The coronavirus pandemic exposed personnel gaps in the American healthcare system. This article builds on the first piece in the series (Immediate Answers) by looking at longer-term solutions in the continued fight against the coronavirus and better bulwark American healthcare institutions moving forward.
The previous article outlined the impending shortage of doctors and how certain residency and licensing barriers prevent American healthcare institutions from maximizing the talents of foreign-born and foreign-trained healthcare professionals. It also covered what steps states could take to relax those restrictions to fight the shortages during the coronavirus pandemic. This article focuses on how easing restrictions from both the federal government and American states’ can address the brain waste from not engaging foreign-trained professionals. Easing these restrictions could help the country fight COVID-19 and cope with the looming healthcare shortages of the aging American population.
Ease Temporary Visa Restrictions
As evidenced in Part I of this series, the federal government must implement innovative ways to extend status or ease visa restrictions. Immigrant doctors who are in the country on a J-1 or H-1B visa will have to divert their attention from saving lives to ensuring they do not become illegal.
H1-B Visas
Many hospitals employ doctors on an H-1B1 visa1, resulting in significant implications if their visas expire. Obtaining an H-1B is a tedious and competitive process with a cap of only 85,000 H-1Bs issued annually. The visa’s restrictions limit a doctor’s ability to move from one area to another; sponsors are required to list every facility they intend to employ the recipient when they petition for a visa. Restricting doctor movement can have devastating effects, particularly in rural communities where hospital resources are already more strained. For example, if a doctor of one town becomes infected, a doctor of the same specialty residing in the next town over, cannot provide services if that facility does not appear on their H-1B visa. In the face of the pandemic, this restriction created roadblocks, which aggravate the shortage-related strains on the American healthcare system.
J-1 Visas
The J-1 Visa allows immigrants to practice in the U.S. Doctors on the J-1 visa are sponsored by the Educational Commission for Foreign Medical Graduates and have passed the medical examinations required. The J-1 visa’s specifications require immigrant doctors to return to their home country upon the completion of their residency. After two years, they can apply for another visa to immigrate back to the United States. To avoid this, applicants can apply for various waiver programs, including the Conrad 30 Waiver Program, which is available only if they commit to practicing in a federally designated HPSA. While states have some discretion in where physicians are allowed to practice, they are awarded only 30 waivers. This significantly undermines the goal of the program. Similar to the H-1B visa, physicians do not have movement flexibility, and are tied to one location. This constraint will be detrimental to the healthcare system as the pandemic worsens, and communities require more help.
Long-term Reform
While short-term changes will alleviate the scarcity of doctors (as seen during the pandemic), many long-term changes are also required to ensure that the U.S. continues to avert this problem in the future. Visa, residency, and licensing reforms can, for the time being, alleviate many problems states are currently experiencing. However, the shortages exposed by COVID-19 will remain and worsen without more long-term changes.
First, Congress should permanently enact the Conrad 30 Waiver Program by passing the Conrad State 30 Physician Access Reauthorization Act, a bipartisan bill introduced in the House and Senate in 2019. This bill extends the program through the 2021 fiscal year, but both chambers of Congress should consider making it permanent. This measure will guarantee a way for states to recruit more physicians, getting rid of the uncertainty of extending the program every few years.
Second, the Medicare funding cap passed in 1997 limiting the number of residency spots should be revised to increase funding. The Resident Physician Reduction Shortage Act currently pending in the House should pass immediately to increase residency slots by 15,000. The provision setting the cap was written in the Balanced Budget Act of 1997 with the support of the American Medical Association, the Association of American Medical Colleges, and various other influential interest groups. Since Medicare funds a vast portion of resident salaries, the Act fixed the number of slots to 1996 levels. Because of this funding cap, the U.S.—which in 1997 had a surplus of doctors—now has a shortage of doctors. Increasing Medicare-funded residency slots will allow international medical graduates who retain all the credentials to obtain residencies and remain in the country to train and help.
Lastly, state medical boards should implement a credential system to recognize foreign training and residency from comparable educational systems. Fifty percent of states would observe an increase in licenses awarded to doctors if international and U.S. licensure requirements are streamlined. Going further, states should create a task force to examine specific barriers that deter foreign-trained doctors from practicing in the U.S. Doing so will allow states to frame their policies specific to their needs and recruit doctors more efficiently. Minnesota and Massachusetts have already implemented successful task forces and have set policy recommendations to address specific obstacles.
Conclusion
In moments of crisis, the USCIS should redefine physician movement and empower states to address the shortage of doctors in their communities as well as provide maximum flexibility for doctors to provide services to the sick. Additionally, the U.S. should take similar steps as the United Kingdom and automatically grant extensions to visas that are nearing expiration. Granting automatic extensions will preempt the limbo faced by applicants when the USCIS offices closed and ensure applicants’ can focus on helping their communities. With respect to J-1 visa recipients and waiver applicants, the USCIS should automatically grant waivers and extend expiring J-1s. Additionally, states should have a higher allocation of waivers, and restrictions on where a doctor can practice under the waiver program should be eliminated, allowing states to dictate where to place doctors. Finally, the requirement of moving back to one’s home country for two years should be suspended so that immigrant doctors can continue to serve during the Coronavirus pandemic.
There are many ways to address the current shortage of doctors, a few of them outlined above. The need for many of the bills currently suspended in Congress to pass, and for states to engage in efforts to ease restrictions and recruit trained physicians, is now higher than ever. Whether immediate healthcare services for Americans suffering from coronavirus or as a means to facilitate the dissemination of the vaccines, these policy recommendations position the U.S. to speed up the process of overcoming the pandemic and save lives in the process. By mobilizing these workers as latent resources and alleviating the barriers to entry, the U.S. could encourage more immigrants with experience in healthcare to participate in American healthcare institutions. Doing so would bolster treatment, information, and distribution mechanisms across the country and will better prepare the United States for both moments of crisis and the rising quotidian healthcare needs of the citizens.
Photo by Arya Pratama.
Pooja Vora received her bachelors from Temple University in 2011, after which she worked as a paralegal for eight years in various areas of the law; immigration, patent, and tax. Currently, she is a Masters Candidate at Georgetown University, McCourt School of Public Policy where she is pursuing her interest in immigration, education, housing, and racial equity issues. At McCourt, she was a Research Assistant for Eva Rosen, where she was responsible for researching court eviction cases and researching different eviction laws. This past year, she, along with other McCourt colleagues, participated in a sprint led by the U.S. Census Bureau to develop an app aiming to help resettled refugees find services near their place of residence.
Pooja is a founding member and past president of the McCourt Migration and Refugee Policy Initiative whose mission centers around highlighting and promoting evidence-based migration issues. She is also a student representative on the McCourt Diversity and Inclusive Environment Committee, working with staff and faculty members to advocate for and promote a more diverse student body and environment. Ultimately, she hopes to combine her areas of interest and pursue policy issues to advance equity for all children in the K-12 education system.
- H-1B is an employer-based nonimmigrant visa that allows U.S. employers to sponsor workers in specialized occupations. The intent of the visa is to assist U.S. employers in temporarily hiring individuals with a certain skill set that they would otherwise be unable to locate from the U.S. workforce.