Visa Worries Besiege Immigrant Physicians Fighting COVID-19

Kari Oakes

April 28, 2020

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Physicians and their sponsoring health care facilities shouldn't have to worry about visa technicalities as they work on the front lines during the COVID-19 pandemic, said health care leaders and immigration reform advocates.

In a press call hosted by the National Immigration Forum, speakers highlighted the need for fast and flexible solutions to enable health care workers, including physicians, to contribute to efforts to combat the pandemic.

Nationwide, over one in five physicians are immigrants, according to data from the Forum. That figure is over one in three in New York, New Jersey, and California, three states hard-hit by COVID-19 cases.

Dr Amit Vashist

Many physicians stand willing and able to serve where they're needed, but visa restrictions often block the ability of immigrant physicians to meet COVID-19 surges across the country, said Amit Vashist, MD, senior vice president and chief clinical officer for Ballad Health, Johnson City, Tenn., and a member of the public policy committee of the Society of Hospital Medicine. Ballad Health is an integrated health care system that serves 29 counties in the rural Southeast.

"This pandemic is a war with an invisible enemy, and immigrant physicians have been absolutely critical to providing quality care, especially on the front lines – but current visa restrictions have limited the ability to deploy these physicians in communities with the greatest need," said Dr. Vashist during the press conference.

Visa requirements currently tie a non-US citizen resident physician to a particular institution and facility, limiting the ability to meet demand flexibly. "Federal agencies and Congress should provide additional flexibility in visa processing to allow for automatic renewals and expediting processing so immigrant medical workers can focus on treating the sick and not on their visa requirements," said Dr. Vashist.

Dr. Vashist noted that, when he speaks with the many Ballad Health hospitalists who are waiting on permanent residency or citizenship, many of them also cite worries about the fate of their families should they themselves fall ill. Depending on the physician's visa status, the family may face deportation without recourse if the physician should die.

"Tens of thousands of our physicians continue to endure years, even decades of waiting to obtain a permanent residency in the United States and at the same time, relentlessly and fearlessly serve their communities including in this COVID-19 pandemic," said Dr. Vashist. "It's time we take care of them and their long-term immigration needs, and give them the peace of mind that they so desperately deserve," he added.

Frank Trinity, chief legal officer for the Association of American Medical Colleges, also participated in the call. "For decades," he said, the United States "has relied on physicians from other countries, especially in rural and underserved areas."

One of these physicians, Mihir Patel, MD, FHM, a hospitalist at Ballad Health, came to the United States in 2005, but 15 years later is still waiting for the green card that signifies U.S. permanent residency status. He is the corporate director of Ballad's telemedicine program and is now also the medical director of the health system's COVID-10 Strike Team.

"During the COVID crisis, these restrictions can cause significant negative impact for small rural hospitals," Dr. Patel said. "There are physicians on a visa who cannot legally work outside their primary facilities – even though they are willing to do so."

Regarding the pandemic, Mr. Trinity expressed concerns about whether the surge of patients would "outstrip our workforce." He noted that, with an unprecedented number of desperately ill patients needing emergency care all across the country, "now is the time for our government to take every possible action to ensure that these highly qualified and courageous health professionals are available in the fight against the coronavirus."

Mr. Trinity outlined five governmental actions AAMC is proposing to allow immigrant physicians to participate fully in the battle against COVID-19. The first would be to approve a blanket extension of visa deadlines. The second would be to expedite processing of visa extension applications, including reinstating expedited processing of physicians currently holding H-1B visa status.

The third action proposed by AAMC is to provide flexibility to visa sponsors during the emergency so that an individual whose visa is currently limited to a particular program can provide care at another location or by means of telehealth.

Fourth, AAMC proposes streamlined entry for the 4,200 physicians who are matched into residency programs so that they may begin their residencies on time or early.

Finally, Mr. Trinity said that AAMC is proposing that work authorizations be maintained for the 29,000 physicians who are currently not U.S. citizens and actively participating in the health care workforce.

Jacinta Ma, the Forum's vice president of policy and advocacy, said immigrants are a critical component of the U.S. health care workforce as a whole.

"With immigrants accounting for 17% of health care workers amid the COVID-19 pandemic, it's clear that they are vital to our communities," she said. "Congress and the Trump administration both have an opportunity to advance solutions that protect immigrants, and remove immigration-related barriers for immigrant medical professionals by ensuring that immigrant doctors, nurses, home health care workers, researchers, and others can continue their vital work during this pandemic while being afforded adequate protection from COVID-19."

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