New Visa Restrictions Affecting Foreign Physicians' Entry Into US

Ken Terry

June 12, 2017

CHICAGO — Although President Donald Trump's executive order suspending travel to the United States from six Muslim-majority countries is still tied up in the courts, other aspects of the Trump anti-immigration policy are affecting the ability of international medical graduates (IMGs) to train and work in this country, said panelists at an educational session today at the American Medical Association's (AMA) House of Delegates conference held here.

Meanwhile, the Association of American Medical Colleges (AAMC) filed an amicus brief with the US Supreme Court today on behalf of itself and 21 other health-related organizations. The brief argues against the Trump Administration's request for a Supreme Court stay of a district court injunction that halted the travel ban. If the stay request is granted, the travel ban could go into effect while the high court considers the case.

The speakers at the AMA forum emphasized that tightened visa application rules issued by the state department are starting to affect the ability of foreign doctors to accept positions in US residency programs — and not only in the countries covered by the travel ban, which include Iran, Libya, Somalia, Sudan, Syria, and Yemen.

William Pinsky, MD, president and CEO of the Educational Commission for Foreign Medical Graduates, said that 247 Pakistani doctors matched this year to US medical residencies, and 27 of those doctors were denied visas. That's an 11% denial rate, he pointed out. By comparison, he said, only one to three Pakistani doctors per year who matched to residences had been unable to obtain visas in recent years.

After the session, Dr Pinsky told Medscape Medical News that there has also been a significant rise in denials of visas to Indian doctors who planned to train in the United States. India has a very large Muslim population. Meanwhile, J-1 visa applications from Iranian doctors declined by a third and from Syrian doctors by 60%, this year, he said.

Foreign physicians accepted to residency programs in the United States must obtain J-1 visas that allow them to come here to pursue their education. Upon completion of their residency, they are required to return to their home countries for at least 2 years. But they can get a J-1 visa waiver if they agree to practice in an underserved area for at least 3 years. Then they must apply for an H-1B visa, which allows them to stay in the United States.

Jerard Jensen, JD, general counsel of the Marshfield Clinic Health System, said the tightening of the visa process has also begun to affect IMGs who need to convert their J-1 visas to H-1B visas to take jobs they have been offered here.

Suspension of Processing Program

One reason is the recent suspension of the visa premium processing program by the US Citizenship and Immigration Services (USCIS). Doctors who needed H-1B visas used to be able to apply to a consulate, pay $1,200, and get a visa within 15 days. Now, he said, it takes 6 months. This is a matter of concern for the Marshfield Clinic, which is in a rural area, he noted.

Kristen Harris, a Chicago-based immigration attorney, said that the USCIS provided a workaround for physicians affected by the premium processing ban as the result of an intervention by Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), and Heidi Heitkamp (D-ND). Using a little-known regulation, USCIS will in some cases expedite processing of H-1B visas for doctors who are eligible for J-1 waivers so they can work in medical shortage areas.

Noel Deep, MD, a naturalized citizen from India who is governor-elect of the Wisconsin Medical Society, said it is critical that IMGs be allowed to serve in these areas. The AMA estimates that there are 280,000 IMGs in the United States, or about one in four practicing doctors, he said. More than half of internists are IMGs, he noted. In the rural critical access hospital with which he is affiliated, he said, three of the four hospitalists are IMGs. So are three of the hospital's four oncologists, and two of its three internists. The only neonatologist, also an IMG, left the area this year.

Mohamed Khan, MD, the division chief of radiation oncology at MD Anderson Cancer Center in Houston, Texas, said that the federal assault on immigration from some countries does "two way damage." First, it makes IMGs who are in the United States but are not yet citizens fearful to travel abroad out of concern they won't be allowed back in. Second, he notes, IMGs may decide to train and work in another country because of the US immigration policies. This not only affects patient care, he said, but also has an adverse impact on research.

The Trump administration's revised travel ban has now been blocked by two federal appeals courts, including the Fourth Circuit in Richmond, Virginia, and the Ninth Circuit in San Francisco. The AAMC amicus brief filed today with the Supreme Court argues that health professionals from other countries are essential in rural and other medically underserved communities.

In addition, a news release on the brief said, "International researchers and scientists strengthen the laboratories at medical schools and teaching hospitals that develop cures for life-threatening and chronic conditions ….  "Suspending the entry of medical and research professionals into the U.S. on the basis of their nationalities would ultimately undermine the health security of our nation, especially as we face a looming physician shortage."

Among the associations joining the AAMC in its brief are the American Academy of Family Physicians, the American Academy of Pediatrics, the American Association of Colleges of Nursing, the American Association of Colleges of Pharmacy, the American College of Healthcare Executives, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Dental Education Association, the American Nurses Association, the American Psychiatric Association, the American Public Health Association, the Association of Academic Health Centers, the Association of Schools and Programs of Public Health, the Association of Schools of Allied Health Professions, the Association of University Programs in Health Administration, the Greater New York Hospital Association, the Hispanic-Serving Health Professions Schools, the National Medical Association, the National Resident Matching Program, the Physician Assistant Education Association, and the Society of General Internal Medicine.

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