Current US Visa Rules Restrict, Limit COVID-19 Physician Pool

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MARCH 26, 2020 -- Efforts are underway to ease visa restrictions that are currently limiting what foreign physicians inside the United States can do and what foreign medical students who are barred from entering the country would be able to do ― help fight the COVID-19 crisis.

Non-US citizens who completed medical school outside the country and who last week matched into US residencies are now temporarily blocked under COVID-19 restrictions from getting the visas that most need to enter their programs.

According to the National Resident Matching Program, this year, 4222 non–US citizen international medical graduates (IMGs) matched to first-year residency positions. They were to start work on July 1. Orientation typically starts in June, and paperwork begins now.

The US State Department's halt on consulates' issuing most visas during the pandemic affects physicians who have been practicing in the United States for years and who are now applying for extensions to finish their training. It also affects those who want to be able to practice where needed instead of only in the underserved areas their current visas or waivers allow.

The restrictions come as the United States is on track to become the epicenter of the pandemic.

Groups Push State Department to Facilitate Visas

The Educational Commission for Foreign Medical Graduates (ECFMG), the US agency that certifies IMGs to pursue US graduate medical education and that sponsors J-1 visas of foreign national physicians, has been lobbying the US State Department to facilitate the issuance of visas to boost the physician workforce. It is also asking the State Department to allow more time for the graduates to move here.

The American Medical Association (AMA) issued a statement Wednesday also asking for those exceptions.

The AMA notes, "Nearly 21 million people live in areas of the US where foreign-trained physicians account for at least half of all physicians."

The ECFMG notes in a press release that New York, the current US hotspot of the COVID-19 pandemic, has the most foreign national physicians who have J-1 visas in the country.

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William W. Pinsky, MD, CEO of ECFMG, told Medscape Medical News the visa suspensions would wreak havoc with the system if there were no pandemic and that this year, suspensions are particularly threatening.

"In an average year, about 25% of residents and fellows in training are IMGs," he said. "They provide supervised care to patients, particularly important in safety net areas.

"This year, the importance is even higher. If, all of a sudden, 25% of new house staff cannot be there, from a caregiver perspective, it increases the burden," he added.

Residents May Need to Be Quarantined

Pinsky said an additional concern is that currently, the J-1 visas cannot be granted until 30 days before programs start.

"Assuming that people from other countries are going to be able to find transportation to get here, I would assume they would have to be quarantined for 2 weeks," he said. "That would also likely require the institutions where they're working to facilitate the quarantine. This is where it all makes your head explode."

Pinsky said the communication between his agency and the State Department has been "excellent," and on Tuesday, the department asked ECFMG for additional information "as soon as possible."

"I take that as a very positive element of cooperation in understanding how important this is," he said.

"All this is doable," Pinsky said. "It's just a matter of figuring things out."

Physician Sisters Both Need Visas

An infectious disease (ID) fellow in Boston, Massachusetts, who asked that her name be withheld because of sensitivities involving visa status, told Medscape Medical News that her J-1 visa expires this summer and that she is worried about what that means for finishing the last year of her fellowship.

Her sister, who is currently in the United States on a tourist visa, last week matched into an internal medicine program in Washington, DC. She is waiting to see whether she can get a J-1 visa to start the program.

The ID fellow said she is frustrated that some have called for medical retirees to work and are asking students to help with some services when "you're looking at a pool of 4000 doctors who are willing to serve."

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Continued visa suspension "would directly affect quality of care, especially at a time we need doctors the most," she said.

"It's keeping foreign doctors from getting in the system, staying in the system, and then staying after their training is over to contribute to the workforce," she added.

Physician's Visa Restricts Him From Pitching In

Praveen Ranganath, MD, MPH, an oncologist originally from India who is now working under an H1-B employment visa in Anderson, Indiana, is restricted by the terms of his visa to work only in oncology and must only work in his rural, underserved hospital system.

These times call for flexibility, Ranganath told Medscape Medical News. He says restrictions must be lifted temporarily so that doctors such as himself can help with the expected influx of COVID-19 patients.

"In an emergency, you need all hands on deck," he said. "It makes no sense."

Physicians, he said, should not be lumped in with engineers and other employees that the restrictions were intended to govern.

If it comes down to it, Ranganath said, he would help COVID-19 patients.

"If it was a patient dying or me being deported, I would rather save the patient," he said.

But Ranganath hopes restrictions will be eased soon.

Pinsky points out that facilitating the visas in the United States does not prevent physicians from helping in their own countries. One purpose of the J-1 visa is with respect to cultural exchange; the understanding is that the training will be put to use when physicians return home.

"It's the opportunity for these individuals to get more advanced training that will lead to better care back in their home countries," he said.

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