TN Visa: Physician

Background of Physician TN Visa Category

  • The TN visa occupational category for Physician was first listed in the United States-Canada Free-Trade Agreement (FTA) in 1989. See 54 Federal Register 12 (Jan. 3, 1989). The predecessor to NAFTA, the FTA provided work authorization under TC visa status, which was only available to Canadian citizens.

  • The occupational category for Physician was carried over and included in the NAFTA list of available occupations in 1994. See 58 FR 69205 (Dec. 30, 1993). All NAFTA occupations were carried over into the USMCA.

TN Visa Physician Applicant Requirements:

  • To qualify for TN visa status under the occupational category for Physician, an individual must possess one of the following:

    • Doctor of Medicine (M.D.);

    • Doctor en Medicina; or

    • State / Provincial license.

  • Additional information on the educational background of Physicians may be found in the U.S. Department of Labor's Occupational Outlook Handbook (OOH). See Royal Siam Corp. v. Chertoff, 484 F.3d 139, 145 (1st Cir. 2007).

TN Visa Physician Job Duty Requirements:

  • As stated in the TN visa regulations at 8 CFR § 214.6 (c), the Physician TN visa category is only available for teaching or research positions.

  • 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. See Operations Instruction (OI) Section 214.6.

  • This is not the case under the current law, according to a legacy INS letter. The 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. See Bednarz Letter (March 15, 1995).

  • Physicians under TN visa status may only engage in patient care that is incidental to their teaching or research. See NAFTA Handbook (1999). To determine if patient care is incidental, U.S. immigration inspectors will consider the following factors:

    • The amount of time spent in patient care relative to teaching and/or research;

    • Whether the physician receives compensation for such services;

    • Whether the salary offer is so substantial in teaching and/or research that direct patient care is unlikely; or

    • Whether the physician will have a regular patient load. Id.

  • Physicians who wish to provide patient care should consider the H-1B visa as an alternative. An individual may engage in direct patient care in the U.S. under the H-1B category if he or she:

    • Has a license or other authorization from the state of his or her intended employment, if the state requires a license or authorization;

    • Has passed the United States Medical Licensing Exam (USMLE); and

    • Has competency in oral and written English which is demonstrated by: (a) Having passed the English language proficiency test given by the Educational Commission for Foreign Medical Graduates (ECFMG); or (b) Having graduated from a qualifying accredited school of medicine (whether or not the school is located in the United States). 9 FAM 41.53 N4.2-5.

  • In addition to the information provided above, individuals can also refer to the U.S. Department of Labor’s Occupational Outlook Handbook (OOH) for guidance on the generally accepted job duties for this occupation.

More Information:

Revised April 29, 2023.