Immigrant doctors, nurses, and other health care workers are on the front lines in the fight against the spread of COVID-19 in the United States. With the coronavirus pandemic straining health care systems, some states, such as New York and New Jersey, have taken steps to bolster their workforce by suspending requirements and making it easier for immigrant and foreign-trained doctors to join the fight. Connecticut is asking retired doctors and nurses to volunteer to serve, and the New York University Grossman School of Medicine and four medical schools in Massachusetts are allowing current students to graduate early to start helping right away. The Liaison Committee on Medical Education, under the American Medical Association and the Association of American Medical Colleges, released guidance for medical schools considering similar early-graduation policies. The COVID-19 pandemic is projected to peak starting in the next two weeks, with patient need far exceeding the capacity of the health care system in many areas. Increasingly more front-line providers are getting sick, which exacerbates the shortage and worsens the situation.
Nearly 29 percent of all U.S. physicians, 22 percent of nursing assistants, and 38 percent of home health aides are foreign born; together, foreign-born workers make up 17 percent of the entire health care and social services industry. But there are many challenges for immigrant medical professionals who work in this country. Even under normal circumstances, immigrant doctors must overcome numerous hurdles, ranging from unfair state licensing requirements to rigid visa rules, to practice in the United States.
Paradoxically, COVID-19 has actually heightened the barriers faced by badly needed immigrant medical professionals. For instance, office closures and the suspension of visa services at consulates overseas are severely hampering the ability of health care professionals to get medical licenses, obtain visas, and remain in status. Federal and state policymakers, as well as the Educational Commission for Foreign Medical Graduates (ECFMG), an entity that certifies international medical graduates (IMGs) to work in the United States, must immediately work together to lift barriers and enable immigrant and foreign-trained health care professionals to quickly serve in COVID-19 hot spots. This column outlines actions that the federal government and states should take to increase health care service capacity in U.S. cities and localities immediately.
The federal government should immediately increase the number of immigrant doctors serving where they are needed most
Immigrant doctors commonly utilize J-1 visas for their residencies before turning to the Conrad 30 waiver program, or J-1 waivers, to continue practicing in the United States and gain a pathway to lawful permanent residence. Other immigrant doctors come through the H-1B program for high-skilled workers. In either case, U.S. Citizenship and Immigration Services (USCIS) and the U.S. Department of State must remove roadblocks, even if temporarily, to allow more immigrant doctors to practice.
Expedite and automatically extend work authorizations for immigrant health care professionals
All types of immigration-related applications are getting delayed or even jeopardized for a variety of reasons. For example, there are widespread closures of USCIS offices that interact with the public to help process these applications, suspension of routine visa services in U.S. consulates around the world, and cancellation of medical board exams that are essential for a physician to get licensed. While the administration recently announced that it would continue to process employment authorization extension applications using previously submitted biometrics, that does not solve the problem for initial petitions for which biometrics cannot now be collected, nor does it relieve health care professionals working today from having to take the time to apply for an extension and hope for a timely adjudication. USCIS should grant automatic extensions of work authorizations to allow immigrant health care professionals to continue their vital work in these critical times. The United Kingdom just announced that it will automatically extend foreign doctors’, nurses’, and paramedics’ visas that were going to expire before October.
Another prudent action for the State Department would be to encourage consular officers to waive interview requirements for medical professionals if they do not appear to be ineligible for the visa. The State Department late last week issued similar guidance with respect to all first-time and returning H-2A and H-2B applicants—temporary agricultural and nonagricultural workers, respectively. It is no less important that the United States at this time have access to skilled health care professionals willing to assist the country’s response to the virus.
Suspend restrictions on where immigrant physicians with H-1B and J-1 waivers can work
Immigrant physicians with H-1B visas are restricted from changing employers without extensive paperwork, and their status is contingent upon the ability and willingness of employers to sponsor them. With suspended services and delayed processing due to COVID-19, being able to shift quickly to hospitals that are stretched thin, including to rapidly created field hospitals, is critical—and yet all but impossible under the current system. Similarly, immigrant physicians with J-1 waivers cannot change employers easily unless there is an “extenuating circumstance.”
USCIS should waive all geographical restrictions and define any transfer related to assisting the fight against COVID-19—including both treating COVID-19 patients and serving general medical needs that would otherwise strain the country’s fragile health care system—as an extenuating circumstance. USCIS should also suspend Simeio filing requirements for H-1B health care workers, which require them to file an amended petition to practice in a new location. In response to COVID-19, the Army Corps of Engineers is looking into converting 114 facilities across the country into temporary hospitals and is already transforming the Javits Center in New York City and the TCF Center in Detroit. These new locations are quickly going to need medical professionals to staff them—removing burdensome bureaucratic hurdles will ensure that this is possible.
States must cut red tape to make it easier for immigrant doctors to serve in high-need areas
Although the federal government holds the key to increasing the number of immigrant doctors, states should also take steps to remove roadblocks in order to quickly increase their health care workforce.
Ease residency requirements for foreign-trained doctors
The number of years of U.S. medical residencies required for foreign-trained doctors to get licensed in the United States—regardless of how many years of experience they have in other countries—is often higher than it is for a graduate from a U.S. medical school. States should at least apply the same standards to IMGs as they do to U.S. medical graduates. In these desperate times, New York Gov. Andrew Cuomo (D) recently issued an executive order to temporarily allow foreign-trained physicians who have at least one year of U.S. graduate medical education to provide medical care in the state. New Jersey Gov. Phil Murphy (D) also signed an executive order granting temporary licenses to doctors with licenses in foreign countries; other states should follow suit.
This month, the ECFMG matched more than 7,000 IMGs to residency programs all over the United States; among them, more than 4,200 are noncitizens. This means that there are thousands of doctors who are qualified to help with the COVID-19 crisis but have not yet started their U.S. residencies to get a license. Many of these IMGs may already have years of residencies completed in other countries. States should work with the ECFMG to identify countries that have education standards similar to the United States, recognize residencies completed there, and allow these medical professionals to join the fight against COVID-19 immediately.
Allow unmatched immigrant doctors without licenses to help
States need to work with the ECFMG to identify immigrant doctors who, despite having passed the U.S. exams, were not matched with a residency program in the United States and as such are unable to fulfill state licensing requirements. The number of residency slots available each year is limited and has been insufficient in the past to meet the demand of medical school graduates. Just last year, more than 2,800 foreign-trained doctors who are not U.S. citizens passed the required levels of the U.S. Medical Licensing Examination but were not matched with a residency. States have created programs for people with a medical education who for one reason or another cannot get into a residency program; these types of programs can ensure they continue to work in some capacity. For example, Missouri enacted a law in 2017 allowing medical graduates who are “resident[s] and citizen[s] of the United States” or “legal resident alien[s]” and who have completed two levels of the U.S. Medical Licensing Examination but have not started their residencies to serve as assistant physicians. The same type of new professional category can be used to allow immigrant doctors who did not get into residencies to contribute amid this workforce crunch.
The ECFMG should enable more immigrant doctors to join the workforce
The ECFMG has been responding swiftly to the COVID-19 pandemic. Following the announcement that the United States was suspending routine visa processing, it worked with USCIS to make sure that more than 4,200 foreign-trained doctors who were approved for a J-1 visa could get their visas processed. These doctors were supposed to travel to the United States to begin their residencies in July 2020; the ECFMG should push for them to start earlier to help with the pandemic.
There is more that the ECFMG can do in the fight against COVID-19. Immigrant doctors with J-1 visas must complete their residencies in an accredited graduate medical school approved by the ECFMG and the State Department. At least temporarily, the ECFMG, in coordination with the State Department, should relax its rules and allow J-1 visa holders to easily transfer to COVID-19 hot spots even when those places are not ECFMG or the State Department approved.
Conclusion
Even before the COVID-19 pandemic hit the United States, the nation was facing a severe and growing shortage of doctors. As cases of COVID-19 increase to heretofore unimaginable levels, and new hot spots emerge nationwide, states, the ECFMG, and medical schools are taking extraordinary measures to increase capacities and staff of health care facilities. Unfortunately, the Trump administration’s ongoing push toward restrictive immigration policies is trending in the opposite direction, as evidenced by the continuing effort to end the Deferred Action for Childhood Arrivals (DACA) initiative, which has allowed an estimated 27,000 health care professionals to work when and where they are needed most. Congress also has the power to make numerous legislative changes to ensure that immigrant doctors, from DACA recipients to those with J-1 waivers, can contribute more fully and stay and work in the United States if they choose to do so. There is so much more that the federal government and states can still do to help the country get through this public health crisis. This is a time to rise to the occasion and utilize all available resources to fight the pandemic.
Silva Mathema is an associate director for policy on the Immigration Policy team at the Center for American Progress.
The author would like to thank Gregory H. Siskind from Siskind Susser for providing his expertise.
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