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Proposed Visa Renewal Change Carries Doctor Shortage Risk

Oct. 19, 2020, 9:15 AM

Hospitals in disadvantaged rural and urban areas could face physician shortages and operational chaos if a proposed change in federal immigration policy makes it harder for foreign-born doctors to remain in the U.S.

Medical groups, including the American Hospital Association and the Association of American Medical Colleges, are sounding the alarm. They’ve asked the Department of Homeland Security to exclude foreign-national physicians in U.S. medical residency and fellowship programs from proposed requirements needed to extend their authorized stays in this country.

People who stay in the U.S. beyond their legal limit do so “in part, because they do not file applications or petitions, such as extension of stay,” the Immigration and Customs Enforcement proposal said. As a result, Homeland Security is concerned about “a potential for increased risk to national security.”

But without the physician exclusion, the groups say more than 12,000 foreign-born doctors in U.S. graduate medical programs could face months-long annual visa renewals that could interrupt their U.S. education and prevent them from providing supervised care during the Covid-19 crisis. The potential staffing losses would exacerbate national physician shortages, the groups say, and disrupt patient care at nearly 750 U.S. hospitals where the physicians train.

“The disruptions will be felt most acutely” in states like New York, Michigan, Florida, Massachusetts, and New Jersey where large numbers of foreign doctors train, the groups said in an Oct. 9 letter to Chad F. Wolf, acting secretary of homeland security. Copies of the public comment letter were also sent to 42 U.S. senators whose states could be affected.

“We’re beginning those conversations” with lawmakers about a potential legislative fix if a regulatory solution can’t be found, said William Pinsky, president and CEO of the Educational Commission for Foreign Medical Graduates.

“What we’re specifically asking for is to maintain the current policy for the physicians,” Pinsky said.

Currently, each doctor’s authorized period of stay is extended for a year after the commission completes that individual’s visa sponsorship review. The proposal would require an additional application step and put stricter time limits on the stay period.

“This regulatory change, which will establish a fixed period of admission” for certain categories of visa holders “aims to help DHS enforce our nation’s immigration laws and promptly detect national security concerns, while protecting the integrity of these nonimmigrant programs,” the DHS said in a statement.

Oversight of Doctors

Foreign doctors training in the U.S. make up 8.5% of all physicians in accredited graduate medical programs, according to a commission fact sheet.

“These people are in these programs because there aren’t enough American graduates to fill them,“ said Bruce Morrison, immigration consultant to the American Hospital Association. “They’re not there instead of Americans. They are there in addition to Americans.”

To pursue a U.S. medical education, these doctors obtain a temporary, non-immigrant J-1 visa, which allows them to participate in clinical training activities. The commission is the lone visa sponsor of all 12,000-plus J-1 physicians in the State Department’s Exchange Visitor Program, a public diplomacy initiative designed to improve international relations.

The commission has oversight of the doctors and works with their teaching hospitals to follow their activities.

In the entire history of the program “we’ve never misplaced an individual,” Pinsky said. “If somebody leaves the training program because of illness or poor performance, we’re notified and they leave the country at a designated time.”

Participants can stay in the exchange visitor program up to seven years, but the commission’s J-1 visa sponsorship must be renewed annually after reviewing each participant to ensure compliance with federal guidelines. Currently, a “duration of status” provision gives J-1 physicians “an authorized period of stay” in the U.S. that corresponds to the commission’s one-year period of approved visa sponsorship, Pinsky said.

The proposed rule change would require J -1 physicians to apply to the U.S. government each year to extend their authorized stay. They would do so through the U.S. Citizenship and Immigration Service, which could take five to 19 months to process, Pinsky said. Or they could leave the U.S. and apply through a U.S. consulate office abroad.

“Either way, the rule change will disrupt the training of thousands of physicians—physicians who already have been thoroughly vetted, already are serving on our nation’s health care teams, and already are carefully monitored,” a commission FAQ said.

Impact on Urban, Rural Hospitals

The impact would be disproportionately felt at urban safety-net hospitals, which serve large numbers of uninsured and low-income Medicaid patients. On average, these facilities train about four times as many physician residents as all other hospitals, according to America’s Essential Hospitals, which represents some 300 nonprofit safety-net hospitals.

Rural hospitals would also take a hit. When the J-1 doctors complete their training, they must get a waiver to remain in the country, Morrison said. Most do so by working in the Conrad 30 Waiver Program, which gives each state 30 slots to fill with foreign doctors who must provide five years of service in rural and inner-city areas with physician shortages.

“If the J-1 program loses its ability to process these foreign doctors, then those rural hospitals won’t have that supply of doctors,” Morrison said.

“We urge policymakers to consider these impacts carefully and recognize that the J-1 physician population in the United States is already carefully monitored,” the groups’ letter said.

The proposed rule change is in a public comment period. Interested parties have until Oct. 26 to provide their input.

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Brent Bierman at