Help international medical graduates Help us

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In the United States, immigration and administrative barriers impede a valuable supply of healthcare workers.

The United States needs more healthcare workers.

The American Medical Association (AMA) estimates that the shortage of doctors could reach 139,000 by 2033. And a recent study shows that the shortage of nurses could reach 510,394 by 2030. Although no single factor To explain this shortage, experts have pointed to the aging US population and its growing health care needs, the high cost of medical training, rising levels of burnout, and problems with funding interns in medicine.

International medical graduates (IMGs) are part of the answer to the shortage of healthcare workers in the United States.

IMGs have supported the American healthcare system for decades. These are physicians who earned their medical degrees overseas and came to the United States to complete their training or to permanently join the American health care workforce.

The AMA reports that IMGs currently make up 25% of licensed physicians in the United States. This proportion has increased by nearly 18% over the past decade. A disproportionate number of IMGs work in internal medicine and geriatric medicine, two understaffed specialties.

Despite their importance to the US healthcare system, IMGs face a heavy administrative burden to qualify to practice medicine in the United States.

All IMGs must complete an accredited residency program in the United States or Canada, regardless of their foreign education. Physicians who wish to enroll in a training program must be certified by the Educational Commission for Foreign Medical Graduates, a private, nonprofit organization authorized to certify IMGs. The certification process takes an average of three years, during which time candidates must prove their medical credentials and must pass two stages of the United States medical licensing exam.

IMGs who are not US citizens or permanent residents must also obtain a visa. Many IMGs apply for a J-1 visa, a temporary visa available to applicants participating in work or study exchange programs. The J-1 visa, however, only allows IMGs to stay in the United States for a maximum of seven years unless there is a documented need for an extension, after which they must return to their home country for at least less than two years. .

Under Section 214 of the Immigration and Nationality Act, this return requirement can be waived for up to 30 IMGs per state each year. This waiver, called the Conrad 30 waiver program, is available to IMGs who commit to working full-time for at least three years in a healthcare facility located in disadvantaged, often rural, areas.

Some IMGs apply for an H-1B visa, which is a nonimmigrant visa for skilled workers. To begin the H-1B visa process, the IMG employer must register with the Department of Homeland Security (DHS).

But H-1B visas are far from guaranteed. The application process is very competitive as the federal government receives far more applications than it is authorized to grant. When the number of applications exceeds the cap, DHS randomly selects petitions filed during the first five days of the registration period in a process called the “H-1B lottery.”

In 2020, DHS issued an interim final rule that endangered the H-1B lottery system. Instead of randomly selecting applicants, the interim final rule would allow DHS to rank and select applicants with the highest salaries.

Experts have argued against the rule, arguing that it would have the greatest impact on IMGs who serve patients who need it most, such as those in low-income and under-resourced communities. Last fall, a federal court struck down the rule, finding that DHS failed to comply with the requirements of the Administrative Procedure Act when it issued the interim final rule because it failed to comply with the appropriate notice and comment period.

Although the court struck down the DHS rule, under the lottery system, the agency continues to deny many H-1B applications.

In addition to residency and certification requirements, IMGs must also obtain a medical license from the state or states in which they intend to work. State licensing requirements for IMGs are intended to mirror requirements for national graduates, but the requirements are not uniform. However, all states require at least one year of training in an accredited program in the United States or Canada.

Once IMGs are allowed to enter and work in the United States, they often face personal and institutional challenges. In a recent study, researchers explain that IMGs have difficulty adapting to both residence and American culture. They also found that IMGs face discrimination and are often undervalued by their peers. For example, one respondent in their study explained how some residents implied that IMGs were not as competent as American trainees.

Some experts say the problem with the US healthcare system is not a lack of doctors, but a lack of administrative support and underutilization of non-physician healthcare workers such as nurses, nurse practitioners and physician assistants. . Structural changes to the U.S. healthcare system may reduce the workload of healthcare professionals and improve patient care, but these changes will not alleviate the emotional and administrative burden that IMGs currently face, or remove the need of DIM in the United States.

IMGs are here to stay, and they can provide much-needed health care services in many parts of the United States. So what can we do to help them help us?

One way to help IMGs enter the United States is to modify the Conrad 30 waiver program. In 2019, U.S. Senator Amy Klobuchar (D-Minn.) introduced a bill to raise the cap on waivers Conrad 30 from 30 to 35 visas per state per year. And over the past two years, Congress has considered two other bills that claw back unused employment-based visas to increase the number of foreign-trained doctors and nurses available to work during the pandemic. All of these bills have not yet passed the committee stage.

Legislative action is part, but not all, of the support that IMGs need. To reduce the burden of IMGs, policymakers and health care administrators should work to expedite the immigration process, simplify state licensing requirements, and change policies and the discriminatory culture of the American healthcare system.

After relying on their expertise for so long, America should recognize, value and support IMGs.

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