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Physician Immigration in the Age of Trump

Twenty-five percent of all physicians in the United States are foreign-born.  That’s right, more than a quarter.  Additionally, 16% of all healthcare professionals are born abroad.

Foreign healthcare professionals are actually a good thing.  Why is it good that over a quarter of doctors employed in the United States aren’t born in the US?  The answer to that question is very straightforward.  A simple statistic can answer it.

According to the Association of American Medical Colleges and a report prepared by IHS, due to a rising demand for physicians, there is “a projected shortfall between 46,100 and 90,400 physicians by 2025.”

As baby-boomers get older, more and more healthcare professionals are required to keep up with the increasing demand for healthcare services.  Similarly, doctors who are part of the baby-boomer generation are getting ready to retire.  More people needing healthcare combined with a large number of healthcare professionals retiring might be one of the worst situations imaginable.

Unfortunately, you can’t just turn to med school students in the US and expect them to fill that gap.  There’s simply not enough American-born healthcare professionals to alleviate the growing shortage.  Additionally, American healthcare professionals tend to avoid underserved regions.  That’s where foreign-born healthcare professionals come into play.

Foreign doctors, nurses, and other healthcare professionals are one of the main ways to alleviate the shortage of healthcare workers in the United States.  Moreso, these highly-educated immigrant healthcare workers are often sent to the most underserved regions of the United States.  These underserved areas lack adequate healthcare.

Foreign physicians, to come to the United States to practice, usually obtain a J-1 visa.  The J-1 visa is just one of many visas available to healthcare professionals.  Another visa available to skilled workers abroad hoping to come to the US to work in healthcare is the H-1B visa.  However, most highly-skilled immigrant healthcare workers opt to first apply for the J-1 visa.  Why?  It all has to do with the way in which the United States structures its visas.

The J-1 visa is a temporary, nonimmigrant visa status which is specifically utilized to empower foreign physicians to engage in residency and clinical fellowships in the United States.  The length of time that a J-1 visa remains valid depends on the duration of the program that an immigrant is accepted.  Once that program concludes, physicians and other healthcare workers are required to return to their home country for two years.  However, healthcare professionals can get out of this requirement via one of two ways.

The first is through a direct sponsorship from an employer.  The second is a self-sponsorship.  The first method is typically the preferred path and the one that’s most effective.  The visa holder backed by their employer will apply for a medical labor certification. If the visa-holder is not required to return to their home country, they can then apply for an H-1B visa or green card.


Additional Information on the H-1B Visa

The main reason healthcare professionals aren’t required to return home is because they are needed in regions of the United States that have a shortage of doctors, nurses, or other healthcare workers.  These areas include Appalachia, the Rust Belt, and the Deep-South.

Foreign-born healthcare professionals are actively reducing the shortage and aiding some of the most impoverished and underserved parts of the United States.  Unfortunately, this might not be the case for long.

The Trump Administration has shown it’s going to keep its word on immigration reform.  This immigration reform is proving to generate a lot of uncertainty and worry among foreign workers, including healthcare professionals.

Throughout his campaign, President Trump promised harsh immigration reform.  From building a wall on the US-Mexico border to banning Muslims from entering the United States, now President Trump based much of his campaign around immigration.  He promised to put “America first.”

Of course, many of those who opposed Trump, especially other politicians, never expected President Trump to follow up on those campaign promises.

That turned out not to be the case, and President Trump has already proved to be strict on immigration.  Already, President Trump has attempted to sign into law two travel bans.  Additionally, he’s halted the screening of expedited H-1B visas and has stated multiple times that he wants to do more to the H-1B visa program.

This is where foreign-born healthcare professionals seeking visas and even those already holding a visa are at risk.

Though the Trump Administration has spared the J-1 visa, the H-1B visa certainly hasn’t been spared.  Moreso, President Trump’s travel bans have shown just how much of an impact the President’s immigration reform could have on foreign healthcare professionals.

When the first travel ban was signed into order, it included visa and green card holders.  Healthcare professionals that were visiting family abroad in one of the seven countries listed in the executive order weren’t allowed to return to the United States.  Even if a doctor who is a resident of say Iran was in the country when the executive order was signed, they could potentially have their visa revoked.  Both travel bans were quickly deemed unconstitutional and suspended.  However, President Trump said that he would continue to pursue harsh immigration reform and has yet to rule out any new travel bans.

The biggest issue facing foreign healthcare workers is the H-1B visa restrictions.  President Trump has been a vocal opponent of the H-1B visa program.  There’s concern over whether not foreign companies and workers abuse the H-1B visa program.  The H-1B visa program has also been linked to increased outsourcing.  However, most H-1B holders aren’t misusing their visas and are just looking for a career in the United States.  Of course, that’s not how the President and the Administration see it.

Already, the processing of expedited H-1B visas has been suspended. Processing of an expedited H-1B visa will usually take a week or two.  Non-expedited H-1B visas will typically take months to process.  This creates a problem for doctors and nurses that are looking to apply for the H-1B visa.

Let’s say for example, that a physician’s residency in the United States is coming to an end.  He or she can apply for an H-1B visa to avoid having to spend two years in their home country.  However, because foreign nationals are no longer allowed to expedite the popular H-1B visa, that doctor would have to wait months for their application to be processed.  This could result in the doctor returning home or being unable to find a permanent job in the United States.

Of course, there’s still a lot of uncertainty surrounding how the Trump Administration will handle immigration.  However, one thing is for sure, and that is that President Trump isn’t afraid to carry out harsh reform.  The President’s attitude towards immigration could very well impact highly-skilled workers who are in the United States legally.  This could include doctors.  Both the President’s travel bans and new H-1B visa restrictions prove that healthcare professionals won’t be spared by the new administration.

If physicians that come from abroad are included in a future executive order regarding immigration, the shortage of doctors will only increase.  One way in which underserved areas of the United States have been able to make up for this shortage is by hiring foreign doctors.  Interestingly, most underserved areas in the United States are blue collar regions that voted for President Trump.  What had not been made clear to voters in underserved areas is that when Trump promised to put America First, their health care was at stake.

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