Politico
By Paige Winfield Cunningham
April 22, 2013
The immigration bill might have a partial solution to the doctor shortage in underserved areas: import them.
Or more precisely, make it easier for foreign physicians who come to the U.S. for their medical residencies to stay on after their training — if they’ll then serve three years where they are most needed.
The Senate immigration reform plan allows more visas for certain categories of students and workers — but it steers physicians to a visa process that will include time in underserved areas, many of which are in rural America.
“The [bill] is not trying to recruit plastic surgeons in Central Park,” said Adolph Falcon, senior vice president for the National Alliance for Hispanic Health.
The plan, if eventually approved by Congress, would also make it harder for some immigrant doctors to become permanent U.S. residents, depending on what kind of visa they get and where they work.
And critics of the proposal say it might not really do all that much to address physician shortages, particularly as demand goes up as coverage expands under the health law.
Basically, there are two kinds of visas that foreign doctors can get: an H-1B visa for specialty workers or a J-1, which is an educational or cultural visa.
Many foreign residents obtain the educational visa — which requires them to return to their home country for at least two years after completion of their training. Later, they can seek permanent U.S. immigration status. If they don’t want to go home, under current law, they can remain in the U.S. if they agree to work in a medically underserved area for at least three years.
The specialty worker visa — the H-1B, which is well-known in the tech industry — is a smoother path to permanent U.S. residency. The immigration bill would raise the H-1B caps from 65,000 to 110,000 annually — though not all would go to physicians. Doctors can apply for that visa to stay here legally right away — and the process would be streamlined under the bill.
Or maybe not. Hospitals would have to start paying a $1,500 fee per medical resident with the H-1B visa. And they might not want to do that.
In that case, the physicians in training would go the education visa route — and then that three-year stint in underserved areas. The legislation would also add worker protections and allow their spouses to work.
It would also make more of those slots available for doctors if certain conditions are fulfilled — but some experts say that still won’t bring in enough doctors to places that need them.
“Given the predicted need for additional need for physicians based on Obamacare, this is disastrous as there will not be enough physicians available to fill these positions,” said Stephen Perlitsh, an immigration attorney based in New York .
Nearly 6,000 areas in the U.S. have more than 3,500 people per primary-care physician, leading the Department of Health and Human Services to officially designate them as shortage areas. The Health Resources and Services Administration says it would take 7,550 more primary-care doctors to eliminate all the shortage areas.
The immigration reform bill also contains a number of other provisions that could open the door to more doctors working in underserved areas. In 2010, 27 percent of physicians and surgeons in the U.S. were foreign-born, according to the U.S. Census Bureau.
The legislation would eliminate per-country caps limiting how many people may immigrate to the U.S. each year. Right now, those caps apply to doctors as well as other types of applicants — meaning it can take years for physicians in countries with large backlogs to gain permanent residency.
“A physician from India could take up to five or eight years to get a green card,” said Raj Iyer, a California-based immigration attorney.
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