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Natalie Jones has a problem she can never solve. Despite all her inducements for new nurses, the human resources recruiter cannot hire enough of them at JFK Hospital in Atlantis, Fla. Right now, Jones has about 40 openings in the operating room, patient floors and the rest of the 387-bed hospital. “It’s pretty commonplace,” she says. “Every town, every city is having a shortage.” The solution: Look in countries as far away as South Africa and the Philippines for nurses. And Jones is not alone. Hiring directors at hospitals and technology companies are going overseas for employees. It’s a time-consuming and expensive task, but a necessary one in today’s economy. The number of hires is impossible to calculate, say executives and the attorneys who help them through the difficult process of importing employees. But they agree that they must look outside the United States for help. The search for foreign workers is taking hospitals like JFK to Great Britain and Asia, where nurses seek higher-paying opportunities elsewhere. Technology companies are also looking to Asia, which is producing large numbers of engineers and computer programmers. Interestingly, Latin and South America have not become a steady source of professionals. Despite the proximity to south Florida, those regions are not exporting as many skilled workers to the U.S. as other parts of the world. All companies meet — and compete — at the offices of the U.S. Immigration and Naturalization Service. Local executives say it can take from six months to two years to get approval for one employee. The paperwork, time and expense bother employers, but they suffer it because they have few other choices if they want to operate in the U.S. The most common and accommodating visa issued by the INS is known as “H-1B.” Employers apply for a pass for a foreign worker that permits entry for a total of six years. An employer can later apply for a green card, which allows the worker permanent residency and opens the door to U.S. citizenship. An H-1B is tough to get. In October of last year, the INS issued 115,000 visas. All were gone in less than six months, even though the agency had almost doubled the number of visas available in 1998 in response to heavy demand for technology workers. Slightly more than half went to people from India and China. It’s first come, first serve, and technology companies — especially the largest like Microsoft, Motorola and Intel — always seem to get to the head of the line. That frustrates Vasu Reddy, chief executive officer of Delray Technologies Inc. in Delray Beach, Fla. A year ago, he sought 15 hires for his young company, which provides wireless computer networks to businesses. By the time he had filed applications, large technology companies had swallowed 25 percent to 30 percent of the visas. And even though he thought Delray Technologies had filled out all the forms, nine months later some applications were still not finished. “You file a response to questions, and the INS takes 60 to 90 days to respond,” Reddy says. “It can ask for more information and the process can go on and on.” Why not hire Americans? “We simply don’t have enough people in the U.S.,” Reddy says, noting that the company needs programmers in Java, Oracle and other Internet-related software. “We look to get people from India, other parts of Asia or Colombia.” Those foreign workers do not work for less, Reddy says. “If a guy comes over from India, in three or six months, he will have the same salary as an American worker.” Just standing in line for a visa is not cheap. Reddy says it costs his company $610 per application, $175 for a document review and another $1,000 to $2,000 in upfront fees to attorneys. In all, each application costs $2,500 or more. But not getting key workers can be even more expensive. Earlier this year Delray Technologies sought private financing that was contingent on putting key personnel in place within a 45- to 60-day period. “Some of our core people are still not here yet,” Reddy says. “Some took seven to eight months. We missed out on the opportunity to raise money because we were not ready.” Help is coming in the form of increases in the number of H-1B visas. President Clinton on Oct. 17 signed a bill that raises the number of annual visas by 70 percent to 195,000. The increase would help companies like Delray Technologies, but in other ways, the law could hurt them by making it easier for competitors to raid his staff of 12, which he hopes to double in the next year. Under the new law, a foreign worker can jump jobs while the new employer labors through the H-1B visa application process. Under the old law, workers were less likely to switch companies because they could not work while waiting the months that it takes for their new employer to obtain a new visa. And many workers didn’t want to risk that their application would fail and they would have to leave the country. Now, those dangers are more remote, so workers are more easily lured away by promises of higher salaries and benefits. “It’s a disadvantage to a smaller company,” Reddy says. “Larger companies can come in and say to a foreign worker, ‘I’m going to give you more.’ They know that the employee is trained and therefore very valuable.” Reddy tries to work around the labor shortage by operating an office in India where programmers are paid less. He could move the entire company to that country, but customers want the firm in the U.S., he says. “They want me to be available when they need me.” Delray Technologies has few means to keep employees other than salary and stock options. But JFK and other hospitals require foreign nurses to sign two-year employment contracts. That allows them to recoup the expenses of obtaining a visa, qualifying the nurse to practice in Florida, and moving that person to this country. JFK and other hospitals rely on recruiting specialists such as All About Staffing in Sunrise. The firm, which serves hospitals in the HCA-the Healthcare Co. chain, searches out candidates, works with locally based recruiters in other countries, handles visa paperwork, and holds candidates’ hands. “The key is to get someone who can get through the red tape,” says Sarah Lea Tobocman, who heads the immigration practice at Gunster Yoakley in Miami. She notes that employers are legally responsible for the information in a visa application. “You have to know what you are doing in those countries,” adds All About Staffing administrator Elizabeth Tomkin. “Hospitals don’t have time for that.” For example, candidates in Asia are flown to nearby U.S. territories like Guam to take certification tests because the exams must be given on American soil. There have been procedural problems, such as an American nursing board requirement that an applicant have a Social Security number before taking a qualifying test — while a U.S. rule says that an applicant cannot be issued a number before qualifying for the test. The candidate’s country must approve emigration, a process that Tomkin says can be drawn out, expensive and filled with paperwork. And there are different U.S. visas depending on a nurse’s education. Individuals with a bachelor of arts or science degree qualify for an H-1B, while those with a two-year associate degree or less can qualify for an EB-3 visa. The EB-3 visa is targeted toward nurses, says Luis Cordero, a partner at Holland & Knight in Miami. The hospital is spared the year it can take to prove to the U.S. Department of Labor that it must hire overseas rather than in this country, but the employer must spend three to six months applying for a green card. It can take months more to get the employee an interview with the nearest U.S. consulate and another 90 days to obtain a work permit. At each step, the application process is fraught with delays, says Tomkin. “You have to pay such attention to details.” The burden is reversed for doctors because so many want to come to the United States, and there are just a handful of openings in each specialty at teaching hospitals like Jackson Memorial Hospital in Miami. If there are half-dozen openings in a specialty, there are usually between 800 and 1,000 applicants, says Lori Allyn Raskin, manager of physician services at Jackson. About 200 are interviewed, and a lucky six get offers. That does not guarantee that a selected foreign doctor will fill those slots, because the rules of immigration can be just as difficult. Ideally, a doctor would come from Europe, Latin America or Asia on a H-1B visa and work toward a well-paying and respected practice. In reality, most arrive on what are known as J-1 visas, which allow them to train in the United States for as long as seven years, but forcing them home to practice for at least two years. If the U.S. or the home country has financed the doctor’s education in some way, the doctor is eligible for only the J-1 visa. “Foreign countries like the J-1 visa,” Raskin says, because it forces the doctors back home. “That’s why some won’t let them come here unless it’s a J-1.” Foreign doctors can apply for a H-1B visa, says Brian Garcia, an immigration attorney with Akerman Senterfitt in Miami. But they are lumped in the application process with technology and other health care workers. The doctors must hire their own attorneys and pay their own way into the United States. Doctors who want a H-1B visa tend to get short-changed, Raskin says. If they graduate from U.S. or foreign medical schools in June, they have long missed a chance at the application process that began the previous October. So they must queue up for the coming October. “I recommend that they go ahead and get their name in right away,” she says. The hospital will try to keep the position open as long as possible.

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