APA Joins in Call For Prioritizing Visas for IMGs
Abstract
APA and five other medical organizations highlighted the vital role that international medical graduates (IMGs) play in the health care system, especially during the ongoing pandemic.
In a statement released last month, APA and its partner organizations called upon President Donald Trump’s administration and Congress to take immediate action to support international medical graduates (IMGs), whose work is especially important to the U.S. health care system during the COVID-19 pandemic.
“IMGs are already willingly at the forefront providing critical health services, fighting against not only the virus but the mental health effects as well.”—Saeed Ahmed, M.D.
“Like all physicians practicing medicine during the pandemic, IMGs are answering the call every day to care for their patients while facing shortages of personal protective equipment and diagnostic testing,” wrote APA and its partner organizations, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Osteopathic Association. Known as the Group of Six, the organizations represent more than 600,000 physicians and medical students.
In addition to fearing for their personal safety during the pandemic, IMGs must also contend with the uncertainty of their visa status, the organizations pointed out.
Specifically, APA and its partner organizations urged the federal government to support the IMG workforce by taking the following actions:
Expedite processing of H-1B visas for IMGs.
Prioritize change of status applications for those on O-1, J-1, and H-1B visas.
Grant an automatic, one-year extension of H-4 visas for spouses and dependent children of IMGs. “The IMGs who have sacrificed so much to better the lives of U.S. patients should not be separated from their families, especially during a pandemic,” the groups wrote.
“Further delays in visa processing will unnecessarily compromise the nation’s COVID-19 response, needlessly endanger vulnerable patient populations, and will place even greater pressure on those serving heroically in this effort,” the groups wrote. “It is imperative that IMGs be allowed to continue their important work on the front lines of the COVID-19 pandemic without fear of the loss of their immigration status or that of their families.”
Amid Stress of Pandemic, Psychiatrist Faces Uncertainty Over Visa
Like many psychiatrists, Kamalika Roy, M.D., has still been seeing patients in person during the COVID-19 pandemic. She volunteered to conduct admission evaluations for new patients, because, as she explained, if doctors don’t continue to provide care, many patients will not get the help they need.
Yet as Roy, an assistant professor of psychiatry at the Oregon Health and Science University, works alongside her fellow psychiatrists during the pandemic, she faces a crisis of her own: By the end of the academic year, she may be forced to leave the United States.
Roy is an international medical graduate (IMG) whose residency and fellowship took place in the United States. She has an H-1B visa, but due to the ongoing pandemic, a host of issues have derailed the process of renewing her visa, which expires on July 14.
The pandemic has highlighted long-standing problems within the U.S. immigration system. “It’s a constant source of negative emotions because you know you have to fight year after year, without any end to it,” she said.
When Roy completed her fellowship training in the United States, she applied for and was granted a J-1 Waiver, which requires she work in a federally designated underserved community. She has done so in Oregon for the past three years, and as a faculty member she also teaches and supervises medical students, residents, and fellows.
Roy’s H-1B visa means her life in the United States is predicated on her working full time. It must be renewed every three years, which is a complicated process that requires various approvals from different authorities. For example, Roy’s employer must prove that it is not paying her an unfair salary compared with other doctors. But, as many physicians’ salaries have been cut due to the pandemic, Roy said she’s unsure if her current salary will meet the U.S. Department of Labor (DOL) wage requirement, as the prevailing wage set by DOL may not reflect postpandemic salaries yet.
“It’s such a complex process, and now I’m stuck waiting because if the DOL does not approve my application, then there will be no way to renew my H-1B visa,” Roy said. “During this pandemic, everything has slowed down to such an extent that it’s impossible to get through this process quickly.
“I have family here,” she continued. “I have a house here. I’ve worked in this underserved area for three years, I have been in this country for 11 years, and I even have an approved petition for permanent residency.”
Despite that approved petition, however, Roy and thousands of other physicians of Indian origin are expected to have to remain in the the United States on H-1B visas for decades before they are granted permanent status. Permanent residency, or green cards, are allotted by country of origin, and there is a disproportionate backlog of green card applications for skilled workers from India.
If Roy’s H-1B visa is not approved in time, she will have a 60-day grace period to find another job or leave the country. “Finding another job in 60 days, as a doctor, is impossible,” she said.
She said some of her colleagues in similar situations are already planning to leave and practice in a more welcoming country. She’s considering doing so as well, because she feels she has no other options.
“We are sick and tired of this,” she said. “At some point, you have to tell yourself that this is enough, and you did enough fighting. There is no point pushing an illogical system, and there is no point losing your life over it. This could be a life-ruining situation.”
In mid-May, APA sent out a call to action urging members to write their members of Congress in support of the Healthcare Workforce Resiliency Act (HR 6788/. 3599). The legislation would recapture up to 15,000 unused employment-based visas for use by international physicians and their families to stay in the United States and continue to treat patients. Information on the legislation and how to send a letter of support is posted here.
Also last month, APA and 10 other psychiatric organizations also pressed the federal government to protect IMGs during the pandemic in a letter to Kenneth Cuccinelli, J.D., the acting director of the U.S. Citizenship and Immigration Services.
The letter urged the government to resume the premium processing that was put on hold on March 20. Premium processing guarantees expedited processing of an applicant’s visa within 15 days. “The ability of resident and fellow psychiatric physicians and their families to continue to live and work in the United States is threatened by this recent federal immigration directive,” the letter stated.
“International medical graduates make up about 30% of psychiatry residents as well as practicing psychiatrists in this country right now,” said Nyapati R. Rao, M.D., M.S., president of APA’s Caucus of IMG Psychiatrists. Many of those IMGs are also working in underserved areas that have been hardest hit by COVID-19, he added.
“IMGs face many impediments that make it difficult to do the important and immediate job of attending to the pandemic victims,” he said. “They especially need support right now. For an IMG, it is hard enough to adapt to the U.S. due to the visa hurdles, culture shock, and enormous complexity of the U.S. health care system. On top of that, dealing with the crises caused by the pandemic is a double whammy.”
“Imagine physicians going into work, caring for patients who are sick, and risking their lives right now,” said Vishal Madaan, M.D., president-elect of APA’s Caucus of IMG Psychiatrists. “On one hand, they’re made to feel like heroes, and yet in the back of their minds, they don’t even know if their visas will be approved in a timely manner, when their time in this country is up, or what’s going to happen with their families.”
That is the problem thousands of physicians are experiencing, Madaan said. Not only has the pandemic slowed visa processing, but furloughs and pay cuts at their institutions are also causing difficulties for practicing IMG physicians.
“There are people who have only a few weeks left, and they don’t know where to go from here,” he said.
Madaan urged fellow psychiatrists to advocate through APA. “The U.S. has always been supportive of IMGs and bringing in new talent in a meritocratic way,” he said. “Immigration matters related to physicians must be expedited especially now, when there’s already a huge shortage of physicians.”
Saeed Ahmed, M.D., is an IMG and addiction psychiatry fellow at Boston Medical Center and the VA Boston Healthcare System. He said he has realized that his patients need physicians like him more than ever as they deal with mental and substance use disorders during the pandemic.
“We are all in this together—doctors, nurses, patients, and other essential workers—regardless of our origins or background,” he said. “All professionals with the skills, credentials, and drive to join the fight should be encouraged and facilitated to do so, and that should include obvious assets like IMGs.” ■
“America’s Frontline Physicians Call for Immigration Protections for International Medical Graduate Physicians (IMGs) During COVID-19 Pandemic” is posted here.
“APA Leads Medical Society Letter Urging Administration to Extend Visas, Expedite Approvals for International Medical Graduates” is posted here.
