Dr. Tian Works to Improve Pathway to Legal Status for Dentists on H-1B Visas

Originally from Jinan, China, Geng Tian, DMD, FAGD, came to the United States in 2011. He received his undergraduate degree from the University of Minnesota and his DMD from the University of Pittsburgh School of Dental Medicine. He currently practices in Leesville, South Carolina, and has pursued both a Fellowship in AGD as well as national leadership roles. As a member of AGD’s national Dental Practice Council (DPC), he chairs a new subcommittee created to identify and monitor issues that affect associate dentists in the United States on H-1B visa status. Below, he shares his personal story, as well as information about the subcommittee and its goals.

As many of you know, being a dentist is no easy feat. Not only do we spend our days fixing things in the dark, cramped and often damp environment of the oral cavity, but we also may juggle the demands of running a business. Now, imagine doing all of that while also dealing with the uncertainty of your legal status in the country. That’s the reality of practicing dentistry on an H-1B visa — it adds a whole new layer of complexity.

The H-1B visa allows U.S. employers to hire professionals of other nationalities in specialized fields, and I’m incredibly grateful for it. Without this program, my four years of dental school would have been nothing more than an expensive lesson in student debt and a collection of dental textbooks. Employment-based immigration is my only option for staying in the United States, but the process is long and exhausting.

After graduating, I had just one year of temporary work authorization to gain experience working in different locations via optional practical training (OPT) — unlike STEM [science, technology, engineering and mathematics] graduates, who get three years of OPT. Following my mentor’s advice, I chose to refine my skills through a general practice residency (GPR).

Unfortunately, a small mistake during the visa application process — whether by an attorney, an applicant or even a school official — can cause a denial, doubling the processing time. I learned this the hard way. Instead of diving straight into my GPR, I ended up on an unplanned five-month “vacation” in New York City while waiting for my OPT issues to be resolved. To make matters worse, Pennsylvania refused to renew my driver’s license because my immigration status was still pending, and New York wouldn’t issue me a new one. Let’s just say I became way more familiar with the subway system than I ever intended. I was finally able to start my program after my OPT approval in late October, but the OPT was only valid for 9 months. I worked every Saturday and with no vacation leaves in order to complete the program successfully.

Then, in January, way before my OPT ended and in order to continue practicing after residency, I scrambled to find a dental office willing to sponsor my H-1B visa because the visa is awarded through a lottery process every March (unless the employer is a cap-exempt organization like a university, hospital or federally qualified health center). For context on how competitive the application process is, in 2024, the selection rate was a mere 16.6%. Waiting for the lottery results was incredibly nerve-wracking; missing out would have meant losing my job offer and desperately searching for a cap-exempt employer, or, worse, having to leave the country with my family.

Licensing was another hurdle. Because of my immigration status, the process had extra steps. Many states link the expiration date of professional licenses to the length of the applicant’s legal status. When I applied for my South Carolina dental license in March, it was initially valid for just six months — until September. Luckily, once my visa was approved, my license was extended to its full term.

Once granted, an H-1B visa is valid for three years and can be extended up to six years total. If you’re in the process of obtaining a green card (permanent residency), the H-1B can be extended beyond the six-year limit until the green card is granted. However, since the visa is employer-specific, changing jobs means finding a new employer willing to sponsor both the visa and the green card. The silver lining? Transferring an H-1B to a new employer doesn’t require going through the lottery again — just filing a petition for transfer.

It’s a pleasure for me to share my story and let you know that AGD recognizes the struggles dentists on H-1B visas face.

Since graduating in 2018, I’ve only traveled abroad once to visit my parents. To return to the United States, I had to apply for a visa stamp through an interview at a U.S. embassy abroad. Although this process usually takes about a week, the interview may need to be scheduled way ahead of time, and administrative checks can lead to lengthy delays, making it nearly impossible to squeeze into a short vacation. If the stamp isn’t issued in time, my employer might have to find another associate. Sorry, I won’t be able to join you all in Montreal for AGD2025 this July, which is really disappointing.

As you can imagine, this journey has been physically, mentally and emotionally draining. With just one year of OPT, I had to make a tough decision: use it for advanced training or focus on securing a job with an employer willing to sponsor my H-1B. I also considered applying for specialty training, but many residency programs only accept U.S. citizens or permanent residents, narrowing my options. Ultimately, I chose to prioritize my place in the H-1B lottery and green card waitlist, putting specialty training on hold. To add to the challenge, the lottery aspect of the H-1B process deters many private dental practices from sponsoring noncitizen dentists, because there is a strong chance the associates they hire may not receive an H-1B visa, and they will have to start the hiring process over again. In my area, only a handful of offices within a 30-mile radius are open to sponsorship — and many of them just aren’t the right fit.

It’s a pleasure for me to share my story and let you know that AGD recognizes the struggles dentists on H-1B visas face. AGD’s DPC, of which I am a member, has formed a subcommittee to address these issues. We have reached out to the Department of Homeland Security to gain a deeper understanding of the situation, and we have already gathered some valuable insights. Moving forward, the subcommittee hopes to identify opportunities for easing some of the restrictions around H-1B visas for dentists and for educating AGD members about the process of integrating a dentist on an H-1B visa into their practices. We’ll also explore potential pathways for dentists — and possibly even physicians — on H-1B status to secure green cards more easily.

While the road is tough, I’m hopeful that, with continued advocacy and support, it will become a little less rocky for future dentists like me.

If you have comments or a personal story you would like to share with the DPC subcommittee regarding dentistry and the H-1B visa program, please contact practice@agd.org.