Originally published by VOX
The Trump administration has agreed to clear the way for foreign doctors to make a larger contribution to America’s coronavirus response, waiving restrictions that prevented foreign doctors assigned to rural areas from administering medical care and providing telehealth services outside their approved locations, according to Sen. Amy Klobuchar (D-MN). Wednesday’s policy change will allow up to 1,500 foreign doctors to practice in crisis areas.
Foreign doctors have long faced barriers to practicing in the US. Despite being willing to contribute to the country’s coronavirus response, many have been unable to do so, either because they have been shut out of American residency programs or because the immigration system stands in their way.
Physicians in the Conrad 30 program, which is designed to encourage foreign doctors to practice in underserved areas, can now go where they are needed without jeopardizing their visas or green cards. Klobuchar, along with a team of bipartisan lawmakers, had requested in April that the Trump administration lift restrictions on where Conrad 30 doctors can practice in order to bolster hospital staffing in areas hard-hit by the coronavirus.
“Doctors need to be able to act now to use their knowledge and training to save lives without fear of the loss of their immigration status,” the lawmakers wrote at the time.
US Citizenship and Immigration Services did not immediately respond to requests for comment on the policy change Wednesday.
Hospitals across the country are facing staffing shortages. New York City has asked former medical workers to come out of retirement to deal with the increased patient load. So has the Veterans Affairs medical system, which already has about 44,000 medical vacancies that it has been struggling to fill amid a competitive market. Washington, DC, has even been recruiting volunteers without any medical training.
Despite these shortages, some for-profit hospitals have nonetheless been forced to lay off health care providers because they’re facing rising costs associated with treating coronavirus patients, including purchasing expensive equipment such as ventilators and additional personal protective equipment for staff, as well as a decline in revenue due in part to bans on elective procedures.
The US was projected to face a shortage of doctors even before the pandemic hit: The Association of American Medical Colleges had estimated that it could reach 46,900 to 121,900 physicians by 2032. And in rural areas, particularly in states such as Mississippi and Arkansas, doctors were already in short supply. The US health system relies heavily on immigrants, who make up 17 percent of all health care workers and more than one in four doctors.
The US immigration system had long presented a barrier to foreign doctors
Every year, roughly 4,000 foreign doctors come to the US on J-1 visas for residencies at teaching hospitals, which rely on Medicare funding to pay their salaries. While most of those doctors would like to stay in the country after they complete their training, only about 1,500 of them are ultimately able to do so.
That’s because they are required to return to their home countries for at least two years upon completing their training in order to be eligible for an H-1B skilled worker visa or a green card, unless they can obtain one of a few sought-after waivers.
The Conrad 30 program offers waivers to 30 doctors in every state who agree to practice where the government has designated a health care worker shortage, primarily in rural areas. Sen. Klobuchar has been pushing for legislation that would expand the program since at least 2013. That bill, which has been endorsed by the American Medical Association, would allow more than 30 waivers to be granted to physicians in a given state depending on need.
Doctors can also obtain waivers through the Department of Health and Human Services by conducting medical research in a field that is of interest to the agency, or by practicing in underserved areas designated by the agency.
But even for those who are able to obtain waivers, the process of applying for a green card can involve long waits, particularly for immigrants from India, which produces about one-third of all foreign doctors training in the US. There are per-country caps on the number of green cards issued annually, and India gets the same number of green cards as any other country, despite being one of the most populous nations in the world. (A bill that would have eliminated these country caps recently failed in the Senate.)
Not only does the current system make it exceedingly difficult for doctors to stay in the US long term, but it also severely restricts where they can go in the country. Under the terms of both J-1 and H-1B visas, doctors can’t just change jobs. They usually can’t even moonlight at another hospital and take on extra hours.
Those in the Conrad 30 program now have some more freedom — but they still represent only a fraction of the foreign doctors currently in the US on these visas. At a time when doctors need flexibility to go to areas of the country hit hard by the coronavirus, these restrictions are a huge obstacle.