TN Visa – Physician

NAFTA Requirements for TN Visa as a Physician.

To qualify for TN visa status under NAFTA as a Physician, an applicant must possess one of the following:

1. Doctor of Medicine (M.D.);
2. Doctor en Medicina; or
3. State / provincial license.

The Physician TN visa category is only available for teaching or research positions. 8 C.F.R. § 214.6 (c). 

The term “state/provincial license” is defined as “any document issued by a state, provincial, or federal government, as the case may be, or under its authority, but not by a local government, that permits a person to engage in a regulated activity or profession.” See 8 C.F.R. § 214.6 (c) n.2.

Additional Guidance: Patient Care.

According to a U.S. immigration inspector's manual, “[f]oreign medical school graduates…may not engage in direct patient care” under the Physician TN visa category. NAFTA Handbook (1999). However, “[p]atient care that is incidental [to] teaching and/or research is permissible.” Id. But the patient care must be “casually incurred in conjunction with the physician’s teaching or research.” Id. To determine if patient care is incidental, U.S. immigration inspectors will consider the following factors:

1. The amount of time spent in patient care relative to teaching and/or research;
2. Whether the physician receives compensation for such services;
3. Whether the salary offer is so substantial in teaching and/or research that direct patient care is unlikely; or
4. Whether the physician will have a regular patient load. Id.

U.S. Medical School Graduates

The language in the NAFTA Handbook may imply that the prohibition on direct patient care applies only to foreign medical school graduates, and not to U.S. medical school graduates. Not so under the current law, according to a legacy INS letter.

Previously, under the U.S.-Canada Free Trade Agreement (the predecessor to NAFTA), Canadian citizens who graduated from U.S medical schools could obtain “TC” visa status as a Physician and participate in residencies, internships, and direct patient care. Operations Instruction (OI) Section 214.6.

However, the NAFTA TN provisions do not distinguish between foreign medical graduates and U.S. medical graduates. Neither group of Physicians may engage in clinical, or direct, patient care under TN visa status. Bednarz Letter (March 15, 1995).

References:

• NAFTA Handbook (1999).

• Bednarz Letter (March 15, 1995).

• Operations Instruction (OI) Section 214.6.

• OOH, Physicians and Surgeons (2008-09).

Revised July 25, 2008.