U.S. Citizenship and Immigration Services (USCIS) released a new policy memorandum on January 4, 2017, that designates as precedent Matter of T-O-S-U-, a 2015 decision of the Administrative Appeals Office (AAO). The decision explains that physicians of national or international renown who are graduates of medical schools in foreign states are exempt from the U.S. Medical Licensing Examination (USMLE) requirement in the H-1B context.
In the new policy memo, USCIS noted that Matter of T-O-S-U- clarifies that 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.” USCIS noted that the decision also suggests, but does not mandate, what types of evidence may be persuasive in establishing eligibility for this exemption.
The AAO originally decided Matter of T-O-S-U- on February 20, 2015, as a nonprecedent case. The petitioner had filed a petition to classify the beneficiary, an “Assistant Professor—Clinical Physician,” as an H-1B temporary nonimmigrant worker. The California Service Center (CSC) denied the petition, concluding that the evidence did not demonstrate that the beneficiary was exempt from the USMLE requirement as a “physician of national or international renown in the field of medicine.” The AAO withdrew the CSC’s decision and approved the petition, noting that regulations specifically provide a licensing examination exception for physicians of national or international renown in the field of medicine.
The AAO said that to satisfy this exemption, the petitioner must demonstrate that 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.
To establish “renown” for purposes of adjudicating exemption claims, the AAO said that “national or international renown” could be restated as “widely acclaimed and highly honored within one or more countries.” But the AAO noted that this cannot be interpreted to permit standards that may allow physicians from certain countries where renown in the field of medicine is more readily achieved—considering factors such as population size and available medical resources—to more easily qualify than those from countries where renown in the field of medicine is more difficult to achieve. Considering that physicians meeting the requirements for this exemption can provide patient care in the United States without passing the USMLE or establishing competency in English, the AAO said the standard for national renown “should be set at a level that requires achievements necessary to garner national renown in the United States and thus, applied consistently, would obviate potentially adverse effects on U.S. patients.” The AAO said it “reserve[d] without answering the question of whether international renown must also be at a level comparable to that which would result in national renown in the United States.”
The AAO provided the following “non-exhaustive list” of evidence that, depending on the qualitative nature of the evidence, may establish eligibility for the exemption:
- 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;
- 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;
- 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.
The USCIS policy memo includes the original decision in Matter of T-O-S-U-. The USCIS made the decision a precedent on January 4, 2017.