COMMENTARY

New Visa Rule Will Harm Docs, Risk Lives During Pandemic

William W. Pinsky, MD

November 12, 2020

A seemingly innocuous rule change to nonimmigrant visas proposed by US Immigration and Customs Enforcement (ICE) will significantly and negatively impact healthcare delivery during the worsening pandemic. The current administration must reconsider this rule change so as not to further impair our country's healthcare response. Should it choose to move forward with the change, the incoming administration must then immediately take action to strike it down.

The proposed rule would terminate "duration of status," thereby eliminating an authorized period of stay. It would establish a specific end date for exchange visitors and other visa categories (J, F, and I classifications). This change would require foreign national physicians who are currently in the United States on J-1 visas to apply for an extension of visa status every year. Based on the US Citizenship and Immigration Services' published visa processing times, under normal circumstances, this could very well lead to thousands of physicians becoming unable to continue their medical training.

Patient care at hundreds of teaching hospitals across the United States is provided by more than 12,000 foreign national residents and fellows who participate in the US Department of State's Exchange Visitor Program on J-1 visas. These trainees are essential to a teaching hospital's ability to provide continuity of care under normal circumstances. The role they play during the COVID-19 pandemic is even more critical to our nation's health. Seven of the country's leading organizations in medical education and healthcare have raised serious concerns about how this proposed rule change will affect those trainees currently aiding in our pandemic response and the patients they serve.

As physicians, we must oppose any changes to policy that threaten direct harm to those in our care. The patients most impacted will be those in underserved and rural areas, as well as those living in critical access points in large cities. Even medical trainees who are not directly impacted by the rule change would still have their education and training negatively impacted; a significant burden of clinical responsibilities would shift to them as a result of losing their peers who are on J-1 visas.

The intent of the proposed rule change is clear. ICE claims the move will create greater clarity in terms of how long these visa holders may lawfully remain in the United States and reduce overstay rates for nonimmigrant visa holders. However, physicians on J-1 visas are already a closely monitored group. 

As J-1 physicians progress through training, they are required to apply annually to the Educational Commission for Foreign Medical Graduates (ECFMG) in order to extend their visa sponsorship. The process ensures that each physician is progressing in training and is meeting the required milestones. Through that review and direct reporting to the Student and Exchange Visitor Information System (SEVIS), a US government database, the ECFMG already guarantees both oversight and monitoring of all J-1 physicians in the United States.

Nothing of substance will be gained by the proposed rule change, but losses are guaranteed, as physicians in training and their patients face undo harm. The proposed rule change will create immediate chaos for teaching hospitals and limit our national response to the pandemic. During these challenging times, policymakers must consider the unintended consequences of their actions, especially when lives are at stake.

The comment period for this policy change has now closed. More than 32,000 individuals, institutions, and organizations responded. Many of these stakeholders share our concern that these new restrictions will cause major and unnecessary disruption to the training of these physicians and the patient care they provide.

We appeal to ICE, the Department of State, our nation's current lawmakers, and President-Elect Biden to consider the devastating consequences of this proposed rule change before it is too late. Although the public comment period is closed, physicians, residency program directors, and healthcare advocates can still play an important role by appealing to legislators. In the interest of our nation's already overburdened healthcare system, and the lives of the patients we serve, we ask that the current "duration of status" provision be maintained.

William W. Pinsky, MD, is president and chief executive officer of Educational Commission for Foreign Medical Graduates|Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) in Philadelphia, Pennsylvania. He can be reached at president@ECFMG.org. 

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