sustained H-1B Case: Medicine

(b)(6)
U.S. Department: of Homeland Security 
U.S. Citizenship and lmmigralion Services 
Administrative Appeals Office (A/\0) 
20 Massachusetts Ave., N.'vV., MS 2090 
Washington, DC 20529-2090 
U.S. Citizenship 
and Immigration 
Services 
DATE: FEB 2 0 2015 OFFICE: CALIFORNIA SERVICE CENTER FILE: 
INRE: Petitioner: 
Beneficiary: 
PETITION: Petition for a Nonimmigrant Worker Pursuant to Section IOI(a)(IS)(H)(i)(b) of the 
Immigration and Nationality Act, 8 U.S.C. § 1101(a)(15)(H)(i)(b) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
Enclosed please find the decision of the Administrative Appeals Office (AAO) in your case. This is a 
non-precedent decision. The AAO does not announce new constructions of law nor establish agency policy 
through non-precedent decisions. 
(:hank�o�/)) 
/ ��=--
( ..../( n Rosenberg 
\ , 
' Chief, Administrative Appeals Office 
www.uscis.gov 
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NON-PRECEDENT DECISION 
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DISCUSSION: The service center director denied the nonimmigrant visa petition, and the matter is 
now before the Administrative Appeals Office (AAO) on appeal. The appeal will be sustained. 
The petition will be approved. 
I. PROCEDURAL HISTORY 
The petitioner filed a Petition for a Nonimmigrant Worker (Form I-129) to classify the beneficiary, 
an "Assistant Professor-Clinical Physician," as an H-lB temporary nonimmigrant worker pursuant 
to section 101(a)(15)(H)(i)(b) of the Immigration and Nationality Act, 8 U.S.C. 
§ 110l(a)(15)(H)(i)(b). 
The Director of the U.S. Citizenship and Immigration Services (USCIS) California Service Center 
(director) denied the petition, concluding that the evidence did not demonstrate that the beneficiary 
was exempt from the United States medical licensing examination requirement as a "physician of 
national or international renown in the field of medicine." See 8 C.F.R. § 214.2(h)(4)(viii)(C). The 
matter is now before the Administrative Appeals Office (AAO) on appeal. Upon de novo review, 
we find that the petitioner has overcome the specified basis for denial of the petition.1 The appeal 
will be sustained. 
II. APPLICABLE LAW AND INTERPRETATIONS 
Section 21 2(j) of the Act, 8 U.S.C. § 1182(j), states in pertinent part: 
(2) 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 101(a)(15)(H)(i)(b) 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) the alien has passed the Federation licensing 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 
(ii) (I) has competency in oral and written English or (II) 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. § 110l(a)(41), defines the term "graduates of a medical 
school" to mean "aliens who have graduated from a medical school or who have qualified to 
1 We conduct appellate review on a de novo basis. See Dor v. INS, 891 F.2d 997, 1002 n.9 (2d Cir. 1989). 
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practice medicine in a foreign state, other than such aliens 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 (INS) concluded that these individuals are not subject to section 2120) 
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 
exception 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-1 B 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. 
(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 (or an equivalent 
examination as determined by the Secretary of Health and Human Services) 
or is a graduate of a United States medical school;2 and 
2 The United States Medical Licensing Examination (USMLE) replaced the Federation Licensing 
Examination (FLEX). 57 Fed. Reg. 42755 (Sept. 16, 1992); 59 Fed. Reg. 1468 (Jan. 11, 1994). The 
USMLE website states the following: 
In the United States and its territories ("United States" or "US"), the individual medical 
licensing authorities ("state medical boards") of the various jurisdictions grant a license to 
practice medicine. Each medical licensing authority sets its own rules and regulations and 
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NON-PRECEDENT DECISION 
(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. 
To satisfy the exemption at 8 C.F.R. § 214. 2(h)(4)(viii)(C), the petitioner must therefore 
demonstrate the beneficiary: (1) is a physician; (2) is a graduate of a medical school in a foreign 
country; and (3) is of national or international renown in the field of medicine. 
III. LEGAL ANALYSIS 
A. Definitions 
Neither the Act nor the regulations define the terms "physician" or "of national or international 
renown in the field of medicine."3 Accordingly, we reviewed the definitions of these terms with 
regard to their common usage as well as their meaning within the context of H-lB petitions and 
other nonimmigrant and immigrant classifications. 
We look first to the term "physician." While the term appears throughout the governing regulations, 
\Ve found only one specific definition, stated parenthetically, in regulations relating to a national 
interest waiver (NIW) for second-preference immigrant petitions: "[a]ny alien physician (namely 
doctors of medicine and doctors of osteopathy) . . . . " 8 C.F.R. § 204.12(a); 65 Fed. Reg. 53889 
requires passing an examination that demonstrates qualification for licensure. Results of the 
USMLE are reported to these authorities for use in granting the initial license to practice 
medicine. The USMLE provides them with a common evaluation system for applicants for 
medical licensure. 
Bulletin, U.S. Med. Licensing Examination, http://www .usmle.org/bulletin/overview (last visited February 
19, 20 15). Despite the existence of a national medical licensing examination, each individual state 
determines its own requirements for medical licensure. There are instances, such as here, where a state's 
physician licensing requirements differ from those under federal immigration law such that a beneficiary 
may satisfy one but not the other. 
3 Analogous with the definition at section 101(a)(41) of the Act, we interpret the phrase "graduate of a 
medical school in a foreign state" to mean individuals who have graduated from a foreign medical school or 
who have qualified to practice medicine in a foreign country. 
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(Sept. 6, 2000) (clarifying that this provision applies to "physicians (namely doctors of medicine 
and doc tors of osteopathy)") . 
Outside of the immigration regulations, several other expert sources use a similar definition. For 
example, the U.S. Department of Health and Human Services (HHS) defines a physician as "a 
doctor of medicine or osteopathy." 45 C.F.R. § 60.3. The U.S. Department of Labor's (DOL) 
Occupational Outlook Handbook (Handbook) reports that there are two types of physicians: 
medical doctors and doctors of osteopathic medicine.4 Lastly, the American Medical Association 
describes the term physician as a doctor of medicine or doctor of osteopathy. 5 This common 
description "doctor of medicine or osteopathy" is likewise appropriate here for the term "physician" 
as used in 8 C.F.R. § 214.2(h)(4)(viii)(C). 
Next we reviewed the phrase "national or international renown," which contains both geographic 
and qualitative elements. While the geographic and qualitative elements inform each other, we will 
parse them out temporarily here for purposes of construction. First, the term "national or 
international" in 8 C.F.R. § 214. 2(h)(4)(viii)(C) refers to one or more countries, and that the 
adjective "national" does not refer only to the United States in this context. Cf, e.g., 53 Fed. Reg. 
43217, 43220, 43225 (Oct. 26, 1988) (referring to "national" as "(foreign or U.S.)"); 45 Fed. Reg. 
83926, 83927 (Dec. 19, 1980) (with regard to Schedule A filings, DOL noted that "national" refers 
to one country and "international" refers to two or more countries); The Mary Imogene Bassett 
Hasp., 92-INA-232 (BALCA 1993) (finding the individual was a "physician of national (in South 
Africa), but not of in tern ational, renown in the field of medicine"). Although they relate to different 
classifications, these interpretations are apt for the present context. 
Turning our focus to "renown," the commonly understood meaning of the term is "[t]he quality of 
being widely honored and acclaimed." 6 See, e.g., Webster's New College Dictionary 961 (3rd ed. 
2008). We will adopt this common definition of "renown" for purposes of 8 C.F.R. 
4 While it is not a binding or exclusive resource, the U.S. Department of Labor's (DOL) Occupational 
Outlook Handbook (Handbook) is an expert and persuasive source of information on the duties and 
educational requirements of a range of occupations. The Handbook is available on the Internet at 
http:// www .stats.bls.gov/oco/. U.S. Dep't of Labor, Bureau of Labor Statistics, Occupational Outlook 
Handbook, 2014-15 ed. , Physicians and Surgeons, on the Internet at http://v.rww.bls.gov/ooh/healthcare/ 
physicians-and-surgeons.htm#tab-2 (last visited February 19, 20 15). 
5 See the American Medical Association (AMA) website, http://w ww. ama-assn.org/ama (last visited 
February 19, 2015). 
6 In detern1ining whether an alien is "renowned," we note that this term is also mentioned in connection with 
the fo llowing nonimmigrant classifications: H-1 B distinguished merit and ability (prominence) for models, 
0-1 extraordinary ability (distinction), and P-1 internationally recognized. 8 C.F.R. § 214.2(h)(4)(ii), 
(o)(3)(ii), (p)(3). More specifically, these categories are described as requiring inter alia "a high level of 
achievement [in the field] evidenced by a degree of skill and recognition substantially above that ordinarily 
encounte red[, ] to the extent that [such achievement] is ren ow ned .... " Jd. This case, however, focuses 
solely on how USCIS in terprets "physicians of national or international renown" for purposes of 8 C.F.R. 
§ 214.2(h)(4)(viii)(C). 
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§ 214.2(h)(4)(viii)(C) and next consider how the terms "national or international" and "renown" 
interact. 
According to the two definitions we have adopted above, "national or international renown" could 
be restated as "widely honored and acclaimed in one or more countries," and this definition could 
generally suffice to adjudicate most 8 C.F.R. § 214.2(h)( 4)(viii)(C) exemption claims. But we note 
that the U.S. Department of State (DOS) recognizes that "national renown" in some, individual 
countries - considering factors such as population size and available medical resources - may not 
be comparable to the national renown exhibited by a physician in the United States. 
According to DOS: "In general, evidence required to support a claim to international renown would 
be similar to that required to support a claim to qualification for labor certification under Schedule 
A, Group II Aliens of Exceptional Ability in Sciences or Arts." Volume 9 of the Foreign Affairs 
Manual, 9 FAM 40.52 note 2. DOS further states, however, that "[the] evidence required to support 
a claim to national renown, while not required to be of the same high standard, would nonetheless 
have to show a degree of excellence comparable to that which would result in national renown in 
the United States." !d. (emphasis added). 
This interpretation is in accord with that previously expressed in a final rule issued by DOL with 
respect to Schedule A physicians of national or international renown, in which it explained the 
following: 
Establishing that a physician has only national renown, especially from a nation with 
limited medical education and medical resources, is not sufficient for DOL to 
predetermine that there would be no adverse effect on workers in the United States. 
Absent passage of the [requisite medical examination], the achievements of nationally 
known physicians (and surgeons) cannot be shown to be of the caliber necessary to 
avoid adverse effect, as required under the Immigration and Nationality Act. 
45 Fed. Reg. at 83927. 
We are persuaded by the interpretation expressed by DOS and supported by DOL. Therefore, with 
respect to this exemption from the additional requirements at 8 C.F.R. § 214.2(h)(4)(viii)(B), while 
a beneficiary's achievements may be renowned in a country outside the United States, the petitioner 
must demonstrate that such renown in the field of medicine is at a level comparable to that which 
would result in national renown in the United States. 
Accordingly, in this context and for purposes of 8 C.F.R. § 214.2(h)(4)(viii)(C), a "physician of 
national or international renown" is: (1) a doctor of medicine or osteopathy (2) who is widely 
honored and acclaimed in the field of medicine (3) within one or more countries, so long as the 
level of national renown is comparable to that which would result in renown in the United States. 
B. Evidence 
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The regulations do not currently provide a list of the specific types of evidence for demonstrating 
that an a lien is a physician of national or international renown under 8 C.F.R. § 214.2(h)(4)(viii)(C). 
We therefore reviewed and took into account the types of documentation that are often persuasive in 
establishing eligibility for these cases, as well as the categories of probative evidence that are 
described in the regulations for other classifications, including H-lB distinguished merit and ability 
(models), 0-1 extraordinary ability, P-1 internationally recognized, and labor certification under 
Schedule A, Group II Aliens of Exceptional Ability in Sciences or Arts. The following is a non­
exhaustive list of suggested evidence that may establish eligibility for the exemption at 8 C.F.R. 
§ 214.2(h)(4)(viii)(C):7 
• 
Documentation of the beneficiary's receipt of nationally or internationally 
recognized prizes or awards in the field of medicine; 
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; 
• 
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); 
• 
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; 
• 
Evidence of the beneficiary serving as a speaker or panelist at medical 
conferences; 
• 
Evidence of the beneficiary's participation as a judge of the work of others in the 
medical field; 
Docum entation of the beneficiary' s m embership in medical associations, which 
require significant achievements of their members, as judged by recognized 
experts in the field of medicine; 
Evidence that the beneficiary has received recognition for his/her achievements or 
contributions from recognized authorities in the field of medicine; and 
• 
Any other evidence demonstrating the beneficiary's achievements, contributions, 
and/or acclaim in the medical field. 8 
7 The list of documents is not mandatory, exhaustive, or numeric. Rather, it provides guidance as to the types 
of evidence that may establish eligibility for this exemption. 
8 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 USMLE and English testing requirements, not 
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IV. DISCUSSION 
In the instant case, the petitioner is a university that operates a multidisciplinary academic medical 
center, which is nationally ranked in the United States in several medical specialties. In this matter, 
the petitioner states that the beneficiary will be expected to perform duties in the areas of teaching, 
research, and clinical patient care, with patient care being the primary component of the position. 
The petition was accompanied by evidence that the beneficiary received a Doctor of Medicine 
degree .from the in Canada and has licentiate status with the 
"1 The beneficiary possesses an active license to practice medicine in Ohio, the 
state of intended employment. The petitioner asserts that the beneficiary is exempt from the U.S. 
medical licensing examination requirement, because he is a physician of both national and 
international renown in the field of medicine, specifically in orthopedic surgery. 
In support of this assertion, the petitioner provided probative evidence regarding the beneficiary's 
credentials and employment demonstrating that the beneficiary is highly trained and experienced in 
arthroscopy/sports medicine and arthroscopic hip surgery. This evidence also establishes that the 
volume and complexity of procedures the beneficiary has performed places him at a level of clinical 
experience in the subspecialty matched by few others in the world. The record shows that the 
majority of these surgical procedures took place at one of the most respected medical facilities for 
the subspecialty in Australia. Further, the evidence indicates that the beneficiary is credited with a 
reputation for positive outcomes and patient satisfaction. 
The record also evinces the beneficiary's authorship of scholarly works. The petitioner emphasizes 
in patiicular an article written by the beneficiary regarding orthopedic surgery procedures and 
practices published in the a top-ranking journal in the field of 
orthopedics. 10 The petitioner provided evidence that the beneficiary's article garnered numerous 
classification as an alien of exceptional ability in the sciences. Cf 8 C.F.R. § 204.5(k)(2) (defining 
exceptional ability as "a degree of expertise significantly above that ordinarily encountered in the arts, 
sciences, or business"). Nor is the standard similar to that required to demonstrate extraordinary ability. 
Cf 8 C.F.R. § 214.2(o)(3)(ii) (defining extraordinary ability as "a 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"). So, while the 
types of evidence may be similar, we do not intend to suggest that the standard to establish an individual as a 
physician of national or international renown is equivalent to eligibility standards for these other categories. 
9 The is a school of medicine accredited by the 
Thus, the beneficiary is a graduate of a school of medicine accredited by a body approved for 
that purpose by the Secretary of Education. See 8 C.F.R. § 214.2(h)(4)(viii)(B)(2)(ii); 34 C.F.R. § 600.20 
to 600.55. For additional information, see the website at 
(last visited February 19, 2015). 
10 
In suerort of this assertion, the petitioner "dotted the 'i"' by providing documentation from the 
website indicating the journal's standin with regard to several defined 
categories, including its Impact Factor, Total Cites, Total Articles, and 
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independent citations by peers in professional journals, major trade publications, and other major 
media. Further, the record demonstrates that the beneficiary's work has been presented at major 
medical conferences in the United States, Canada, and France. 
The petitioner submitted letters from physicians who are recognized authorities in the field of 
orthopedic medicine and who attest to the beneficiary's renown in the field of orthopedic surgery. 
Specifically, the authors describe and corroborate the beneficiary's level of clinical experience, 
expertise performing surgery in his subspecialty, and accomplishments in Canada and Australia. 
The petitioner references other documentation to be considered in support of the petition. 
Specifically, the record contains evidence that the beneficiary served as a physician for a nationally 
ranked sports team in Canada. Further, the petitioner asserts that the beneficiary's salary in the 
proffered position should be considered, as it is significantly higher than others within the 
occupation and reflects the value of the beneficiary's prior experience and his reputation. 
Upon review of the totality of the evidence, we find that the petitioner has shown by a 
preponderance of evidence that the beneficiary is a physician of national renown in the field of 
medicine and, thus, is exempt from the medical licensing examination requirement. 11 See Matter of 
Chawathe, 25 I&N Dec. 369, 376 (AAO 2010) "[t]he 'preponderance of the evidence' standard 
requires that the evidence demonstrate that the applicant's claim is 'probably true,' where the 
determination of 'truth' is made based on the factual circumstances of each individual case"). As the 
beneficiary satisfies the other requirements for approval, including that he possesses a license to 
practice medicine in the state of intended employment, the petition will be approved. 
V. CONCLUSION 
In visa petition proceedings, it is the petitioner's burden to establish eligibility for the immigration 
benefit sought. Section 291 of the Act, 8 U.S.C. § 1361; Matter ofSkirball Cultural Ctr., 25 I&N 
Dec. 799, 806 (AAO 2012). Here, the petitioner has sustained that burden. Accordingly, the 
director's decision is withdrawn. 
ORDER: The appeal is sustained. 
11 
The petitioner asserts that the beneficiary is a physician of national and international renown in the field of 
medicine. Applying the standard above, the evidence supports a determination that the beneficiary's national 
renown in the field of medicine is at a level comparable to that which would result in national renown in the 
United States. Accordingly, we need not address here whether the beneficiary is internationally renowned or 
whether, generally, international renown must also be at a level comparable to that which would result in 
national renown in the United States.