Immigration Rules Threaten to Reduce IMG Workforce During Pandemic
Abstract
At a time when the United States is in great need of health care workers to provide care during the COVID-19 pandemic, the country is in danger of losing a major segment of that workforce because of roadblocks to obtaining or renewing H1-B work visas. Other skilled international workers are facing the same problems.
The COVID-19 pandemic has affected the social, economic, physical, and psychological well-being of people all over the world. At press time, more than 110,000 people had died from COVID-19 in the United States, the number of new cases in many states is again rising, and the country is caught in a tug of war over protecting people’s safety versus reviving the economy. Unemployment, isolation, travel restrictions, and social distancing have multiplied the distress of the financial and health care crisis caused by the pandemic.
At a time when this country’s need for health care workers has never been greater, a specific group of physicians is encountering problems that threaten their ability to care for patients and their families—international medical graduates (IMGs). IMGs make up about 30% of the psychiatric workforce.
An estimated 12,000 to 15,000 IMG physicians are on H1-B work visas and practice on independent licenses. These visas have to be renewed every one to three years. According to the National Resident Matching Program, another 12,000 to 16,000 IMGs are in training and have visas that need to be renewed every year. Though the U.S. Citizenship and Immigration Services (USCIS; part of the U.S. Department of Homeland Security) is the highest authority for H1-B visa approvals and renewals, visa applications go through several hurdles including the physician’s institution, state licensing authority, and Department of Labor before a visa petition reaches the USCIS.
An H1-B visa is a nonimmigrant visa that is provided for employers to obtain graduate-level workers in specialty occupations from overseas. (It does not provide immigrant status.) Physicians make up just one group impacted by the Trump administration’s immigration policies.
Even before the pandemic, the H1-B visa process was unusually complex, time consuming, and fraught with uncertainty—not just for physicians, but for all individuals who are applying for an H1-B visa or a renewal. According to the National Foundation for American Policy, the denial rates for new visas and renewals rose significantly for H1-B visas since 2017 compared with previous years, as USCIS gradually and systematically added more hurdles and subjective measures to the already bureaucratic process.
While IMG physicians are required to go through battles that can last months and even years to obtain a work visa, they are a critical part of this country’s health care workforce, especially during the COVID-19 pandemic. They constitute 33% of all primary care physicians and 24% of all trainees in programs accredited by the Accreditation Council for Graduate Medical Education. IMG physicians tend to work in rural and underserved areas with high poverty rates, and overall almost 21 million Americans live in areas where half of the physicians are IMGs.
Many IMGs are in a challenging position given their work responsibilities; inadequate protection; and significantly higher risk of COVID-19 infection, serious illness, and death. Among the additional existential challenges they are facing include the following:
If they are laid off, IMG trainees and physicians on work visas have 30 days to find a new training program and 60 days to secure another job, respectively. This grace period is not nearly long enough to find positions that are hiring immediately, engage in interviews, negotiate contracts, get credentialled, and secure a visa. As a result, their recourse is to self-deport and take their families with them. In many cases, their dependents are U.S. citizens.
IMG physicians who are furloughed might not be able to comply with visa regulations. Work visa contracts are tied to a specific remuneration calculated according to the market analysis.
Physicians facing visa renewal or change of status (from training to work) are at a risk of lapse of status as USCIS suspended its premium processing for all H1-B visas and denied requests for expedited processing.
Physicians’ driver’s licenses are linked with a fully approved H1-B visa, making them unable to drive while they wait for approval of their visa.
Physicians on H1-B visas are restricted to specific work sites, despite being sought for their expertise in areas of higher need during the pandemic.
Despite strong advocacy from the APA, AMA, and other national medical associations, USCIS has not reversed any visa and immigration policies for physicians. The department issued a statement about facilitating visas for overseas IMGs so they could begin their training, but the logistics of their ability to start in time seems complex. Senators from Georgia, Illinois, Delaware, Indiana, Texas, and Vermont introduced the Healthcare Workforce Resilience Act (S 3599), which would grant already approved permanent status petitions to 15,000 IMG physicians. APA and its G6 coalition partners are strongly advocating for this bill to become law. Meanwhile, it is high time for government agencies to expedite all physician-related visa issues to facilitate health care delivery during the pandemic. This country cannot afford to lose any of its essential health care workforce at this uncertain time. ■
