dismissed H-1B Case: Healthcare

U.S. Department of Homela~td Security 
20 Massachusetts Ave. NW, Fh. A3042 
Washington, DC 20529 
U.S. Citizenship 
and Immigratioil 
Services 
FILE: WAC 04 059 52225 Office: CALIFORNIA SERVICE CENTER Date: [t); , - t 1 I. 
PETITION: Petition for a Nonirnmigrant Worker Pursuant to Section lOl(a)(lS)(H)(i)(b) of the 
Immigration and Nationality Act, 8 U.S.C. 5 1 lOl(a)(lS)(H)(i)(b) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
This is the decision of the Administrative Appeals Office in your case. All materials have been returned 
to the office that originally decided your case. Any further inquiry must be made to that office. 
Robert P. Wiemann, Director 
Administrative Appeals Office 
WAC 04 059 52225 
Page 2 
DISCUSSION: The service center director denied the nonirnrnigrant visa petition. The matter is now on 
appeal before the Administrative Appeals Office (AAO). The appeal will be dismissed. The petition will be 
denied. 
The petitioner is primary care and family medical services provider. It seeks to employ the beneficiary as 
a health services manager and to classify her as a nonirnrnigrant worker in a specialty occupation pursuant to 
section lOl(a)(l5)(H)(i)(b) of the Immigration and Nationality Act (the Act), 8 U.S.C. 3 1101 
(a)( 15>(H>(i>(b>. 
The director denied the petition on the ground that the proffered position is not a specialty occupation. 
Section 214(i)(l) of the Act, 8 U.S.C. 3 1184(i)(l), defines the term "specialty occupation" as an 
occupation that requires: 
(A) theoretical and practical application of a body of highly specialized knowledge, 
and 
(B) attainment of a bachelor's or higher degree in the specific specialty (or its 
equivalent) as a minimum for entry into the occupation in the United States. 
As provided in 8 C.F.R. 5 214.2(h)(4)(iii)(A), to qualify as a specialty occupation the position must meet 
one of the following criteria: 
(I) A baccalaureate or higher degree or its equivalent is normally the minimum 
requirement for entry into the particular position; 
(2) The degree requirement is common to the industry in parallel positions among 
similar organizations or, in the alternative, an employer may show that its 
particular position is so complex or unique that it can be performed only by an 
individual with a degree; 
(3) The employer normally requires a degree or its equivalent for the position; or 
(4) The nature of the specific duties is so specialized and complex that knowledge 
required to perform the duties is usually associated with the attainment of a 
baccalaureate or higher degree. 
Citizenship and Immigration Services (CIS) interprets the term "degree" in the criteria at 8 C.F.R. 
3 214.2(h)(4)(iii)(A) to mean not just any baccalaureate or higher degree, but one in a specific specialty 
that is directly related to the proffered position. 
The record of proceeding before the AAO contains: (1) Form 1-129 and supporting documentation; (2) 
the director's request for evidence (RFE); (3) the petitioner's response to the RFE; (4) the director's 
decision; and (5) Form I-290B, an appeal brief, and supporting materials. The AAO reviewed the record 
in its entirety before issuing its decision. 
WAC 04 059 52225 
Page 3 
On Form 1-129 and in an accompanying letter the petitioner described itself as an organization that 
provides information about professional medical services to patients, primarily focused on primary care 
and family medical services. The petitioner indicated that it was established in 1994, had three 
employees and gross annual income of $455,000 at the time of filing, and needed to hire the beneficiary 
as a health services manager in a part-time capacity (30 hourslweek) to support its clinical studies and 
clinical services. The duties of the position were described by the petitioner as follows: 
[The beneficiary] will . . . plan, organize, coordinate and supervise the delivery of health 
care to our current patents, and extended community. In addition, she will work closely 
with the [owner] for the development, implementation and funding of clinical 
investigations at our clinic. Work closely with the physician owners for clinical and 
program development. She will oversee personnel matters, billing and collection, 
budgeting, planning, equipment outlays and patient flow. Assist in referrals to 
coordinated care professionals for anti-aging and wellness care. Assist our physician 
staff in the development of a newsletter for patient, community and eventually electronic 
dissemination. 
The petitioner stated that the beneficiary was qualified for the position by virtue of her doctor of dental 
medicine degree in April 1996 from Manila Central University in the Philippines. 
In response to the RFE the petitioner provided additional information about the proffered position by 
submitting a more detailed list of the duties, as well as the percentage of time required by the various duty 
categories. See Exhibit A of the response. The list of duties in Exhibit A is incorporated by reference 
into this decision, and the percentage of time required by each duty category was estimated as follows: 
35 % Direct work with patients (review of charts, referrals, etc.). 
20% Coordination and interaction with health care providers. 
20% Coordination of all aspects of clinical trials. 
10% Newsletter activities. 
10% Billing, insurance, Medicare and Medical functions. 
5% All other. 
The director denied the petition on the ground that the proffered position did not qualify as a spe~cialty 
occupation under any of the criteria enumerated at 8 C.F.R. 5 214.2(h)(4)(iii)(A). The director quoted 
excerpts from the Department of Labor (D0L)'s Occuputional Outlook Handbook (Hundbook) describing 
the occupation of medical and health services managers and concluded, based on the evidence of record, 
that the primary duties of the proffered position were not those of a health services manager. The director 
determined that the duties of the proffered position reflected those of an office manager, administl-ative 
assistant, or administrative services manager - occupations which do not require a baccalaureate or higher 
degree in a specific specialty. The petitioner's business did not have the operational scale or complexity 
that would require the services of a health services manager, the director continued, and the record did not 
WAC 04 059 52225 
Page 4 
show that the duties of the proffered position were so specialized and complex that they required 
knowledge at the level of a baccalaureate or higher degree. The two job announcements in the record for 
health services managers did not establish that a degree requirement is common to the industry in parallel 
positions among similar organizations, the director stated, and no evidence was submitted that the 
petitioner had in the past required a baccalaureate or higher degree in a specific specialty for the position. 
On appeal counsel asserts that the evidence of record establishes the petitioner's need for the services of a 
health services manager, and submits evidence that the California Service Center has twice in recent years 
approved H-1B petitions for health services manager positions with the same duties as those of the 
proffered position, one of which was filed by the instant petitioner for a prior beneficiary in the proffered 
position. Counsel contends that the duties of the proffered position are sufficiently complex to require a 
bachelor's degree. Since the DOL Handbook indicates that a baccalaureate or higher degree in a specialty 
field is required for entry into a health services manager position, counsel maintains that the proffered 
position qualifies as a specialty occupation. 
In determining whether a position meets the statutory and regulatory criteria of a specialty occupation, 
CIS routinely consults the DOL Handbook as an authoritative source of information about the duties and 
educational requirements of particular occupations. Factors typically considered are whether the 
Handbook indicates a degree is required by the industry; whether the industry's professional associ~ation 
has made a degree a minimum entry requirement; and whether letters or affidavits from firrns or 
individuals in the industry attest that such firms "routinely employ and recruit only degreed individuals." 
See Shanti, Inc. v. Reno, 36 F.Supp. 2d 1151, 1165 (D.Minn. 1999) (quoting HirdIBlaker Coy. v. Sava, 
712 F.Supp. 1095, 1102 (S.D.N.Y. 1989)). CIS also analyzes the specific duties and complexity of the 
position at issue, with the Handbook's occupational descriptions as a reference, as well as the petitioner's 
past hiring practices for the position. See Shanti, Inc. v. Reno, id., at 1165-66. 
The AAO does not agree with counsel's assertion that the proffered position is that of a health services 
manager, as described in the DOL Handbook. The occupational category of medical and health services 
managers is described in the Handbook, in pertinent part, as follows: 
The occupation, medical and health services manager, encompasses all individuals who 
plan, direct, coordinate, and supervise the delivery of healthcare. Medical and health 
services managers include specialists and generalists. Specialists are in charge of specific 
clinical departments or services, while generalists manage or help to manage an entire 
facility or system. 
. . . . Future medical and health services managers must be prepared to deal with evolving 
integrated healthcare delivery systems, technological innovations, an increasingly 
complex regulatory environment, restructuring at work, and an increased focus on 
preventive care. They will be called upon to improve efficiency in healthcare facilities 
and the quality of the healthcare provided . . . . 
Large facilities usually have several assistant administrators to aid the top administrator 
and to handle daily decisions. Assistant administrators may direct activities in clinical 
areas such as nursing, surgery, therapy, medical records, or health information . . . . 
WAC 04 059 52225 
Page 5 
In smaller facilities, top administrators handle more of the details of daily operations. For 
example, many nursing home administrators manage personnel, finance, facility 
operations, and admissions, and have a larger role in resident care . . . . 
A small group of 10 to 15 physicians might employ one administrator to oversee 
personnel matters, billing and collection, budgeting, planning, equipment outlays, and 
patient flow. A large practice of 40 to 50 physicians may have a chief administrator and 
several assistants, each responsible for different areas. 
Handbook, 2004-05 edition, at 55-56. The foregoing description of a health services manager does not 
accord with the proffered position at issue in this petition. Medical and health services managers, 
including specialists in charge of specific clinical departments or services and generalists who mana~ge or 
help to manage an entire facility or system, are employed by larger organizations than the petitioner. 
Even smaller employers of health services managers like those cited in the Handbook (smaller facilities 
and medical practices of 10-15 physicians) exceed in size and scale of operations the petitioner's one- 
physician practice. More importantly, it is unclear from the duties of the proffered position, as described 
by the petitioner, whether much, if any, specialized knowledge in the field of health or medicine is 
required. 
In determining the nature of a particular position, and whether it qualifies as a specialty occupatioin, the 
duties that will actually be performed are crucial, not the title of the position. The petitioner must show 
that the performance demands of the position compel its degree requirement. The critical issue is nlot the 
employer's self-imposed standard, but whether the position actually requires the theoretical and practical 
application of a body of highly specialized knowledge and the attainment of a baccalaureate or higher 
degree in the specific specialty as a minimum for entry into the occupation. C$ Defensor v. Meissner, 
201 F.3d 384,387-88 (5th Cir. 2000). 
The AAO is not persuaded by the evidence of record that the beneficiary would be performing the 
services of a health services manager in the proffered position, or that the position requires the job seeker 
to have a baccalaureate or higher degree in a specific specialty. In accord with the director's decision, the 
AAO determines that the duties of the proffered position reflect the duties of an administrative assistant, 
as described in the DOL Handbook, 2004-05 edition, at 469-70. The Handbook summarizes the "core 
responsibilities" of administrative assistants as ''performing and coordinating an office's administrative 
activities, and storing, retrieving, and integrating information for dissemination to staff and clients." 
Handbook at 469. The duties of the occupation are described more specifically as follows: 
. . . [Aldministrative assistants are responsible for a variety of administrative and clerical 
duties necessary to run an organization efficiently. They serve as an information 
manager for an office, plan and schedule meetings and appointments, organize and 
maintain paper and electronic files, manage projects, conduct research, and provide 
information by using the telephone, postal mail, and e-mail . . . . 
Specific job duties vary with experience and titles . . . . In addition to arranging 
conference calls and scheduling meetings, they may handle more complex 
responsibilities such as conducting research, preparing statistical reports, training 
employees, and supervising other clerical staff. 
WAC 04 059 52225 
Page 6 
Some . . . administrative assistants, such as legal and medical secretaries, perform highly 
specialized work requiring knowledge of technical terminology and procedures . . . . 
Medical secretaries transcribe dictation, prepare correspondence, and assist physicians or 
medical scientists with reports, speeches, articles and conference proceedings. They also 
record simple medical histories, arrange for patients to be hospitalized, and order 
supplies. Most medical secretaries need to be familiar with insurance rules, billing 
practices, and hospital or laboratory procedures . . . . 
Handbook at 470. As for the educational requirements of administrative assistants, the HamEbook 
indicates that a high school degree may be sufficient for an entry-level position, but that additional 
training and education is becoming increasingly important to acquire the skills needed for the modern 
workplace. As explained in the Handbook, id., at 470-7 1 : 
. . . [Aldministrative assistants acquire skills in various ways. Training ranges from high 
school vocational education programs that teach office skills and keyboarding to 1- and 
2-year programs in office administration offered by business schools, vocational- 
technical institutes, and community colleges . . . . Specialized training programs are 
available for students planning to become medical or legal secretaries or administrative 
technology specialists. Bachelor's degrees and professional certifications are becoming 
increasingly important as business continues to become more global. 
Thus, the Handbook clearly indicates that a bachelor's degree in a specific specialty, or its equivalent, is 
not the normal minimum requirement for entry into an administrative assistant position. While bachelor's 
degrees are "becoming increasingly important," many other educational avenues are available to be~come 
an administrative assistant, even one with advanced responsibilities, including sub-baccalaureate training 
programs in business schools, vocational-technical institutes, and community colleges. Accordingly, the 
proffered position does not meet the first alternative criterion of a specialty occupation at 8 C.F.R. 3 1214.2 
(h)(4)(iii)(A)(l). 
As for the second alternative criterion of a specialty occupation, at 8 C.F.R. 5 214.2 (h)(4)(iii)(A)(2), the 
record includes job announcements for a director of clinical programs and a medical services director 
which require applicants to have a bachelor's degree in a specialty field. One of the announceme~~ts is 
from a county government, however, and the other appears to be from a health maintenance organization 
(HMO). The petitioner bears no similarity to either of these organizations with respect to its size, scale of 
operations, and line of business. Thus, the job announcements are not persuasive evidence that a degree 
requirement in a specific specialty is common to the petitioner's industry in parallel positions arnong 
similar organizations, as required for the proffered position to qualify as a specialty occupation under the 
first prong of 8 C.F.R. 3 214.2(h)(4)(iii)(A)(2). Nor does the record demonstrate that the proffered 
position is so complex or unique that it can only be performed by an individual with a specialty degree, as 
required for the position to qualify as a specialty occupation under the second prong of 8 C.F.R. 3 ;!14.2 
(h)(4)(iii)(A)(2). 
With regard to the third alternative criterion of a specialty occupation at 8 C.F.R. 5 214.2(h)(4)(iii)(A)(3) 
- "The employer normally requires a degree or its equivalent for the position" - counsel has subrrdtted 
evidence of a previous approval by the California Service Center of an H-1B petition for the same 
WAC 04 059 52225 
Page 7 
position at issue in this petition, in which the beneficiary had a baccalaureate degree in a specialty field. 
Counsel asserts that this approval (as well as another approval for a similar health services manager 
position by another company) should govern the decision in the instant petition. The AAO does not 
agree. The pertinent documentation does not show that either employer made a baccalaureate degrel: in a 
specialty field a requirement for the position. Furthermore, CIS is not required to approve a petition when 
eligibility has not been demonstrated - as in the instant case - merely because of a prior approval that 
may have been erroneous. See, e.g., Matter of Church Scientology International, 19 I&N Dec. 593, 597 
(Comm. 1988). Each nonimrnigrant petition is a separate proceeding with a separate record. See 8 CI.F.R. 
S, 103.8(d). In making a determination of statutory eligibility, CIS is limited to the information contained 
in the petitioner's record of proceeding. See 8 C.F.R. S, 103.2 (b)(lb)(ii). Moreover, the AAO is never 
bound by a decision issued by a service center or a district director. See Louisiana Philhanaonic 
Orchestra v. INS, 2000 WL 282785 (E.D. La.), affd 248 F.3d 1139 (5th Cir. 2001), cert. denied, 122 
S.Ct. 51 (2001). Only published precedent decisions are binding on all CIS employees in the 
administration of the Act. See 8 C.F.R. S, 103.3(c). The AAO determines that the documentation of 
record does not establish that the proffered position qualifies as a specialty occupation under 8 C1.F.R. 
5 2 14.2(h)(4)(iii)(A)(3). 
Finally, the proffered position does not meet the fourth alternative criterion of a specialty occupation, at 
8 C.F.R. S, 214.2(h)(4)(iii)(A)(4), because the record does not show that the duties of the position are so 
specialized and complex that they require baccalaureate level knowledge or higher in a specific specialty. 
The position is that of an administrative assistant, as described in the Handbook, and can be performed by 
an individual without baccalaureate level knowledge in a specialty. 
For the reasons discussed above, the record fails to demonstrate that the proffered position meets any of 
the criteria enumerated at 8 C.F.R. 3 214.2(h)(4)(iii)(A) to qualify as a specialty occupation. The 
petitioner has not established that the beneficiary will be coming temporarily to the United States to 
perform services in a specialty occupation, as required under section lOl(a)(lS)(H)(i)(b) of the Act, 
8 U.S.C. 5 1 101(a)(lS)(H)(i)(b). 
The petitioner bears the burden of proof in these proceedings. See section 291 of the Act, 8 U.S.C. 5 1361. 
The petitioner has not sustained that burden. Accordingly, the AAO will not disturb the director's decision 
denying the petition. 
ORDER: The appeal is dismissed. The petition is denied.