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On February 12, 2022, the Subcommittee on Immigration and Citizenship of the House Committee on the Judiciary held a very informative hearing regarding the relevance of foreign physicians in the United States healthcare system (U.S. U.). The hearing was titled “Is there a doctor in the house? The Role of Immigrant Physicians in the American Healthcare System. The testimony provided underscores the ridiculous maze of immigration rules designed to complicate and unpredict foreign doctors trying to gain permission to serve the American public – even when they desperately need it.
Dr. David J. SkortonPresident and CEO of the Association of American Medical Colleges (AAMC), which is a not-for-profit organization made up of members of the 155 accredited medical schools in the United States and the 16 accredited Canadian medical schools, pointed out the following critical points:
- Based on the AAMC’s review of American Medical Association (AMA) 2020 data for medical practices, approximately 23% of active physicians practicing in the United States identified themselves as foreign-born. Many of them are now US citizens or lawful permanent residents.
- The AAMC projects that the overall physician shortage will total 37,800 to 124,000 physicians by 2034. This projection includes primary care physician shortages between 17,800 and 48,000; and between 21,000 and 77,100 physicians in non-primary care specialties.
- Academically, the number of first-year medical students has increased nearly 35% since 2002 due to an increase in class sizes and the opening of 30 new schools.1 Additionally, five additional medical schools have applied for accreditation, as reported on the Liaison Committee on Medical Education (LCME) website.2 The LCME accredits medical education programs leading to a medicine in the United States and Canada.
- However, increasing US medical school enrollment does not increase the size of the medical workforce without a coordinated increase in graduate medical education (GME) residency positions. Thus, the AAMC supports the provision of the Resident Physician Shortage Reduction Act of 2021 (HR 2256, S. 834 – 117e Congress), which adds 14,000 Medicare-supported GME positions more than seven years.
- Skorton’s testimony also notes that research published in the Journal of the American Medical Association (JAMA) network showed that more than 99% of all USMD graduates enter a residency program or practice full-time in the States. States within six years of graduation.3
With respect to the current reliance of the United States on foreign resident physicians, according to the GME National Census sponsored each year by the AMA and AAMC, approximately 8% of US resident physicians were in United States as nonimmigrant visa holders (e.g., usually J-1 or H-1B).4 Representative Sheila Jackson Lee said in her testimony that in November 2020, international medical graduates (IMGs) accounted for 45% of physician deaths from COVID-19. Additionally, she referenced the AAMC’s prediction that by 2034, the number of people over the age of 65 in the United States will increase by more than 40%.
Testimony at the hearing presented a wide variety of well-documented solutions for the difficult hurdles IMGs face in obtaining nonimmigrant visas for GME and eventually applying for permanent residency in the United States.5 For those who support approving legislative solutions to our physician shortages, including IMGs, the following pending legislation should be considered and hopefully supported:
- The Conrad 30 J-1 Visa Waiver Program was only reauthorized by the Omnibus Fiscal Year 2022 Spending Bill through September 30, 2022. in May 2021 provides the following key changes:
- Extends the Conrad program for three years from the enactment of the bill.
- Increases the number of waivers a state can obtain from 30 to 35, if a certain number of waivers have been used by the state before, in addition to providing other demand-related adjustments.
- Permits the employment of a physician at an academic medical center for the Conrad program, if the work is in the public interest even if the medical center is not located in a medically underserved area (MUA) or area of Shortage of Health Professionals (HPSA).
- Allows eligible physicians who are not selected for one fiscal year’s Conrad slots to extend their status for up to six months to remain in the United States to reapply for the exemption in the following fiscal year.
- Restore a Conrad slot in an issuing state when a beneficiary physician moves to another state due to extenuating circumstances.
2. 1810 presented by current Senator Klobuchar (D-MN) has 25 co-sponsors.
3. The Health Workforce Resilience Act (HR 2255/S.1024) was introduced in the House in March 2021 and proposes to relieve physicians facing extremely long backlogs for immigrant visas. Currently, S. 1024, presented by Sen. Durbin (D-Il), has 25 co-sponsors. Some of the layouts included are:
- Preserves unused employment-based immigrant visas from federal fiscal years 1992 to 2020 for nurses and physicians, who apply for these immigrant visas before the date which is 90 days after the end of the declared national emergency COVID-19. The number of 40,000 unused employment-based visas available will be reserved as follows: 25,000 for nurses and 15,000 for doctors.
- Immigrant visas authorized under the bill are exempt from the normal annual country limitations, which of course relieves heavily oversubscribed categories for people from India and China, for example.
- Accompanying family members of principal immigrant visa applicants will not count toward the 40,000 cap.
- Premium no-cost processing will be available from United States Citizenship and Immigration Services (USCIS) to review and act on petitions and applications from eligible immigrants under the reserved immigrant visa numbers listed.
Other fixes to consider include:
- Expand the scope of the U.S. Department of Health and Human Services (HHS) J-1 Clinical Waiver Program to include subspecialties and practice locations in HPSAs or MUAs without limitation by a certain score.
- Expand H-1B cap exemptions to apply to IMGs providing services in HPSAs or MUAs or adjacent locations primarily serving Medicaid patients, for example.
- Exempt the time spent completing the GME from the six-year H-1B cap on H-1B status.
- Add the occupation of physicians serving in MUAs or HPSAs to Schedule A for labor certification.
- Allow spouses to work incidentally to status based on being dependent on an H-1B physician working in an underserved area.
Our doctor shortages in health care are also expected to be exacerbated by increased retirements of current providers. For a threat to public safety so clearly highlighted by the pandemic, it is incomprehensible that a red carpet has not been rolled out by the United States to facilitate increased residency programs and GME funding for graduates of American medical schools as well as the passage of bills and procedural changes. to reduce the current trauma created by the continuing dysfunction of immigration law and political divisions.
This article originally appeared in Healthcare Michigan, July 2022.
1. https://www.aamc.org/media/9936/download– AAMC Medical School Enrollment Survey: 2020 Results (October 2021).
5. Please refer to the detailed immigration background included in the testimony submitted at the hearing by Kristen A. Harris of Harris Immigration Law.
The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.
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