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Viewpoint: The Doctor is Out. Are Immigration Laws to Blame?

By Andrea Godfread-Brown

Date:

Andrea Godfread-Brown
Andrea Godfread-Brown

The United States health-care system is struggling with an acute shortage of doctors. What does that have to do with immigration? The short answer is: Quite a lot. 

The longer answer leads us to an inescapable conclusion: Our policies at the U.S. border are failing us. They are putting obstacles in the way of bring highly skilled and trained physicians from other countries to address the shortage we face here. A large part of my practice is representing hospitals, medical centers, and physician-practice groups on physician immigration issues. I’ve put together a list of frequently asked questions to explain the issues.

How severe is the shortage?

The Association of American Medical Colleges (AAMC) — in its report: “The Complexities of Physician Supply and Demand: projections from 2016-2030” — estimates that we’ll face an unprecedented shortage of up to 120,000 physicians by 2030. The largest gap, of between 33,800 and 72,700 physicians, will be for non-primary care specialties. The AAMC also estimates a shortage of between 14,800 and 49,300 primary care physicians. 

Much of the demand for health-care services comes from a growing, aging population. “We must start training more doctors now to meet the needs of our patients in the future,” said Dr. Darrell G. Kirch, president of the AAMC (https://news.aamc.org/press-releases/article/workforce_report_shortage_04112018). 

This shortage will be felt most deeply in rural and medically underserved communities that already struggle to get access to adequate health care. According to a recent report by the American Immigration Council (https://www.americanimmigrationcouncil.org/research/foreign-trained-doctors-are-critical-serving-many-us-communities) , more than 247,000 doctors with medical degrees from foreign countries practice in the United States. This report highlights “the critical role foreign-trained doctors play regionally, in underserved communities, in rural areas, and in providing primary health care.”

Why do foreign-trained doctors focus on disadvantaged areas?

Due to certain visa requirements and restrictions, international medical graduates (IMGs) often must practice in underserved communities for a certain period of time before they are allowed to stay and work in a purely “work visa” status or to be able to get a green card. An IMG who entered in a J-1 visa status is subject to the two-year home residency requirement, which must be met or forgiven through a waiver. One very popular and successful program is the Conrad State 30 program which allows J-1 medical doctors to apply for a waiver of the two-year home residency requirement by agreeing to be employed in a medically underserved area (MUA) or health professional shortage area (HPSA) for at least three years. 

That sounds like a good solution. What’s the problem?

It’s all in the numbers. The Conrad 30 program is administered by each state’s health department and allows a limit of 30 waiver slots per state each year to qualified IMGs. This is just not enough in high-demand states such as New York, where the demand for a Conrad waiver is more than double the allotted 30 waiver spots. Those who are here are filling a critical need, but there’s more to be done.

The larger problem is that we have outdated and insufficient immigration laws to address the increasing shortage. An IMG has come to the United States, (often with spouse and children), completed residency training in a specific state or area, and started to build a life for himself/herself. The IMG receives no promise to be able to stay or work or provide a life for his/her family. If an IMG cannot get a waiver he/she cannot get work authorization in the U.S. and must return to his/her home country.

Think about this: IMGs have moved far from home, often with dependent family members, invested significant time and money to get additional training beyond what was required at home, and yet live under the uncertainty that they may not be able to continue to practice. Against that uncertainty, we are now seeing a decline in the number of foreign-trained physicians interested in practicing here. So our policies are not serving the country’s need for more doctors, nor capitalizing on the commitment and expertise of these professionals. 

Consider the type of situation described in this recent profile done by Public Radio International about the highly skilled medical doctor, Dr. Consuelo Lopez de Padilla, with 15 years of practice under her belt in her home country of Venezuela, who must now complete another medical residency training in the United States but can’t match into a program. You can read full article here: https://www.pri.org/stories/2018-03-26/highly-trained-and-educated-some-foreign-born-doctors-still-can-t-practice

How else are immigration laws and policies failing us?

The demand for foreign-trained doctors will only increase as the U.S. population ages and faces an increasing need for affordable health care in this country. This will happen sooner rather than later. The Association of American Medical Colleges (AAMC) found that the demand for doctors will continue to outpace supply, leading to a projected shortfall of between 46,100 and 90,400 doctors by 2025, many in primary care, accelerating through 2030 These shortages are compounded by the fact that large numbers of doctors will be retiring in the next few years.

Yet U.S. immigration policies significantly limit the ability of these doctors to immigrate to and practice in the U.S. As policymakers debate what immigration reforms would best serve the national interest, they should keep in mind that foreign-trained doctors are already taking the lead on providing care to many communities across the U.S.

How can immigration laws be changed to help with the doctor shortage?

As a part of the multi-pronged approach recommended in its report, the AAMC supports federal incentives and programs such as the Conrad 30 Waiver. 

Congress is considering proposed legislation (S. 948) to renew and improve the Conrad 30 Program, but frankly even that falls short. We need a more flexible Conrad 30 Program that is responsive to the demand and community needs for health care nationwide, so if one state doesn’t use its 30 waiver slots, they can be transferred to high-demand states such as New York, and California. Neither current law nor existing proposals include that provision.

Other U.S. immigration laws are also creating barriers to many IMGs from countries such as India, where the green card backlog means that they can face a 10- 15 year wait before they can even apply for their green card. This puts them in a holding pattern and a work visa/ temporary status limbo in the U.S., even as they continue to serve our neediest communities and help solve our physician-shortage problems. 

The need for high-quality health care in the U.S. have been well-documented. Congress must act, and in this case, it should be lowering the wall to enable physicians to enter and deliver their services.                 

Andrea Godfread-Brown is senior immigration counsel in the Syracuse offices of Harris Beach PLLC . Contact her at agbrown@harribeach.com