Immigration restrictions are sidelining many foreign-born doctors and nurses who would otherwise be able to care for patients at medical facilities swamped by the coronavirus pandemic, despite federal efforts to relax requirements for health-care professionals.
Hospitals sponsoring doctors on H-1B visas must list every facility where the doctor will work when they petition for a guest-worker. That makes it impossible for doctors on H-1B visas to quickly assist nearby hospitals inundated with sick patients or where doctors on staff are quarantined and can’t come to work. The problem is especially acute in rural areas, where foreign-born doctors working on certain visas, including H-1B visas, are common because of specific provisions in those programs.
“There are these young, U.S.-trained doctors who are ready to go and work and take care of these patients, but our hands are tied,” said Harini Chintaluri, a physician at a nursing home in the Bronx, N.Y. “At a time when we need to loosen up restrictions, we are in fact tied up more by saying, ‘You’re not to be working under any other capacity other than the one which has been approved on your visa.’”
Staff shortages are a problem for hospital management around the country, so much so that retired doctors in some areas are being asked to step in to the fray. “WE NEED YOU!” the Veterans Health Administration tweeted this week in a call for assistance from retired workers.
The H-1B program’s fine print is complicating coronavirus-response efforts in rural America, where physician shortages were the most dire in the country prior to the outbreak of Covid-19, as the disease caused by the novel coronavirus is known.
Jobs in rural or underserved areas are particularly attractive to foreign-born physicians. Under visa regulations, a doctor who completes a residency in the U.S. can avoid having to return to their country of origin for two years, as is customary, if they practice as a guest-worker for at least three years in underserved areas.
Working in rural America is also supposed to fast-track a foreign-born doctor’s ability to get a green card. But massive backlogs in the system, along with per-country caps that limit how many individuals from a certain country can qualify for permanent residency, result in many foreign-born doctors working in rural areas well beyond the required time limit.
Raghuveer Kura, a physician in southeast Missouri, has seen first-hand the problems these restrictions can cause. Kura has a green card, but many doctors in his area work on H-1B visas. He said a hospital staffing company called him recently because a physician at a local hospital was quarantined, but he was too busy with his practice to help fill the void—and many other local doctors couldn’t help, either.
“They’re not working, but they’d be in violation of the immigration law if they go and help this particular hospital,” Kura said.
Demand for high-skilled specialty occupation guest-workers has steadily increased over the last few years, with employers submitting more than 200,000 petitions for fiscal year 2020. Only 85,000 H-1B visas are available each year, and the health-care sector must compete with other industries, such as tech, engineering, and other specialty occupations. U.S. Citizenship and Immigration Services, which administers the H-1B program, conducts a lottery each year to determine which employers will be able to petition for those workers.
The federal government recently loosened some licensing restrictions for doctors and expanded telemedicine to help physicians combat the onslaught of Covid-19 cases.
Immigration attorneys say additional changes are possible. Citizenship and Immigration Services “has the authority to let H-1B visa doctors move more freely,” but it’s unlikely they’re thinking about that right now, said Greg Siskind, a lawyer who specializes in immigration issues and has worked extensively with guest-worker physicians.
Last week the agency suspended premium paperwork processing for all work-visa and green-card applicants—a system that allows petitioners to pay for expedited service—and it also has closed field offices and other centers to the public due to the pandemic.
Siskind said the federal Health and Human Services Department also could adjust the way it defines areas where health professionals are in short supply. That would give “maximum flexibility” to doctors whose visas are tied to where they work as well as whether the area in which they work is traditionally underserved.
Media representatives from HHS, the Centers for Medicare & Medicaid Services, and Citizenship and Immigration Services didn’t respond to requests for comment.
Rural Areas’ Woes
The H-1B program’s rules even restrict participating doctors from providing care at facilities not listed in their visa paperwork when a physician with the same specialty is quarantined. That’s creating hurdles in small towns like Farmville, Va., which has a population just under 8,000 people, and posing new risk for patients.
Farmville’s only gastroenterologist was recently furloughed for two weeks because they traveled through suspected Covid-19 hot-spots. When a patient came to the emergency room with internal bleeding, they were sent to a facility in a neighboring city, according to Atul Bali, a kidney doctor who works in Farmville on an H-1B visa.
“If we had a doctor who is on an H-1B visa in a nearby city and we required this person’s services to come in, they wouldn’t be able to do so,” Bali said, calling the restrictions “stifling.”
Sending a patient to another community for treatment increases their potential exposure to Covid-19. “The more we move these patients around, the more likely they’ll be exposed to someone who is Covid-positive,” Bali said.
The program’s red tape also compounds the fear many guest-worker doctors have about contracting the virus. Right now, if a doctor holding an H-1B visa dies, their entire family would likely have to leave the country if they’re not already citizens, Siskind said, because the guest-worker generally serves as their sponsor.
Bali said that is “also causing a lot of anxiety and unease” for H-1B doctors.
Delays for Foreign Nurses
The pandemic also has highlighted the shortage of nurses in the U.S. and the long wait hospitals face in sponsoring foreign-born nurses.
“There’s always been a shortage of registered nurses. U.S. schools never graduate enough nurses to fill the need,” said Carl Shusterman, senior counsel at Clark Hill PLC in Los Angeles, who specializes in immigration law.
Most foreign-born registered nurses earned four-year degrees in their country of origin. That makes them ineligible under the H-1B program’s degree requirements, however, because registered nurses in the U.S. earn a degree in two years.
The H-1B program is open to some medical jobs that require a four-year degree in the U.S., such as physician assistants, nurse practitioners, and certified registered nurse anesthetists, but these occupations represent a fraction of all health-care-related guest-workers.
As a result, the most common way for foreign-born nurses to work in the U.S. is to be sponsored by a hospital or physician practice for an employment-based green card. The majority of foreign-born nurses in the U.S. come from the Philippines.
In 2018, many hospitals were able to apply for and sponsor nurses “fairly quickly,” and by June 2019 the waiting time “went down to zero,” said Shusterman, who represents hospitals that recruit foreign-born medical workers.
But things didn’t stay that way. When demand for foreign-born nurses began to rise over the last year, wait times increased as well. By March 1 of this year, wait times had increased to more than three years, Shusterman said.
“Here we are in the middle of this coronavirus and we have tens of thousands of nurses willing to come to the U.S. and they won’t be able to arrive for four years,” he said.