As Covid-19 infections once again surge across the United States, one of the biggest obstacles to saving lives is a shortage of doctors. A federal proposal to change the rules for foreign-born physicians working here will make the problem worse.
For decades, foreign national physicians have come to the U.S. to complete their medical training in teaching hospitals. They enter the country with J-1 visas, which authorize them to remain in the U.S. for the full duration of their training programs, which can range from one to seven years.
This program is good for the physicians, who are able to train in high-caliber teaching hospitals. It also benefits the millions of Americans who live in rural areas that face a shortage of physicians. Even in many urban areas, there aren’t enough doctors, and the problem is growing. The Association of American Medical Colleges forecasts a shortage of as many as 139,000 physicians by 2033.
Today, thousands of foreign national physicians are on the frontlines in U.S. hospitals, working to keep Covid-19 patients alive.
So it’s incredible to me that the U.S. Department of Homeland Security (DHS) wants to hold the threat of deportation over these physicians. DHS is proposing to rewrite visa regulations that would severely limit the ability of foreign national physicians to remain in the U.S. for the duration of their training at a time when we desperately need them.
Foreign national physicians are so essential to helping fill the void that each state has an annual program that allots waivers to permit a certain number of foreign national physicians to remain in the U.S. after their training is completed for an additional three years if they agree to practice in an underserved area.
DHS seems to be ignoring the nation’s need for physicians. Under the proposed rule, J-1 visas would no longer be valid for the duration of physicians’ training programs. Instead, they would be valid for two to four years, which is shorter than the duration of many training programs. This would result in foreign national physicians departing prematurely, before being able to complete their training, and would reduce the chances they would apply to settle in the country, a brain drain we can ill afford.
The rationale DHS gives for its proposed change is “a potential for increased risk to national security.” But the fact is that the U.S. Departments of State and of Homeland Security already closely monitor foreign national physicians and researchers holding J-1 visas through a joint database of the two federal departments. Additionally, all J-1 physicians must renew their visa sponsorship every year.
DHS’s proposal would also disrupt biomedical research. Key members of the scientific teams that work toward medical breakthroughs are postdoctoral fellows, many of whom come to leading academic medical centers in the U.S. from around the world on J-1 visas. Their work has helped find new treatments for serious illnesses such as cancer and cardiovascular disease.
Foreign national postdoctoral fellows, among the best and brightest young scientific minds in the world, would no longer be assured of the ability to complete their work if DHS were to change the visa rules. This would be an unnecessary obstacle in not only their career paths but also their pursuit of new medical knowledge. This is no small matter for research-focused medical centers like the Icahn School of Medicine at Mount Sinai, where I work. We currently employ more than 400 researchers who hold J-1 visas.
One of Mount Sinai’s leading infectious disease experts, who serves on New York state’s Covid-19 Clinical Advisory Task Force, first came to the U.S. on a J-1 visa. He is currently testing a Covid-19 vaccine that he developed with two of our other virus experts, both of whom are immigrants from Austria. Scientists from dozens of countries are generating valuable scientific discoveries in Mount Sinai’s laboratories, and the same is true at other leading medical schools and research institutions.
America’s capacity to attract brainpower from around the globe has been a key factor in the nation’s scientific, medical, and economic success.
As we fight the Covid-19 pandemic, U.S. immigration authorities must not impose random obstacles on the ability of hospitals and research centers to recruit great physicians and scientists to help us advance medical care and science. More than ever, we need their talent, dedication, insight, and innovations as we confront one of the greatest health crises in history.
Kenneth L. Davis is a psychiatrist and president and CEO of Mount Sinai Health System in New York City.
I think this issue is valid, but there is an even more important and urgent systematic issue the healthcare system is facing, and that is the artificial limitation of residency slots. Due to the 1997 Balanced Budget Act, the number of residency slots funded by Medicare, which is the primary source of residency funding, was capped at around 100,000, and that cap has remained in place ever since. So we create a zero-sum system and add J-1 Visas to the mix, and you create another problem that is already being reported: American medical school graduates who do not match. It is insanity. I am almost certain that nearly all who didn’t match didn’t do so because of lack qualifications to be a physician. It stems from the limited seats.
Imagine being an a student who graduates from a US-based medical school with easily over $250,000 in debt, and they don’t may have to have their final training delayed for at least a year with the possibility of never matching at all because we are giving precious spots to non-US citizens who graduated from foreign medical schools. That is sociopathic levels of cruelty.
If you can assure me that every qualified US medical school graduate who applies will match the same cycle as they graduate, then add as many J-1 visas as you want.
Or we can solve both issues and just remove this cap and overhaul our broken visa system which is inherently racist and xenophobic. Fully trained doctors who no longer need official training should have their own category of Visa tied with a guaranteed permanent residence halfway through the initial term should they have shown good standing with local authorities.
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