H-1B cap could push 1,600 doctors from U.S.

By Rimin Dutt

Published: Monday, March 15, 2004

At a time when the United States is going through a shortage of health-care professionals, an U.S. immigration policy could force up to 1,600 graduating international physicians to depart by mid-summer.

Graduating foreign medical exchange visitors will not be able to retain legal status to stay in the country following the completion of their medical residency programs in June. These exchange visitors have traditionally had the option of extending their stay in the U.S. by working for a medically underserved region in the U.S.

However, this year, they will not be able to work because there are no more temporary work visas or H-1Bs available. The cap for temporary work permits for the 2003 to 2004 fiscal year, was reached in February 2004.

Fresh slots for H-1B visa will not be available until the start of the new fiscal year in October. The U.S. Citizenship and Immigration Services confirmed that there was no provision yet for physicians whose visa will expire before fresh H-1Bs become available.

As a result, many medically underserved regions in states such as Utah and Wisconsin could lose out on the opportunity to hire these foreign medical doctors.

"That could be quite devastating," said Richard Cooper, director of the Health Policy Institute at the Medical College of Wisconsin. Cooper is an expert on physician shortage in the U.S.

"They are fully trained physicians. They would be very quick to go to Britain, Canada or India, if they cannot stay in the U.S.," said Cooper.

"Britain is aggressively recruiting physicians," he added.

According to Health Resources and Services Administration, there is a shortage of around 20,000 physicians in the United States at the moment.

"The overall national need in the health professions for shortage areas is 15,000 for primary care physicians and 4,000 psychiatrists," said Michael Berry, Bureau of Health Professions, Health Resources and Services Administration.

There are only about 3,800 American clinicians available to fulfill that demand, said Berry.

Cooper estimates there will be a shortage of 168,000 to 200,000 physicians in the U.S. by year 2020.

"This shortage is from states which can afford to hire doctors, but are not getting the supply," he said.

The Educational Commission for Foreign Medical Graduates estimates that 25 percent of physicians in their residency training are international medical graduates.

According to the American Medical Association, in 2002, 4,798 physicians in residency training were on J-1 or J-2 visa.

J-1, or exchange visitors, are generally required by law to return to their home country after the completion of their residency programs in the U.S. They could get a waiver of that requirement if they agreed to work in a medically underserved region in the U.S. for at least three years.

The U.S. Department of Health and Human Services is the agency that grants waivers at the national level. In addition, the Appalachian Regional Commission, Delta Regional Authority and the State Conrad 30 program also grant waivers to J-1 exchange visitors. Under the State Conrad 30 program, a state could give out up to 30 waivers depending upon the shortage it has.

"It's debatable whether the Conrad 30 waivers are exempt from the H-1B cap," said Greg Siskind, immigration lawyer and chairman of the physicians committee of the American Immigration Lawyers Association. "And the national (U.S. Department of Health and Human Services) is highly restrictive in granting waivers."

"The law is ambiguous," added Rita Kushner, a senior attorney with Wolfsdorf Associates LLP. "We don't know if some J-1 doctors are subject to the H-1B cap or not."

Immigration experts believe that the U.S. government should ease their immigration policies for doctors to allow for more doctors into the country. The H-1B cap was brought back to 65,000 this year from 195,000 last year.

"The H-1B cap got hit just five months into the new fiscal year, next year the quota could be over sooner, this problem is going to get worse," said Siskind.

"Our health insurance premiums are rising; which is fueled by the shortage of doctors," said Siskind. "Everybody has a higher price to pay by not having enough physicians."

Cooper thinks that the physician shortage problem can also be tackled by increasing the number of residency programs in the country. At the same time, the U.S. government should ease the immigration policies for doctors who come for their residency training. The cost and the visa barriers are making the U.S. residency program very complicated, added Cooper.