“Where are you headed for vacation, Mo?” I asked my senior resident. Mo, short for Mohammed, arrived in the U.S. three years ago as a medical resident on a J-1 visa. He had already completed a lengthy residency in his home country of Saudi Arabia, which was obvious in his superior knowledge base and intuition in taking care of patients. He looked up from his computer as he finished up his last note for the day and said, “I just had to call home and let them know I wouldn’t be home this year.”
Mo, along with thousands of other foreign trained doctors, are in fear of losing their jobs and their place in this country as a result of President Trump’s travel ban and immigration policies. But they aren’t the only one’s that will be losing amidst the changes being implemented by our new presidential administration. The American public, particularly the designated medically underserved, rural regions of America, will suffer the most by the lost physician workforce.
Foreign trained doctors make up a quarter of the healthcare force in the US.1 By 2030, the shortfall of U.S. physicians will range between 40,800 and 104,900 physicians, with rural America being hit the hardest by the shortage.2 Foreign-trained doctors that immigrate to the U.S. have helped us fill the critical gap in healthcare. The majority of these immigrants will arrive on a J-1 visa, which requires them to undergo further training in addition to what they have already received in their home countries, and enter for residencies in high-demand areas and specialties. Upon completion of their residency, graduates must return to their home country for a minimum of 2 years before applying for re-entry in the U.S.- unless they obtain a waiver. The Conrad 30 visa waiver allows them to stay in the U.S. if they agree to work in a health professional shortage area, medically underserved areas, or medically underserved population, as designated by the U.S. Department of Health and Human Services.
While many U.S. medical students and physicians have raised the question about whether or not it is fair that internationally trained physicians are able to compete for the same residency spots, foreign doctors are filling the gaps in rural health care that many U.S. medical students do not want to fill. Despite being a rising physician myself, worried about the prospects of landing a residency spot in the now highly competitive atmosphere, I see the facts. International physicians are more likely to pursue general medicine residencies, whereas only 28% of U.S. graduates will pursue internal medicine, pediatrics, or family medicine.3 They are more likely to practice in rural and inner-city areas where the shortage of doctors is greatest.
Furthermore, some might express their skepticism over the quality of the health care delivered by foreign-trained physicians. In fact, the American Council on Graduate Medical Education has endorsed this idea by requiring foreign medical graduates to repeat their residency training upon arriving in the U.S. However, a recent study published by the Harvard T. Chan School of Public Health found that there was no difference in Medicare beneficiary outcomes between those treated by international medical graduates when compared to US medical graduates.4 In fact, patients treated by international medical graduates had a lower 30 day mortality rate. Foreign medical graduates must take an arduous path to be able to practice in the U.S., including prolonged residency training. Thus, we can be reassured of the high quality care being delivered by foreign-trained physicians.
It is time that we embrace immigrant physicians rather than continuing to make it more difficult for them to pursue the American dream. President Trump’s changes to immigration regulations has threatened the job security and safety of thousands of doctors in America, and has threatened the health care for the American people. The expedited “premium processing” of H1-B visa for highly skilled workers, has been temporarily suspended as of April 3rd.5 This leaves over 1,500 foreign medical residents who have obtained a waiver to remain in the U.S. after they graduate from their residency programs, in limbo. Their employers are required to apply for H1-B visas on their behalf, but if this did not occur prior to the suspension, their visa processing application could take several months- leaving them uncertain about whether or not they will have obtained their documents in time to start their jobs.
The U.S. Citizenship and and Immigration Services stated they would review requests for expedited visas on a case-by-case basis, but this will be typically reserved for emergencies, on humanitarian grounds, or for employment that is in national interest.6 Recruiting and maintaining trained health professionals is in our national interest.
The irony is many U.S. physicians aspire to work internationally to tackle issues of access to healthcare, while America has an array of healthcare challenges to confront. The visa programs we have in place for foreign trained health professionals have recruited more doctors to medically underserved areas of the U.S. than the National Health Service Corps, yet we continue to create more barriers for physicians who are wanting to help us fight our own issues of access. Regardless of the fate of the Affordable Care Act, the fate of healthcare in the U.S. depends on a large workforce of devoted physicians. Our healthcare system has been carried by foreign-born doctors, and to take them away would mean to take healthcare away from the people who need it the most.
Swetha Iruku is a third year medical student at Tufts University School of Medicine (Boston, MA). She can be reached at email@example.com
3 Hohn, M. D., Witte, J. C., Lowry, J. P., & Fernández-Peña, J. R. (2016). Immigrants in Health Care: Keeping Americans Healthy Through Care and Innovation. The Immigrant Learning Center, Inc., & The Institute for Immigration Research. Washington, DC. Available at: http://iir.gmu.edu/research/special-
4 Tsugawa Yusuke, Jena Anupam B, Orav E John, Jha Ashish K. Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study BMJ 2017; 356 :j273
5 USCIS Will Temporarily Suspend Premium Processing for All H-1B Petitions <https://www.uscis.gov/news/alerts/uscis-will-temporarily-suspend-premium-processing-all-h-1b-petitions>
6 USCIS Requests to Expedite Applications of Petitions <https://www.uscis.gov/policymanual/HTML/PolicyManual-Volume1-PartA-Chapter12.html>