Nicolai Hinrichsen is Managing Partner of Miller Mayer’s EB-5 practice, one of the largest EB-5 law firms by volume. Miller Mayer has been active in the EB-5 program since its inception in 1993.
Kristal Ozmun, Managing Partner, Miller Mayer General Immigration Practice
Kristal Ozmun is Managing Partner of Miller Mayer’s General Immigration Practice Group. She advises clients across H-1B, J-1, adjustment of status, and EB-5 matters, with a particular focus on physicians and other professionals navigating complex immigration pathways.
