March 21, 2017

Rural health systems could face physician shortages after visa change

Daily Briefing

    An upcoming change in how the United States Citizenship and Immigration Services (USCIS) processes temporary visas for skilled workers could mean provider shortages in rural areas that depend on a "steady flow of doctors from around the world," Miriam Jordan reports for the New York Times.

    In most rural areas, as well as some cities, the proportion of doctors who are foreign born far exceeds the nationwide rate of about 25 percent, Jordan reports. According to the Educational Commission for Foreign Medical Graduates, there were 211,460 international medical graduates practicing in the United States in December 2015.

    What's changing

    USCIS recently announced that beginning April 3, it will temporarily halt a "premium processing" option that allows employers to pay a $1,225 fee to expedite H-1B visas for skilled workers. By paying the fee, employers can have the months-long process completed in as quickly as two weeks, Jordan reports.

    A spokesperson for USCIC said the halt is needed to "work down the existing backlogs due to the high volume of incoming petitions." Individuals can still apply for an expedited review if they can demonstrate an emergency or humanitarian need, according to government officials. Nonetheless, immigration lawyers have said it is extremely difficult to meet that standard and doubt that the agency could handle the influx of emergency requests.

    What it means for providers

    According to Jordan, the change could affect an existing program, called the Conrad 30 program, that aims to address doctor shortages by allowing foreign doctors who complete their residency in United States to stay in the country with H1-B status—rather than have to first return home for two years—if they practice in an underserved area. Such doctors can apply for a green card for permanent residency after three years.

    The visa change could also affect about 400 foreign medical students who come to the United States each year for residencies, Jordan writes. Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, said, "Everyone around the country will be in a mad scramble to figure out this visa situation."

    Educational Commission for Foreign Medical Graduates (ECFMG) Assistant VP Elizabeth Ingraham said  the H-1B and J-1 visa are the two most common visa classifications used by foreign national physicians who wish to enter U.S. residency training.

    Snapshot in rural America

    Health systems are "adjusting to the possibility of being with some doctors for a while," Jordan writes.

    For instance, at Benefis Health System in Great Falls, Montana, 60 percent of the doctors who specialize in hospital care are foreign doctors on work visas. The system provides care to about 230,000 patients across 15 counties. Now, the system is unsure when a transplant doctor from Romania, who is completing a fellowship at the University of Minnesota, will be able to join the system.

    Erica Martin, a recruiter for Benefis Health System, said the system "already has nine months invested" in the doctor, Silviana Marineci. "And now we have no idea when she can start," Martin said. And the system is in the midst of recruiting other foreign physicians, who now face the same situation as Marineci. Without those doctors, Martin said Benefis would have to give additional shifts to other doctors or hire temporary physicians, which can be costly and can present challenges for continuity of care

    Marineci described the situation as "insane." She said, "I won't have an income, I don't know if I will [be able to] afford rent, I don't know where I will be."

    Separately, Rom Satchi, a Canadian who completed his residency at the University of Illinois College of Medicine and recently signed a contract to work with Mama Mia Pediatrics in an underserved area of Las Vegas, said he is uncertain whether he'll be able to get his visa in time for his anticipated start date in June. Satchi plans to return to Canada to wait until the visa is approved.

    "At this point, I have no voice," Satchi said. "I can't do anything."

    Sens. call on administration to maintain premium processing

    Sens. Heidi Heitkamp (D-N.D.) and Amy Klobuchar (D-Minn.) in a letter to the head of USCIS asked that doctors participating in the Conrad 30 program be exempted from the visa processing rule change.

    "The Conrad 30 program has helped address chronic physician shortages in rural America and other underserved areas for over two decades," the senators wrote. "We understand USCIS is facing a backlog, but USCIS has addressed this problem in the past without suspending premium processing for Conrad 30 doctors" (Jordan, New York Times, 3/18; Heikamp release, 3/13).

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