Qualified Isn’t Authorized: Licensing & Immigration Risks in Texas

Transcript

Why Licensing And Immigration Collide

SPEAKER_02 0:00

Born and trained professionals, especially physicians, are an essential part of the U.S. healthcare system. And right now we’re seeing legislative efforts here in Texas that are opening the door to create more pathways for them to practice. But with that opportunity comes a critical reality. Being qualified to practice is not the same as being authorized to practice. This is Know Your Regulator. I’m your host, Simone Murphy, and today we’re talking about where immigration law and professional licensing intersect. We’re diving into how misunderstandings in that overlap can lead to some serious consequences from board complaints or investigations to immigration status issues. My guests today both have a wealth of experience in their fields. I’m joined by immigration attorney and founder of the ML Law Firm, JJ Amel, and professional licensed defense attorney and director of legal services at the Bertolino Law Firm, Troy Bollier. Thank you both for joining me.

New Pathways For Foreign Trained Doctors

SPEAKER_00 0:54

Good afternoon, Simone. Glad to be here.

SPEAKER_02 0:56

Well, we are hearing a lot more about flexibility for foreign-trained physicians. JJ, can you talk to us a little bit about those pathways that are being expanded and what should professionals understand about these opportunities?

SPEAKER_01 1:11

Sure. JJML with ML Law, we’re based in Houston, Texas, and we help professionals enter the U.S. market. And we’re starting to see some reforms in a number of states. The demand for physicians is getting better and better and um or more open and the restrictions are becoming less and less. Texas being one of them. We’re starting to see reforms in other states. And um the it’s just the overall, overall the the you know, what we’ve seen in the past is that physicians had had to go through uh almost go through retraining. You know, they’re coming from abroad, they’ve already done their specializations, uh their fellowships and residency, and um you know, we’re starting to see some some lacks in the United States because the demand that physicians are is is is is greater now. And uh so it’s encouraging to see that. And from an immigration perspective, um that’s really that’s really encouraging because you know these physician these physicians or healthcare professionals have to be licensed so they qualify for their various types of visas. Um so I’m I’m happy to see that this reform is is is is occurring.

SPEAKER_02 2:26

Yeah, absolutely. And Troy, from a licensing perspective, I’m sure there are some common misunderstandings from foreign trained professionals. What are, you know, what are those um man, I said the end of the sentence, the end of my question before I started it. Um sorry. Troy, from a licensing perspective, what are the most common misunderstandings that you are seeing from foreign trained professionals?

SPEAKER_00 2:55

Yeah, absolutely, Simone. Great question. So uh what we’re seeing on the licensing, the regulatory side is people coming with the assumption or the expectation that all of their training and experience is going to automatically translate into the regulatory scheme here in Texas. And that is not always the case. Um I’ve had a number of clients who are very well qualified, very knowledgeable, long-standing practitioners in their field, but their educational background or their examination or specific requirements are different because they’re coming from a different country. Not any less competent, but just different. And the state does not have, many times the agency doesn’t have the discretion under the law that’s passed by the legislature, which only meets every two years, to do something different. So a lot of times you have a situation where there’s a round peg and your client may be, you know, a square peg and not able to fit into those legislative parameters. So we have seen, on like JJ was alluding to, very positive change in that. Um the legislature recently passed House Bill 2038, which amends chapter 155 of the Texas Occupations Code specifically to foreign-trained physicians and gives more flexibility for them to be able to come in and be sponsored by a physician who’s already licensed here and gives them greater flexibility to allow that to happen. But it’s definitely a common misconception that, hey, I can just come here and be able to get the license that I need, and you find out, oh, there might be some roadblocks to that.

SPEAKER_01 4:52

And if I may add, oh, if I may add to Troy’s point, uh from an immigration standpoint, it’s extremely frustrating for physicians who have extended years of experience uh uh not being able to enter the U.S. market. They want, you know, they want they want to live the American dream, right? Um but because of state regulation, state state licensing restrictions, they’re not able to do so. Even though we have this demand, in the particular case I’m thinking of for uh is for physicians, we have a great demand for physicians. Um, but and it’s it’s just very encouraging to see that that legislation is is looking to reform again because many of these physicians are highly qualified, even more qualified from the uh when compared to physicians that have been working are already that are working now.

SPEAKER_02 5:41

Right. Yeah, no, and it it really sounds like as as the doors open, that the expectations around qualifications and compliance are not necessarily changed, they’re just navigated differently.

SPEAKER_01 5:56

And if I may add to that, Simon, you know, when we uh uh apply for a particular visa for a uh physician or uh a client, you know, each visa has a specific intention. And we have to make sure that we’re qualifying that particular person with that intention, but also c um bearing in mind where they’re going to live, right? Yeah. We know that healthcare, law, CPAs, these are are uh highly re highly regulated uh sectors or industries, right? By the by uh state government. So we have to make sure not only from a federal perspective that we’re staying consistent, but also being consistent from a state perspective.

Risks Of Working Without A License

SPEAKER_02 6:37

Yeah. It’s the those dualities, you know, you’ve got both going on at the same time, both are um, you know, kind of have have a hand in this. So let’s talk about what happens when someone practices or even begins working and they don’t have the proper credentials. Troy, what are we looking at here? What what happens?

SPEAKER_00 7:02

Yeah, that’s a great point, Simone. And uh unfortunately I have seen um people who have uh particular immigration status run into this issue. And it can be very concerning for that special niche population more than the general population, right? So not having a proper valid license exposes you to a lot of legal risks. Um it is illegal in Texas for most credentialed licensed professional uh fields to be operating without that state-specific license. It typically is a crime in Texas. It’s it’s a low-level crime, it’s a misdemeanor, but it’s still a crime. And it also violates various state laws and regulatory uh provisions. And so you can be faced with a lot of legal consequences if you’ve accidentally let your license lapse, if you’ve failed to complete timely continuating education, and as a result, your license becomes inactive. Um, if you get a complaint that where your license is temporarily or permanently suspended or revoked, so it’s really important to understand the dynamics of what’s going on with your license in front of your regulatory agency and how that relates to your status on the immigration side, which I’m sure JJ has some unique perspective on.

SPEAKER_01 8:35

Yes, and and and I mean great point, Troy. You know, one of the things that we have to vet as immigration attorneys is, you know, the a client’s background, right? And unauthorized practice of medicine or of or law, you know, these are these can be hindrances to um uh to obtaining a particular type of visa. And so we have to carefully vet, but also carefully answer those questions that the federal government wants to know about our clients’ background. Uh and we never want to uh hide anything, of course, but we want to be careful about how we answer things and make sure that uh, you know, in the case of uh, you know, unauthorized practice that that is remedied. We want to make sure that we can create a create as clean as possible an immigration history that that uh does not hinder uh the ability to obtain state licenses like veterinary such as veterinarians or physicians, physician licenses.

How Complaints Ripple Across Systems

SPEAKER_02 9:37

Yeah. It sounds like really that one issue with a licensing board can really kind of create a domino effect and maybe for lack of a better analogy, sort of a ping-pong kind of going back and forth and back and forth. Um can you guys talk us talk to us about kind of how that plays out across both systems and how they work together? Um, Troy, let’s start with say a foreign-trained professional receives a licensing complaint.

SPEAKER_00 10:08

Yeah, Simone, it’s it really is um disconcerting for anyone who has a license, but it has some added dimensions and concerns for people who are here on a visa and are not citizens. So you get that complaint, and there might be some serious allegations. Those allegations could um suggest criminal misconduct. They could suggest, like we said earlier, unlicensed activity or just other violations of the law or breaches of ethics that could support suspending your license, revoking it, or making a referral to a law enforcement agency for a criminal investigation. Any one of those three things obviously have repercussions in the immigration world because your your status here, um, as I’m sure JJ can explain more, is often tied to your ability to do your job in your particular profession. So if you get an emergency suspension of your license, for example, because of some very serious allegations, you’re not allowed to practice. If your license is revoked and you lose that ability, if you’re now under investigation or you’ve had to address allegations of conduct that is essentially criminal in nature, um, those all have reverberations in in JJ’s world as an immigration attorney.

SPEAKER_01 11:39

Mm-hmm. No, thank you for that, Troy. That’s excellent points. And we have to be very strategic when let’s suppose you have someone who is once licensed here and their visa is contingent on that license. You know, the question we have to ask is does is is the does the vote does the visa become revocable at that point, right? Because as I as I shared earlier, and I want to emphasize here, every visa that we have has an intention, right? And if it’s an employment-based visa, uh and the employment is and the the employer discharges the employee because they can no longer work, does the visa become revocable? And now we’re in a bit of a flux situation. And so we have to be very strategic. We have to work with strategic partners, strategic lawyers like Troy, uh, to make sure we can remedy the situation. Or do we have to change the visas the the type of visas so that the person can uh appropriately challenge uh uh the issues regarding the temporary uh revocation of their license, their ability to work. So we’re dealing with quite a bit of quite a number of issues, a lot of timing, and it can be very distressful for a client that may have had a false accusation. It it’s yeah. So it can be tough. It can be very tough.

Right To Work Proof Becomes Key

SPEAKER_02 13:00

You still have to enter that process, you still have to go through that process, but it can have those consequences, and it sounds like things can escalate pretty quickly when you’ve got the two systems that um you know are very much connected, but they’re totally separate. So I can see that would be really stressful, it’s costly, it’s um there’s a lot of uncertainty there, but surely there can be, you know, some prevention done to avoid experiencing these issues. So let’s talk about identifying these points and putting some preventative action in place. Troy, what would you say are the most common compliance breakdowns that you are seeing individuals experience on the licensing side?

SPEAKER_00 13:43

Yeah, Simone, so one thing that is new and that we’re seeing a big Texas push on that everyone who um who’s affected by these issues needs to be aware of is these um uh right to work requirements. The Texas Attorney General recently issued a new opinion, um, Ken Paxton, in in um in February of this year, um, that state agencies have to document and applicants have to provide proof when they’re applying and when they’re renewing for their license that they have the right to work based on certain documents. Um the Texas Department of Licensing and Regulation is currently considering rules to that effect that are scheduled to go into effect in May. Um the Texas Medical Board legislation I mentioned earlier, House Bill 2038, while it expands opportunities for foreign-trained physicians, it too has language in there saying that you have to demonstrate that you’re lawfully in the United States and you have the right to work. So that’s one issue that is now we’re seeing we’re getting new clients who are having this issue. Um the second thing I would say is you know, either a complaint implicating their ability to continue practicing, if they get an emergency suspension of their license, if they’re facing disciplinary action where their license may be suspended or revoked, or if again, there’s some question about do they have a license or they authorized to practice to begin with, all of those things are gonna be issues that JJ and other immigration lawyers are gonna be having to confront as well because they implicate um your ability to continue on practicing, whether it’s accounting or engineering or being a physician or a veterinarian, whatever your your field is. Um and this is a statewide issue because it’s it’s not just, well, I just named a few of those state agencies, it is statewide now an expectation based on this attorney general opinion.

Visas Versus Green Cards Explained

SPEAKER_01 15:59

Mm-hmm. And to add to what Troy just said, you know, the the way I like to describe our immigration process is you know, well, let me back up. There’s sometimes there’s confusion about uh employment-based work or employment-based visas and uh non-immigrant visas. And I want to quickly explain the two. The way I describe it is like it’s like a school. You have one school that is non-immigrant-based, and you have another that is uh immigrant-based. And immigrant, the word immigrant really is a legal term and it translates into green card or permanent residence. All right. Now, there are certain types of work visas that allow for a person to work for a temp for a period of time for a specific purpose. All right. Now, there’s the other school, the immigrant school, means that this person is becoming a permanent resident, and permanent residency or green card allows that person to work. Many times we’ll start with an immigrant on the immigrant, non-immigrant side, get them here, and then uh and then transfer them over to the immigrant school. And touching on the point of you know authorization to work, uh, let’s suppose you have someone from Mexico and there’s a subsidiary company here in the United States. That person is becoming an intercompany transferee. They’re L that’s an L1 visa. The L1 visa automatically, once once approved, allows them uh to to work. And they’ll put a stamp on their passport, and that’s proof of authorization to work. Uh where in the case of permanent residency, their green card is enough to show that they’re they’re able to work. Now, to put it in context that we know, you know, are US like US for US citizens, US passports fine, social security numbers fine. That gives that’s proof of lawful ability to work.

SPEAKER_02 17:44

Yeah. Are are you seeing any sort of administrative or procedural failures, JJ, on the immigration side of things that can can cause problems for individuals?

SPEAKER_01 17:58

Um, well, the the biggest problem is just is time delay. Um and most of the time we have to recommend to our clients premium processing. And that allows us to accelerate the ability to obtain the visa or uh to do a change of status. Right. Um I I think uh one of the frustrating things is people who are uh refugees or asylumes and they’re trying to get an employment authorization document, it can take it can take them time to renew. So for example, um it’s not it used to be more so that uh you filed so you had to renew your authorization doc uh employment authorization document and it would be uh like in a kind of in a gray area until you you would re you would apply for renewal and um uh you were in this gray area that it was still good. Now we’re not starting to see that so much that you’re having to the renewal process is is becoming kind of questionable. And uh yeah, we’re seeing a lot of change there. And it’s concerning to our clients. Um it’s it’s becoming very concerning to our clients.

What Employers Must Do Now

SPEAKER_02 19:09

Yeah, yeah, I’m sure. For employers too, who are hiring a lot of these foreign-trained individuals, they’re they’ve you know are very heavily tied into this too. What should employers or organizations be doing to assist these individuals and prevent issues for them and for again for their own um organization or business?

SPEAKER_01 19:34

Well, for those companies that regularly hire uh foreign individuals, I’m very much a proponent of getting educated on the front end of things. I don’t, you know, a lot of times we see companies, it becomes an aftermath. Or the issue is already, you’re already way down the line, and they said, Oh, this is an immigration problem, and those then it becomes very difficult to fix. So if a if a company is hiring one to several individu foreign individuals, it’s good for the human resource department, the employer to get educated on what do we have to do to maintain uh this employee. Um and and and right now, as as we’re all aware, you know, immigration law is changing consistently almost day to day. So to be partnered up with an immigration attorney that can send out newsletters or education, uh frequent education uh newsletters, uh pamphlets, et cetera, uh I think is is critical. And especially if you’re hiring on a regular basis um you know uh foreign nationals.

SPEAKER_02 20:37

Yeah, absolutely. And and Troy, anything for you know the licensing side of things that you’d like to add?

SPEAKER_00 20:45

Absolutely, Simone. Businesses have a critical role in this process, and they need to be mindful that as part of their due diligence, they’re making the appropriate license verification checks. You do not want to find out that you hired someone that doesn’t have a license in Texas. You need to be tracking their renewal of their license, that it’s done timely and that it hasn’t lapsed. You need to be checking for their continuing education compliance, which can impact the active status of a license if it’s not timely completed. And you need to avoid any accusations that you’re aiding or abetting unlicensed activity, which could expose the company or individuals who hold licenses at that company at liability in front of the regulatory agency as well. And then, of course, you want to avoid any regulatory complaints against individuals at the company who may be in supervisory roles and have due diligence and legal obligations relating to supervising other types of license holders who are operating under their oversight. So again, there’s A lot. There’s a huge role for employers to play and the employees that they utilize in interacting with and managing and overseeing foreign-trained professionals. And you want to be very careful so that you don’t get drawn into some legal issues that expose the company and your other employees to liability.

SPEAKER_01 22:26

And Troy, your point is is so well received on this end because immigration law is very different than the law that we’re taught as a whole in law school. You know, innocence of proven guilty, right? Well, the burden is the opposite in immigration law. The burden is upon the person trying to receive the immigration benefit to prove that they’re deserving of that. And an employer keeping track of CLEs, making sure that uh the person remains compliant, regulatory or is in regulatory compliance with uh maintaining that license is critical. Especially when we go to renew these visas, uh, we have to prove this up. And that is great evidence. I mean, if we have that evidence already, it helps us do our job better because of what uh because of the burden that we have, right? Absolutely. Couldn’t agree more.

What To Verify Before You Start

SPEAKER_02 23:26

It just goes back to what you were saying earlier, JJ, that that proactive mindset, you know, doing putting things in in place in the in the very beginning, in the first place, really helps you prevent, whether you’re an individual or an employer or you’re managing an organization, it helps you prevent those issues down the line. You’ve got some serious risk management that’s already in place. So as we come to a close, JJ, for a foreign-trained professional who is listening right now, what would you say are the top things that they need to verify before they begin working?

SPEAKER_01 24:04

Well, I think they well, they first need to make sure I would even I would start with the employer first. And if uh so the employer needs to make sure that their candidate meets the requ licensing requirements. One. And then two, it’s upon the the uh the person to be sponsored or the future employee to help prove up with the employer and work as a team to prove up that they’re deserving of the these immigration benefits. And the best thing you can do is plan early and plan strategically, um, having a plan in place. And I encourage human resource departments to, if they haven’t already done so, to uh have a strategy in place, an immigration strategy. And most of the times human resources are already working with what we call the I-9, and that’s really the lawful presence showing lawful presence and the ability to work. It’s incumbent upon human resource departments and their employers or the employers to prove that up.

SPEAKER_02 25:12

Yeah. Troy, anything that you would say on the licensing side?

SPEAKER_00 25:16

Yes, definitely. So you want to verify those credential requirements and confirm your licensure eligibility in Texas. You don’t want to be getting down the road into this process and come to find out your education doesn’t qualify or the exam you took or the experience that you have doesn’t fit the particular regulatory scheme for that licensed profession. You’ve got to do your homework on that and not assume. I recommend people get legal advice early, get representation early, and be proactive because you don’t want these problems to grow and get out of hand. Um make sure that your immigration and your licensed defense lawyers are coordinating, communicating, and collaborating because there’s two aspects to these situations, and you’ve got to get the professional expertise from both sides, right? I have a great dermatologist and I have a great brain surgeon, but I don’t have my dermatologist do my brain surgery. And likewise, I wouldn’t have my brain surgeon help me with issues with my skin. So again, having those experts in those two areas where there’s crossover really becomes critical for you to get the best results in your particular legal situation.

SPEAKER_01 26:46

Troy, may I add another point to your comments? Because I think everything is spot on. Um, you know, one of the things we’ve been talking quite a bit about the employee side, but what about the you know, a little bit more on the employer side? Something that um uh I think employers need to do on the regular is audit uh their employees, meaning like their off their ability to work. And um what this ha this is very a very frequent problem that when a person starts employment, they’re okay, they’re they’re authorized to work, but they don’t check annually uh that oh, has that person maintained status, have the ability to work? So that person continues to work technically unauthorized, right? Or they could have lost their authorization and the employer is not doing their due diligence to make sure, hey, everyone on our staff are they are they able to work? So I want to encourage employers that are listening to this to six months, six-month audits or one annual audits and make sure that the people that you’re that are working for you are authorized to work because there are fines and consequences to those businesses.

Final Takeaways And Subscribe

SPEAKER_02 27:57

Yeah, no, very well said. Absolutely. As opportunity is expanding, that responsibility to understand the systems that you’re operating in, how they operate with each other, um, it it really heightens. So, JJ, Troy, thank you both very much for joining me and really diving into how these two areas of law intersect and how they impact each other, impact employers, organizations, and the individuals themselves. And to our listeners, whether you are a foreign-trained professional or you’re an attorney that’s representing one, licensing and immigration, they do not operate in silos. And when something goes wrong in one area, it can very quickly impact the other. But the good news is, like we’ve learned with the right guidance, understanding, and awareness that most of these issues are preventable. We will have more information about a Mel Law Firm linked below in the description so you can learn more about JJ and the work that his firm does. Be sure to subscribe to know your regulator so you never miss an episode or an update about the rules and regulations impacting your professional license. Until next week, stay inspired and continue engaging with your regulatory agency. Thank you, guys.

SPEAKER_00 29:10

Thank you, Reality. Thank you, Simone.