The COVID-19 pandemic exposed a problem that has existed for some time in the United States: the country’s healthcare system is increasingly dependent on foreign doctors. However, it is becoming increasingly difficult for these professionals to work and settle in the U.S. The reason? Immigration.
Today, 1 in 4 doctors are foreign. This statistic increases in underserved and more rural areas of the country, where many American doctors do not want to work.
This immigrant workforce is essential to offset a terrible shortage of doctors. The need for more doctors is due, in part, to the growing and aging population of the U.S.; the reluctance of U.S.-born doctors to move to poorer and rural areas; and the lack of interest from U.S.-born doctors in entering primary care, which may be less lucrative and prestigious than other areas of medicine.
But, although they are increasingly sought after, foreign doctors are discouraged by the risky, bureaucratic, and costly immigration process of the country.
Immigration Obstacles
U.S. visas can be categorized into two categories: immigrant and non-immigrant. Non-immigrant visas, such as tourist, student, or exchange visitor visas, prohibit holders from having what is called “intention to immigrate,” meaning they do not plan to use their visas to stay permanently in the U.S.
For immigrant doctors to be licensed to practice in the U.S., they need to complete licensing exams. They also need to obtain clinical experience in the U.S. This can be completed with a student visa, which is relatively easy to obtain.
However, all immigrant doctors – even if they are board-certified specialists in their home country – need to be accepted and complete a residency program in the U.S. to practice as specialists. These are intensive, supervised training programs that can last up to seven years.
The majority of immigrant doctors in the U.S. complete their American residencies on non-immigrant visas, although at this point in the process they clearly have the intention to immigrate.
It hasn’t always been this way.
There is a special work visa called H-1B. A few decades ago, many immigrant doctors entered residency programs that sponsored H-1B visas, which served as stepping stones to green cards.
But drastic restrictions on the number of people admitted to this visa program have directed most foreign doctors to what is called the J-1 exchange visa.
The J-1 not only explicitly prohibits the intention to immigrate, but also requires doctors to return to their home country for at least two years after completing their American residency training.
Doctors born abroad, however, seek the J-1 because there is an opportunity to obtain a waiver. If selected for the waiver program, they must commit to a minimum of three years of service in a designated medically underserved area in the U.S.
Although this system may provide short-term relief to the doctor shortage, it can also lead to exploitation.
During the duration of the waiver program, immigrant doctors have minimal ability to change employers without violating the waiver conditions. Underserved areas often have a lack of staff and resources, which can create stressful working conditions.
High Cost
The challenges do not end with the visa process. There are also financial burdens.
International medical graduates often spend tens of thousands of dollars to pay for medical licensing exams in the U.S., various visa applications, international travel and accommodations, residency applications, and green cards.
They also spend months in unpaid positions in hospital settings to gain the necessary clinical experience in the U.S. to apply for residency. Then, to fit into residency, immigrant doctors often need to outperform their American peers on exams. They also need more prestigious research qualifications and stronger letters of recommendation.
Ultimately, a paradox arises: while the U.S. claims it wants to attract and retain world-class talent in the medical field, its Byzantine immigration system continually discourages potential hires.
Source: original text on The Conversation