The H-1B visa, which allows U.S. companies to hire temporary foreign workers to fill needs not met by the U.S. workforce, is not intended as a permanent path to citizenship for immigrants coming to the United States. Last year, an executive order delayed the usage of the H-1B visas for immigrant workers.
Thousands were denied their visa, prompting them to go back home and prepare a backup plan. More than twice as many H-1B applicants were rejected compared to the same time period in 2017, according to U.S. Citizenship and Immigration Services data.
One year later, the executive order, designed to protect the nation, did much to cripple the medical field and leave hospitals and hospital staff clamoring to find replacements to fill the void.
“The current physician shortfall in the U.S. is expected to worsen without multifaceted intervention,” says Darrell G. Kirch, President, and CEO of Association of American Medical Colleges. There will be an estimated deficit of 40,800 to 104,900 physicians by 2030. Recent data shows that 29 percent of physicians are currently practicing in the U.S. were born outside of the U.S.
“Delays or denials of H-1B visas for non-citizen international medical graduates can have a serious downstream impact on patients’ access to care in both the immediate and near future,” American Academy of Family Physicians President Dr. Michael Munger said. “Community health centers, federally qualified health centers, and teaching hospitals rely on medical residents to provide care to thousands of patients each year.”
A 2017 report from the Association of Medical Colleges revealed that international medical graduates comprised more than one-quarter of the current physician workforce in the United States. Specifically, international medical graduates comprise 39.4 percent of internal medicine residents in the U.S. — the highest number of such graduates when compared to other training specialties.
There are two main visas for foreign medical graduates to participate in graduate medical education training:
J1 visas are sponsored by the Educational Commission for Foreign Medical Graduates at no cost to the training hospital—and are harder to come by. The H-1B visas are sponsored by the training hospital at a cost of $3,000-$4,000 per trainee. The 2016 cut in Medicare Graduate Medical Education (GME) funding caused many residency programs to stop sponsoring H-1B visas. Even if those hurdles are cleared, the length of time it takes to complete the process makes it prohibitive.
Length of Time
Both visas can be delayed pending security clearance, but the H-1B visa can take months to be completed. From applying for the medical license (which can take weeks to months) to receiving a state medical license to applying for USCIS approval (weeks to months) and finally applying for the visa — the process is estimated to take at least 7 months.
The current length of time is exacerbated by the stifling executive order passed by America’s administration to delay residency programs — which primarily affected the foreign medical graduates. The delay has caused a bottleneck in the medical field and leaves patients in danger of not having enough doctors to treat them.
“These physicians are very important to our health care workforce,” Munger said. “Without a quick remedy, a policy of delaying or denying visas for continued medical training will contribute to a longer-term shortage of physicians.”
Despite foreign medical graduates welcomed with open arms into the medical community, the current visa system is a significant reason for delays in effectively recruiting and incorporating these graduates into clinical and academic practice in the U.S. That could force future foreign graduates to seek positions outside of the U.S., further increasing the current physician shortage.
Help From the Inside
To help address the physician shortage, the bipartisan Resident Physician Shortage Reduction Act of 2019 has been introduced to Congress to provide increased Medicare support for an additional 3,000 new residency positions each year over the next five years.
“The AAMC supports legislation to increase the federal support for graduate medical education as part of a multifaced strategy to ensure that Americans have access to the care they need when they need it,” Kirch said. “The data consistently shows a significant physician shortage. Because it takes seven to fifteen years to train a doctor, we urge Congress to remove the freeze on federal funding for residency training that has been in place for over two decades without delay.”
A year later, the American economy is reeling from the effects of the executive order and measures to help the medical field are in play, but it still may take hospitals a while to find physicians to fill the gaps.