Hiring Healthcare Workers from Abroad: Nurses, Doctors, and Therapists

US rule for many health workers: nurses, physical and occupational therapists, speech-language pathologists and audiologists, medical lab technologists, physician assistants, and some others need a health care worker certificate (such as CGFNS's VisaScreen) to be admitted on a work visa or green card. Physicians follow separate rules.

EB-3 Schedule A green card. Registered nurses and physical therapists are on DOL's Schedule A list, so you skip PERM recruitment. You get a prevailing wage determination, post a notice of filing, and file Form I-140 directly with USCIS with an uncertified ETA-9089. The nurse must hold a full, unrestricted license in the state of employment, or have passed the NCLEX-RN, or hold a CGFNS certificate.

The catch is time. After the I-140, the nurse waits for a visa number under the visa bulletin, and in 2026:

• Immigrant visa interviews have been paused worldwide since August 25, 2026, with no restart date announced. Nurses abroad cannot finish. See the immigrant visa pause.
• Nationals of the 39 travel ban countries generally cannot get immigrant visas.
• A USCIS memo (PM-602-0199, May 21, 2026) limits adjustment of status for people in temporary status to "extraordinary circumstances," which affects nurses already in the US.

TN for Canadian and Mexican nurses. Registered nurse is a USMCA profession. You can hire a Canadian RN at the border or preclearance with a support letter, or a Mexican RN through a consulate. The nurse needs a US state license and a health care worker certificate.

H-1B. Most staff RN jobs do not require a bachelor's degree, so they rarely qualify. Advanced practice, nurse manager, and specialized roles that require a BSN or higher may qualify.

• J-1 (ECFMG-sponsored) is the usual route into US residency and fellowship training. Most J-1 physicians must return home for 2 years after training unless they get a waiver. The Conrad 30 state waiver program lapsed: USCIS says doctors admitted in or acquiring J-1 status on or after October 1, 2025 cannot get a Conrad 30 waiver unless Congress reauthorizes it. Check your state health department for current options. See J-1 physicians.
• H-1B fits licensed physicians. Universities and their affiliated nonprofit hospitals are cap-exempt and can file any time. Physicians providing patient care generally need a state license and to have passed the required licensing exams.
• O-1 fits physicians with national or international acclaim.
• Green card: EB-2 NIW has a special path for physicians who work in underserved areas; others use PERM.

State alternative licensing. As of May 2026, 27 states and 2 territories have created pathways for internationally trained physicians to get a provisional license without repeating US residency, including Florida, Tennessee, Texas, Virginia, Illinois, and Washington. See state pages such as Florida and Texas.

LMIA. Hospitals (NAICS 622) and nursing and residential care facilities (NAICS 623) are exempt from the low-wage refusal that applies in 26 of 41 metro areas for July 10 to October 8, 2026. Low-wage jobs still need 8 weeks of advertising and fall under the workforce cap, with a higher 20% cap in some sectors. Some caregivers are exempt from the CAD $1,000 LMIA fee. See the LMIA guide.

Permanent residence routes:

• Express Entry healthcare and social services category (12 months of experience in a listed job) and the physicians category for doctors with Canadian experience
• Provincial streams that favor health workers in 2026, such as BC's Health Authority stream, Alberta's Dedicated Health Care Pathway, Saskatchewan's Health Talent Pathway, New Brunswick's Experience pathway (health care, education, and construction only since May 2026), and Ontario's Workforce Priority stream with its self-employed physician pathway
• Atlantic Immigration Program and Rural Community Immigration Pilot for designated employers

Licensing. Nurses usually start with the National Nursing Assessment Service (NNAS), physicians with the Medical Council of Canada, and pharmacists with the Pharmacy Examining Board of Canada, followed by the provincial regulator. Start early; it often takes longer than the immigration steps.

The federal Home Care Worker pilots are paused, so in-home caregivers are harder to bring in for now. See home care worker pilots.

Details: US costs, Canada costs, and the sponsorship cost estimator. To see which US hospitals and clinics already file H-1B petitions, search our H-1B sponsor database.

• Starting immigration before licensing. A visa does not let someone practice. Map the license path first.
• Forgetting the health care worker certificate for US nurses and therapists.
• Filing H-1B for staff RN jobs that don't require a degree.
• Charging recruitment fees or unlawful repayment penalties. H-2 and Canadian rules ban recruitment fees outright, and US PERM costs must be paid by the employer.
• Planning around US immigrant visa timelines without accounting for the August 2026 interview pause and country backlogs.
• Missing Canadian sector advantages, such as the refusal-area exemption for hospitals and nursing homes.