Responding to requests from members and building on long-time policy priorities, ASN recently made significant progress in addressing concerns about federal policy related to graduates of international medical schools. These efforts, reported on April 10, are designed to allow international medical graduates (IMGs) more flexibility to work in health care settings with the greatest need during this public health emergency (PHE) and not solely on the site associated with their H-1B and J-1 visas, and provide expedited access to permanent residence status. 

ASN is supporting progress on three fronts:

• Advocating for congressional passage of the Healthcare Workforce Resilience Act (S. 3599);
• Working with the Council of Medical Specialty Societies (CMSS) to advocate for these flexibilities; and
• Requesting Trump Administration waivers specifically designed to allow IMGs to join the fight against COVID-19 wherever they are needed.
   

“The time is now for lifting these restrictions and unleashing the commitment and talent of the thousands of foreign-born medical professionals across the nation,” said ASN President Anupam Agarwal, MD, FASN. “The U.S. health care system relies heavily on IMGs who comprise 25% of the physician workforce in our country ^[1] and are training or practicing here legally on a visa. Nearly 21,000,000 Americans live in an area where at least one-half of the physicians are foreign-trained ^[2] .”

Dr. Agarwal added, “ASN must lead the call to remove restrictions for thousands of doctors who are currently working in our country and are stuck in the green card backlog. These doctors face many limitations due to their temporary status, such as not being able to take a shift at a second hospital where they may be desperately needed to assist with treating COVID-19 patients. I know firsthand how these restrictions can tie the hands of healthcare professionals.”

On the first front, ASN has endorsed the Healthcare Workforce Resilience Act (S. 3599 sponsored by Senators David Perdue (R-GA), Richard Durbin (D-IL), Todd Young (R-IN), and Christopher Coons (D-DE), and Representatives Tom Cole (R-OK), Brad Schneider (D-IL), Abigail Finkenauer (D-IA), and Don Bacon (R-NE). This bipartisan, bicameral legislation will strengthen the healthcare workforce and improve healthcare access for Americans during the COVID-19 crisis.

The Act directs the U.S. Citizenship and Immigration Services (USCIS) to “recapture” up to 25,000 immigrant visas for nurses and 15,000 immigrant visas for physicians – as well as recapturing immigrant visas for the families of these medical professionals.

These recaptured visas would be drawn from the pool of unused employment-based visas that Congress has previously authorized. The visas would be issued in order of priority date and would not be subject to the country caps. To facilitate timely action, premium processing would be applied to qualifying petitions and applications. All immigrant medical professionals receiving consideration under this bill would be required to meet licensing requirements, pay required filing fees, and clear national security and criminal history background checks before they can receive recaptured green cards.

On the second front, ASN and 28 other specialty societies from CMSS, have written to congressional leadership to ensure that the nation has an adequate health care workforce in order to successfully address the current PHE.

“CMSS urges Congress to encourage the U.S. Department of State and USCIS to:

• Assure that visa policies will continue to identify physicians as important for national security in terms of health.
• Continue and prioritize visa processing for physicians and medical residents
• Expedite USCIS adjudications of extensions and changes of status for physicians and medical residents practicing or otherwise lawfully present in the United States.”
   

CMSS recommended automatically extending visas and other protected status for physicians and medical residents already in the country through the COVID-19 public health emergency to bolster the health care workforce feeling the burden of addressing the pandemic and guarantee greater access to quality health care for all Americans.

The letter also recommended exempting physicians on H-1B visas seeking permanent resident status from country caps, the annual per-country limitation for employment-based immigrants due to the existing restriction that no country have citizens that comprise more than 7% of total yearly green cards available worldwide for family and employment-based categories ^[3] . These restrictions disproportionately impact immigrants from countries with higher rates of immigration to the US, where wait times for a green card can be as long as 10 years, and may be as long as 50 years for certain immigrants who applied for citizenship in 2018 or later.[4]

On the third front, following calls from ASN and other groups, the Trump Administration has agreed to clear the way for foreign doctors to make a larger contribution to the coronavirus response, waiving restrictions that prevented foreign doctors assigned to rural areas from administering medical care and providing telehealth services outside their approved locations.

Under these waivers 1,500 physicians in the Conrad 30 program, which is designed to encourage foreign doctors to practice in underserved areas, can now go where they are needed without jeopardizing their visas or green cards.

ASN will continue to work across the board from Congress to the White House to regulatory agencies to remove barriers preventing health care professionals from contributing their all in this COVID-19 PHE.