Every physician is critical in the battle against COVID-19, but some may soon find themselves sidelined—not by the illness but by the complexities of a U.S. visa process, which can leave applicants in limbo as they transition from one legal status to another.

In a March 2020 letter, ASN asked congressional leaders to encourage the administration to enact policies to make sure no law-abiding physician or medical resident who wants to come to or remain in the United States is prevented from doing so. The letter called for:

• Extending visas and other protected status for physicians and medical residents through the COVID-19 national emergency,
• Expediting approval of visa extensions and changes of status,
• Continuing the H-1b premium processing option, which turns around visa applications in 15 days,
• Establishing visa processing at embassies and consulates worldwide during the health emergency, and
• Allowing physicians and residents with J-1 and H-1b visas to be redeployed in response to the COVID-19 pandemic.
   

Typically, international medical graduates (IMGs) who enter the United States on a J-1 visa to study or conduct research must return to their home countries for two years before they can apply for an H-1b employment visa or a green card. The requirement can be waived for a finite number of physicians, typically those who agree to work in a medically underserved area for three years through the Conrad 30 Program. Some waivers are also granted on the basis of persecution or exceptional hardship or at the request of a federal agency. With all parts of the government under strain at present, physician groups are concerned about the ability of the U.S. Citizenship and Immigration Services (USCIS) office to grant and renew physician visas so the country can benefit from this indispensable workforce.

“We are facing a very critical time,” said Javier A. Neyra, MD, assistant professor of medicine and director of Acute Care Nephrology & CRRT Program at the University of Kentucky College of Medicine. “In July, a lot of foreign graduates come to start their training in residency. My impression is, academic medical centers will do everything they can to be sure the immigration process is completed so these individuals can arrive at the desired time, but we don’t know how this is going to work out. I know individuals who are outside the U.S. who have been told there is no guarantee their visa will be sponsored in time.”

Neyra is himself dealing with the uncertainty. He planned to sponsor a J-1 visa this spring so a researcher could join his team in May. Then his university decided to postpone sponsoring J-1 visas until summer. The person he had in mind got permission from his institution currently sponsoring his J-1 visa to temporarily remain in place, an arrangement approved by immigration authorities. It is unclear, however, whether he will continue to receive a salary, and if so, how his institution will fund it.

Prospects for international physicians at other stages of their careers are even more uncertain. The process of moving from training to practice is far more complex than the process for entering the country on a J-1 visa, Neyra said. The number of applicants for H-1b visas far exceeds the number of visas granted, and changes to the program in 2019 preference applicants who hold advanced degrees from U.S. institutions over IMGs. The USCIS’s March 20 suspension of premium processing for H-1b visas could further compromise the ability of IMGs to start training in July. Meanwhile, there is a sizable backlog of international physicians with H-1b visas currently practicing in the United States who are waiting for permanent resident status.

These issues are especially salient in nephrology because the majority of kidney specialists are international medical graduates. Neyra and his colleagues on the ASN Diversity and Inclusion Committee recently surveyed nephrology program directors to gauge their knowledge of immigration issues affecting the kidney care field. The survey revealed gaps in knowledge, especially concerning the various non-Conrad-30 routes to remaining in practice in the United States. Neyra and his fellow committee members hope to fill those gaps. They have drafted an article to raise awareness and will soon begin developing informational resources for both international graduates and their U.S. sponsors.

Earlier this month, the State Department released guidance clarifying its stance on alternative rotations and clinical assignments for J-1 visa holding physicians during the pandemic. ASN will continue to seek additional federal guidance and flexibility to make sure the kidney disease workforce remains adequate during the challenging months ahead.