Immigration barriers prevent solution to healthcare staffing shortages

Currently, one in five physicians in the U.S. is an immigrant, with certain specialties, such as geriatrics and nephrology, having over 50% of their practitioners trained abroad. However, despite the clear need for these professionals, regulators have failed to streamline immigration processes, making it difficult for qualified foreign physicians to remain and work in the country.

"In light of figures that make it imperative that we do something to help improve our current physician shortages, we can't seem to get our immigration bus in order to be able to drive it down the road and really make a difference," she said.

Barriers include a requirement under the J-1 visa for medical students that they must return to their home country for two years after completing their residency. Many times hospitals want to hold onto these physicians after they complete residency but they are unable to under current policy. If these doctors they are married, spouses usually cannot get authorization to work in the U.S., making permanent relocation untenable.

Established physicians who want to immigrate to the U.S. are limited by quotas on how many can enter each year, leaving many waiting. These barriers were put in place historically to limit immigration. But now that more doctors are needed to help address staffing shortfalls, Congress seems paralyzed to act, especially in such a divisive political climate. Walker said illegal immigration over the southern border has fueled much of the campaign rhetoric on the Republican side, and had been a main talking point in all three of Trump's presidential campaigns, making it difficult for wither party to change policies.

"I think immigration has a problem of having paralysis. Part of that particular problem is due to the politicization of the immigration topic. When we're talking about immigration right now, we're talking about how immigration solves problems. Immigration helps us in our national interest by providing critical healthcare, and I do not want to discount the legitimate concerns we have of illegal immigration, but when we allow illegal immigration to basically throttle a solution that helps the rest of us in the United States, then we're just not making sense. We're not assessing the facts, and we're basically removing a solution that could provide critical to healthcare," concerns Walker explained. 

Proposed legislation could help

Walker highlighted two significant bills that could help address these issues. The first is the Conrad State 30 and Physician Access Reauthorization Act (Senate bill S.665, H.R.4942) seeks to reauthorize and improve the Conrad 30 waiver program. This program allows foreign physicians to work in medically underserved areas in exchange for a waiver of the requirement to return to their home country for two years after completing their residency on a J-1 visa. 

The second is the Healthcare Workforce Resilience Act (H.R.6205), which would recapture unused immigrant visas to allow 15,000 foreign physicians and nursed to obtain permanent U.S. residency.

However, these legislative solutions face significant challenges in Congress, where immigration issues are often politicized and difficult to advance, especially during election years.

Walker advocates for a more coordinated national approach to physician immigration, emphasizing that the current system is failing to meet the urgent healthcare needs of Americans. She said is healthcare systems, medical societies, physicians, nurses and patients want to see a positive change in the staffing crisis, they should contact their Congressmen to advocate for passage of these and other healthcare worker immigration reform measures.

"Wouldn't it be nice if there was an acceptable standard so that it would be more predictable?" she asks, pointing to the potential benefits of simplifying the process for physicians who are willing and able to serve in critical areas.

The medical licensing conundrum for immigrating doctors

Another barrier is that foreign medical degrees are often not recognized in the U.S. as equivalent to a MD or DO, so they have to go back to U.S. medical schools to go through physician training programs a second time.

Walker said this means addresses the complexities of state licensing for foreign-trained physicians is also needed to make it easier for them to come to the U.S. She said many international medical graduates face the daunting prospect of having to requalify for licensure., even if they are already licensed and practicing medicine in their home countries. While some states are taking steps to streamline this process, a lack of national standards exacerbates the problem, making it harder to deploy physicians where they are most needed, particularly in rural and underserved areas.

Indeed, the areas facing the largest shortfalls are places like rural Appalachia and rural Mississippi. This has pushed regional commissions to expand J-1 visa waiver programs to enable more foreign doctors to immigrate if they are willing to practice in rural areas with high levels of healthcare disparities. Walker said organizations such as the Appalachian Regional Commission (ARC) made of of areas of several Appalachian states, and the Delta Regional Authority (DRA), made up of rural, lower income areas of several Mississippi delta state regions from Missouri and Kentucky to the Gulf of Mexico, are typically created by the states and their senators who see there is a major need to be addressed. 

"States and state senators are typically of a starting point to try to get legislation passed for a commission that typically covers a region so that you can go ahead and have additional state-based numbers for J waivers. In the licensure context, the state is also, the states are also serving as leaders because different states are seeing they have to fix this and they're going to do something at a state level. And what they've done is try to streamline licensure for foreign physicians and to accept certain credentialing without requiring the physician to go through further hoops. So I think that states are being very creative and it's good, but it certainly would be better if we had some type of national approach so that we could go ahead and connect our dots on every kind of barrier that might prevent a physician from being able to practice in the United States who's qualified, capable, and going to an area where we desperately need help," Walker concluded. 

Watch the full video interview for more.