dismissed H-1B Case: Medicine

U.S. Citizenship 
and Immigration 
Services 
In Re: 23944938 
Appeal of California Service Center Decision 
Form 1-129, Petition for Nonimmigrant Worker (H-lB) 
Non-Precedent Decision of the 
Administrative Appeals Office 
Date: JAN. 26, 2023 
The Petitioner seeks to employ the Beneficiary under the H-lB nonimmigrant classification for specialty 
occupations. See Immigration and Nationality Act (the Act) section 101(a)(15)(H)(i)(b), 8 U.S.C. 
§ 1101(a)(15)(H)(i)(b). The H-lB program allows a U.S. employer to temporarily employ a qualified 
foreign worker in a position that requires both: (a) the theoretical and practical application of a body 
of highly specialized knowledge; and (b) the attainment of a bachelor's or higher degree in the specific 
specialty (or its equivalent) as a minimum prerequisite for entry into the position. 
The California Service Center Director denied the Form 1-129, Petition for a Nonimmigrant Worker, 
concluding that the Beneficiary does not meet the requirements set forth in section 212(j)(2) of the 
Act and 8 C.F.R. § 214.2(h)(4)(viii), regarding nonimmigrant H-lB physicians who are exempt from 
either (1) the teaching or research provisions, or (2) the licensing exam and English testing 
requirements. Accordingly, the Director determined that the petition cannot be approved. On appeal, 
the Petitioner contends that he is exempt from the requirements of 212(j)(2) of the Act and 8 C.F.R. 
§ 214.2(h)( 4 )(vii i)(B) because he satisfies paragraph (C), as a "physician of national or international 
renown." 
The Petitioner bears the burden of proof to demonstrate eligibility by a preponderance of the evidence. 
Section 291 of the Act; Matter of Chawathe, 25 l&N Dec. 369, 375 (AAO 2010). We review the 
questions in this matter de nova. Matter of Christo 's Inc., 26 l&N Dec. 537, 537 n.2 (AAO 2015). 
Upon de nova review, we will dismiss the appeal. 
I. LEGAL FRAMEWORK 
Section 212(j)(2) of the Act states the following : 
An alien who is a graduate of a medical school and who is coming to the United States 
to perform services as a member of the medical profession may not be admitted as a 
nonimmigrant under section 1101(a)(15)(H)(i)(b) of this title unless-
(A) the alien is coming pursuant to an invitation from a public or nonprofit private 
educational or research institution or agency in the United States to teach or 
conduct research, or both, at or for such institution or agency, or 
(B) (i) 
(ii) 
the alien has passed the Federation I icensing examination 
(administered by the Federation of State Medical Boards of the United 
States) or an equivalent examination as determined by the Secretary of 
Health and Human Services, and 
(I) has competency in oral and written English or 
(11) is a graduate of a school of medicine which is accredited by a 
body or bodies approved for the purpose by the Secretary of 
Education (regardless of whether such school of medicine is in 
the United States). 
Section 101(a)(41) of the Act, 8 U.S.C. § 1101 (a)(41 ), defines the term "graduates of a medical school" 
to mean foreign nationals "who have graduated from a medical school or who have qualified to 
practice medicine in a foreign state, other than such [foreign nationals] who are of national or 
international renown in the field of medicine." 
Because section 101(a)(41) of the Act excludes individuals of national or international renown in the 
field of medicine from the definition of "graduates of a medical school," the former Immigration and 
Naturalization Service concluded that these individuals are not subject to section 212(j) of the Act. 
See 59 Fed. Reg. 1468, 1469 (Jan. 11, 1994) (amending the final rule "to indicate that aliens of national 
or international renown in the field of medicine are exempt [from the] requirements set forth in section 
212(j)(2) of the Act"). Accordingly, in implementing sections 10l(a)(41) and 212(j) of the Act, the 
regulations specifically provide a licensing examination exemption for physicians of national or 
international renown in the field of medicine. 
The regulations at 8 C.F.R. § 214.2(h)(4)(viii) state: 
Criteria and documentary requirements for H-1B petitions for physicians-
(A) Beneficiary's requirements. An H-1B petition for a physician shall be 
accompanied by evidence that the physician: 
(1) Has a license or other authorization required by the state of intended 
employment to practice medicine, or is exempt by law therefrom, if the 
physician will perform direct patient care and the state requires the license 
or authorization, and 
(2) Has a full and unrestricted license to practice medicine in a foreign state 
or has graduated from a medical school in the United States or in a foreign 
state. 
2 
(B) Petitioner's requirements. The petitioner must establish that the alien physician: 
(1) Is coming to the United States primarily to teach or conduct research, or 
both, at or for a public or nonprofit private educational or research 
institution or agency, and that no patient care will be performed, except that 
which is incidental to the physician's teaching or research; or, 
(2) The alien has passed the Federation licensing examination (administered by 
the Federation of State Medical Boards of the United States) or is a graduate 
of a United States medical school; and 
(i) Has competency in oral and written English which shall be 
demonstrated by the passage of the English language proficiency 
test given by the Educational Commission for Foreign Medical 
Graduates; or 
(ii) Is a graduate of a school of medicine accredited by a body or 
bodies approved for that purpose by the Secretary of Education. 
(C) Exception for physicians of national or international renown. A physician who is 
a graduate of a medical school in a foreign state and who is of national or international 
renown in the field of medicine is exempt from the requirements of paragraph 
(h)(4)(viii)(B) of this section. 
II. ANALYSIS 
The Petitioner does not dispute that the Beneficiary satisfies neither 8 C.F.R. § 214.2(h)(4)(viii)(B)(1) 
or (2). Accordingly, the issue on appeal is whether the Petitioner has established the Beneficiary's 
eligibility for the exemption at paragraph (C), pertaining to physicians of national or international 
renown. 
A. Adopted Decision and Evidence 
Neither the statute nor the pertinent regulations define the term "physician of national or international 
renown." However, USCIS personnel are directed to follow the reasoning in the Administrative 
Appeals Office (AAO) adopted decision, Matter of T-O-S-U-, Adopted Decision 2017-01 (AAO Jan. 
4, 2017) when analyzing this issue. The policy memorandum accompanying the adopted decision 
states that: 
Matter of T-O-S-U- clarifies that, for purposes of 8 C.F.R. § 214.2(h)(4)(viii)(C) 
(2016), a "physician of national or international renown" is a doctor of medicine or 
osteopathy who is widely acclaimed and highly honored in the field of medicine within 
one or more countries, so long as the achievements leading to national renown are 
comparable to that which would result in national renown in the United States. The 
decision also suggests, but does not mandate, what types of evidence may be persuasive 
in establishing eligibility for this exemption. 
3 
USCIS Policy Memorandum PM-602-0140, SUBJECT: Matter of T-O-S-U-, Adopted Decision 2017-
01 (AAO Jan. 4, 2017) 1 (January 4, 2017), http://www.uscis.gov/legal-resources/policy-memoranda. 
As we explained in Matter of T-O-S-U-, "the regulations do not currently provide a list of the specific 
types of evidence for demonstrating that a foreign national is a physician of national or international 
renown under 8 C.F.R. § 214.2(h)(4)(viii)(C)." Matter of T-O-S-U-, Adopted Decision 2017-01 at 6. 
Therefore, the adopted decision directs us to consider the types of documentation that are often 
persuasive in establishing eligibility in other visa classifications, namely, the categories of probative 
evidence that are described in the regulations for classifications involving national or international 
renown, recognition, or acclaim. As Matter of T-O-S-U- states, these categories include "H-1B 
distinguished merit and ability (models), 0-1 extraordinary ability, P-1 internationally recognized, and 
labor certification under Schedule A, Group 11 Aliens of Exceptional Ability in Sciences or Arts. Id.; 
see also 8 C.F.R. §§ 204.5(h)(3), 214.2(h)(4)(vii)(C), (o)(3)(iii)- (v), (p)(4)(ii)(B), (p)(4)(iii)(B)(3)." 
In Matter of T-O-S-U-, we compiled the following non-exhaustive list of evidence that, depending on 
the qualitative nature of the evidence, may establish eligibility for the exemption at 8 C.F.R. § 
214.2(h)(4)(vi ii)(C): 
1. Documentation of the beneficiary's receipt of nationally or internationally recognized 
prizes or awards in the field of medicine; 
2. Evidence of the beneficiary's authorship of scientific or scholarly articles in the field of 
medicine published in professional journals, major trade publications, or other major 
media; 
3. Published material about the beneficiary's work in the medical field that appears in 
professional journals, major trade publications, or other major media (which includes the 
title, date, and author of such material); 
4. Evidence that the beneficiary has been employed in a critical, leading, or essential capacity 
for organizations or establishments that have distinguished reputations in the field of 
medicine; 
5. Evidence of the beneficiary serving as a speaker or panelist at medical conferences; 
6. Evidence of the beneficiary's participation as a judge of the work of others in the medical 
field; 
7. Documentation of the beneficiary's membership in medical associations, which require 
significant achievements of their members, as judged by recognized experts in the field of 
medicine; 
8. Evidence that the beneficiary has received recognition for his/her achievements or 
contributions from recognized authorities in the field of medicine; and 
9. Any other evidence demonstrating the beneficiary's achievements, contributions, and/or 
acclaim in the medical field. 1 
1 As explained in Matter of T-0-S-U-: 
We recognize that a petitioner seeking eligibility under 8 C.F.R. § 214.2(h)(4)(viii)(C) is requesting an exemption to either 
the teaching or research provisions or the USM LE and English testing requirements for purposes of classification of the 
beneficiary as an H-1B nonimmigrant, and not an immigrant visa classification as an alien of exceptional ability in the 
sciences .... We further recognize that the ·'national or international renown" standard is not the same as that required to 
demonstrate extraordinary ability. See 8 C.F.R. §§ 204.5(h)(2) and 214.2(o)(3)(ii) (defining extraordinary ability as "a 
4 
Matter of T-0-S-U-, Adopted Decision 2017-01 at 6-7. 
We emphasize that the above list of documents is not mandatory or exhaustive. Rather, it provides 
guidance as to the types of evidence that may establish eligibility for this exemption. Although, we have 
numbered this list, we have done so only for ease of reference. The burden remains on the Petitioner to 
demonstrate how the evidence presented establishes the Beneficiary's national or international renown 
within one or more countries. See section 291 of the Act, 8 U.S.C. § 1361 (2012); Matter of Skirball 
Cultural Ctr., 25 l&N Dec. 799, 806 (AA0 2012). 
B. Legal Discussion 
For ease of analysis, we provide a discussion of the Petitioner's evidence as organized by the types of 
evidence in the list, as well as a qualitative examination of that evidence. While we may not discuss each 
piece of evidence individually, we have reviewed and considered each one. Additionally, because the 
Petitioner does not argue that the evidence it provided would fall within the types numbered 1, 3, or 5, 
we omit a discussion relating to those types. 
Evidence of the beneficiary's authorship of scientific or scholarly articles in the field of medicine 
published in professional journals, major trade publications, or other major media 
An in-house affiliated organ within theOhospital system, called th 
Hospital, produces! I an electronic journal. From all sources and all countries, 
I !accepts original unpublished research manuscripts, manuscripts to review, clinical case study 
reports, review articles, as well as letters to the editor related to clinical, epidemiological, and basic aspects 
of medicine. Written works appearing in are edited by the editor-in-chief as well as an 
editorial committee. The Petitioner presented evidence that the Beneficiary is a named author on five 
written works, including case study summaries and research project findings, which appeared in I I I I 
When considering the quality of the evidence, we conclude that the Petitioner has not provided sufficient 
evidence with which to determine whether an in-house medical journal published within a private hospital 
system would be considered a professional journal or major trade publication, particularly as it accepts 
submissions from "all sources." We also question whether I !considered the Beneficiary's 
employment as a pediatrician within the same hospital system when it accepted the Beneficiary's works 
for publication.2 Regardless, the record does not reflect the effect, if any, that the Beneficiary's works 
produced in the field of medicine. 
level of expertise indicating that the person is one of the small percentage who have arisen to the very top of their field of 
endeavor"). Although the types of evidence that may be submitted in support of any of these types of cases may be similar, 
the standard to establish an individual as a physician of national or international renown is not equivalent to the eligibility 
standards for these other categories. 
Matter of T-O-S-U-, Adopted Decision 2017-01 at 7. 
2 The record reflects that the Hospital in Mexico employed the Beneficiary as a 
pediatrician. 
5 
We reviewed the Google Scholar printout provided; however, it does not clearly indicate which articles 
belong to the Beneficiary or whether the articles were cited by others. Rather, the printout lists a variety 
of articles, and we cannot distinguish which articles the Beneficiary wrote. Although most articles have 
a link to the number of versions the article has and another link to related articles, very few articles contain 
any indication they have been cited. As such, the Google Scholar printout does not support a finding that 
the Beneficiary's articles were read or discussed by other professionals, nor does it establish that they had 
any effect on the field of medicine. Although the Petitioner asserted that the Beneficiary's research 
appeared at congresses and conferences for medical professionals in 2012 and 2013, the Petitioner did 
not back that claim with sufficient evidence. The Petitioner must support its assertions with relevant, 
probative, and credible evidence. See Matter of Chawathe, 25 l&N Dec. 369, 376 (AA0 2010). Nor 
did the Petitioner explain what research the congresses and conferences featured in 2012, as the Petitioner 
has not claimed the Beneficiary published any research prior to 2013. 
We examined the advisory opinion from Dr. I lof the University of I school of 
Medicine in I las well as the letter from Dr.I lthe chief of 
the emergency department at one of Mexico's government-run public hospitals. Although Dr.I I 
and Dr.I lboth emphasized the importance of the Beneficiary's written works, neither provided 
a sufficient explanation for why the articles are important. To support their conclusion that the 
Beneficiary's research is important, both Dr. I land Dr.I I relied upon the premise that all 
research is important. While we recognize that all research adds information to the pool of knowledge in 
some way in order to be accepted for publication, we conclude that not every physician who has written 
research reports and case studies for publication will be found to be widely acclaimed and highly honored 
in the field of medicine within one or more countries. 
The Director concluded that the record did not demonstrate that the Beneficiary's published work differed 
from that of other doctors or researchers, as it is common for doctors and researchers to write and publish 
material. Similarly, we conclude that even if we consider Ito be a professional journal or 
trade publication which contains the Beneficiary's written scientific or scholarly articles, this would not 
establish how the evidence is probative of the Beneficiary's national or international renown. 
Evidence that the beneficiary has been employed in a critical, leading, or essential capacity for 
organizations or establishments that have distinguished reputations in the field of medicine 
The Petitioner presented evidence that the Beneficiary had been employed in highly ranked institutions, 
such as the I I hospital and the medical school within I I 
university. We certainly do not question the ability of these institutions to effectively execute their 
missions. However, that is not the issue before us. As the Director explained, the Petitioner has not 
established how this employment indicates that the Beneficiary is of national or international renown. 
The Petitioner did not submit evidence establishing that these employers only hire individuals of national 
or international renown, nor has the Petitioner established how the Petitioner's employment at these 
organizations was in a critical, leading, or essential capacity. 
To illustrate, the Beneficiary worked as a pediatrician and professor at While physicians, especially 
teaching physicians, are important for any hospital, the evidence does not suggest that the Beneficiary 
occupied a role that was significant or integral in comparison with other physicians and professors within 
the hospital. As the Director explained, the Petitioner did not establish how the Beneficiary's role at the 
6 
hospital, which involved overseeing the education of other physicians or evaluating other physicians' 
performance, demonstrated the Beneficiary's national or international renown. Similarly, the Petitioner 
has not explained how the Beneficiary's role as a professor atl I which employs an 
academic staff of approximately 2,990 persons, according to the evidence the Petitioner provided, would 
be considered critical, leading, or essential. Therefore, while we agree tha ________ 
are highly ranked organizations and that they have respected reputations nationally, the evidence does not 
sufficiently establish that the Beneficiary has national or international renown simply by virtue of his 
employment with such organizations. 
Evidence of the beneficiary's participation as a judge of the work of others in the medicalfield 
The Petitioner asserted that the Beneficiary worked as a professor at the Mexican Institute ofl I I I and at I I As a professor in the hospitals, the Beneficiary taught other 
physicians, oversaw their education, and evaluated their performance. While we do not doubt the veracity 
of this assertion, it lacks detail and context. For instance, overseeing and evaluating another physician's 
performance could simply mean that the Beneficiary observed another doctor's surgery and formed his 
own personal opinion about how that doctor performed. Such opinion may or may not be shared with 
anyone else and may even be irrelevant or inconsequential. Without more detail and context, the 
Petitioner has not established how serving as a professor in hospitals represents participation as a judge 
of the work of others in the medical field. 
In Dr. __ opinion letter, he claimed that the Beneficiary: 
[W]as the sole evaluator of the performance of their physicians for several years in the 
field of pediatrics. His evaluations of these highly distinguished physicians determined 
their advancement, the computation of their bonus compensation, whether any 
disciplinary action was required, and whether their very employment should be terminated 
if their performance was not to his satisfaction. [The Beneficiary] had the ultimate 
discretionary authority over their work performance and judged the quality of their work 
on a continuous basis for years. 
However, the letters from the organizations that employed the Beneficiary do not contain these claims. 
We question the origin of the information provided and it appears that Dr.I I may have inflated the 
role of the Beneficiary, particularly as it relates to the above human resource functions. 
The Petitioner asserted that atl I the Beneficiary taught pediatrics to other physicians, 
had ultimate discretionary authority over their work, and judged the quality of their work on a continuous 
basis. However, a professor's duty to evaluate or judge the performance and work of students at a 
university, even physician students, is the primary role of a professor. These duties are not outside of a 
professor's regular day-to-day work. Accordingly, we conclude that the Beneficiary's judgment of 
others' work in this context is not indicative of his national or international renown, either as a pediatrician 
or as a professor. 
The Petitioner submitted a letter from Dr . ______ which clarified that the Beneficiary 
served as an evaluator, judge, and member of the jury panel on seven students' examinations for entry 
into the emergency medicine specialization at the Mexican Council of In In 
7 
support, the Petitioner provided a copy of the Beneficiary's certificate for his participation as a judge over 
the course of two days in February 2016. Dr.I !further stated that only "well-regarded" physicians 
were invited to be judges and that they selected the Beneficiary because of his national reputation for 
excellence. Dr. did not provide detail concerning how determined that the Beneficiary 
has a national reputation for excellence or what makes him "one of the very best in his area of practice." 
Although the Petitioner provided more detail concerning the Beneficiary's role as a judge in this context, 
the evidence does not suggest that the Beneficiary gained wide acclaim or honor in the field of medicine 
as a result of judging the examinations of seven emergency medicine candidates in a single two-day event. 
Nor does the evidence establish that the Beneficiary was required to have such acclaim and honor in order 
to serve as a judge. 
Considering the evidence of the Beneficiary's participation as a judge both individually and collectively, 
we conclude that it is not probative of national or international renown. 
Documentation of the beneficiary's membership in medical associations, which require significant 
achievements of their members, as judged by recognized experts in the field of medicine 
We reviewed the letters from the Mexican Board _____ thel I and the ___ 
stating that the Beneficiary is a member of each of their 
organizations, respectively. The authors of the letters praise the Beneficiary's reputation, achievements, 
and contributions to the field of medicine. Each organization claims the Beneficiary's achievements 
enabled him to become a member; however, none of the letters contain a detailed explanation of the 
Beneficiary's specific achievements. Therefore, we cannot determine what achievements were judged as 
prerequisites for the Beneficiary's membership in these organizations, nor can we ascertain how they 
were significant. Additionally, the authors do not explain how or when experts in the field judged the 
Beneficiary's achievements, nor the identities or specific roles of the specific "recognized experts." 
Rather, the letters repeat portions of regulatory criteria found at 8 C.F.R. 214.2(o)(3)(iii) regarding 0-1 
non immigrants of extraordinary ability. Merely repeating the language of a statute or regulation does not 
satisfy the petitioner's burden of proof. Fedin Bros. Co., Ltd. v. Sava, 724 F. Supp.1103, 1108 (E.D.N.Y. 
1989), aff'd, 905 F. 2d 41 (2d. Cir. 1990); Avyr Associates, Inc. v. Meissner, 1997 WL 188942 at *5 
(S.D.N.Y.). Similarly, USCIS need not accept primarily conclusory assertions. 1756, Inc. v. The Attorney 
General of the United States, 745 F. Supp. 9, 15 (D.C. Dist. 1990). Here, the evidence regarding the 
Beneficiary's "significant achievements" and the "recognized experts" that judged them is general and 
conclusory in nature. Therefore, we conclude that the evidence is not probative of national or 
international renown. 
Evidence that the beneficiary has received recognition for his/her achievements or contributions from 
recognized authorities in the field of medicine 
For the same reasons as described above, we conclude that the evidence of the Beneficiary's achievements 
or contributions is general and conclusory. Therefore, the record does not reflect that the Beneficiary has 
achievements or contributions in the field, nor does the record reflect that the Beneficiary received 
recognition from recognized authorities in the field of medicine. Even if the Petitioner had provided 
evidence that the Beneficiary received recognition for his achievements or contributions from recognized 
authorities in the field of medicine, the Petitioner would still need to establish how this indicates that the 
Beneficiary is a physician of national or international renown. 
8 
Any other evidence demonstrating the beneficiary's achievements, contributions, and/or acclaim in the 
medical field 
The record does not reflect that the Petitioner submitted other evidence that cannot be categorized in the 
evidence types discussed above.3 Once again, the list referenced above is not mandatory or exhaustive. 
Rather, it provides guidance as to the types of evidence that may establish eligibility for the exemption. 
When viewing the evidence individually as well as collectively and in the totality of circumstances, we 
conclude that the Petitioner has not established that the Beneficiary is a physician of national or 
international renown. In other words, we conclude that the record does not establish that the Beneficiary 
is widely acclaimed and highly honored in the field of medicine within one or more countries. Therefore, 
the Beneficiary does not qualify for the exemption at C.F.R. § 214.2(h)(4)(viii)(C). 
We acknowledge that the Beneficiary offers valuable services as a physician specialized in the field of 
pediatrics and that his education and qualifications suggest that he has performed well in his past 
employment positions at highly ranked institutions. Nevertheless, the evidence is not sufficient to 
conclude that the Beneficiary is a physician of national or international renown. 
111. CONCLUSION 
The record does not demonstrate that the Beneficiary meets the requirements for classification as an 
H-1B physician as required by 212U)(2) of the Act and 8 C.F.R. § 214.2(h)(4)(viii). Therefore, the 
Director's decision will be upheld. It is the Petitioner's burden to establish eligibility for the benefit 
sought. Section 291 of the Act. The Petitioner has not done so here. 
ORDER: The appeal is dismissed. 
3 In its initial filing, the Petitioner provided evidence of the Beneficiary's salary. Although, the Petitioner provided 
evidence that medicine is the third best-paid profession in Mexico, the Petitioner did not provide evidence with which to 
compare the Beneficiary's salary to the salaries of other pediatricians in his geographical area. Furthermore, the Petitioner 
did not provide any additional evidence or arguments regarding the Beneficiary's salary either in response to the Director's 
RFE or on appeal. We conclude that the Petitioner has not provided sufficient evidence with which to conclude that the 
Beneficiary's salary is indicative of national or international renown. 
9