International Medical Education

Backlog of H-1B visas for physicians affects patients in need


The AMA recently sent a letter to U.S. Citizenship and Immigration Services (USCIS) imploring them to clear the backlog for conversion from H-1B visas so that foreign-trained physicians already practicing in the U.S. can obtain permanent resident status.

There is a sizable backlog of international medical graduates, primarily from India and China. These doctors are actively practicing in the U.S. but waiting to receive their green card due to a massive backlog caused by per-country limitations imposed by law.

"These physicians play a critical role in providing health care to many Americans because they tend to choose primary-care specialties and work in areas of the country with higher rates of poverty," says the letter from AMA CEO and Executive Vice President James L. Madara, MD.

"They are providing important medical services to communities in need. According to a recent report, about 20.8 million Americans live in areas where at least half of the physicians are foreign-trained."

Not only does the backlog present a problem for physicians who are waiting on their residential status—some of whom have been waiting decades—but workforce experts have predicted that the U.S. will face a physician shortage for both primary care and specialty physicians in the decade to come due to the growth of the aging population.

This will disproportionately affect areas of the country that are already experiencing a physician shortage.

"Currently, more than 85 million people live in parts of the U.S. that have been designated as primary health care professional shortage areas. An estimated 15,000 physicians are needed nationwide to remove this designation," Dr. Madara wrote. The six-year limit on H-1B visas, coupled with a USCIS policy, is creating additional roadblocks for these physicians who are sorely needed to serve some of Americas most underserved and sick patient populations.

At the 2018 AMA Annual Meeting, the House of Delegates adopted a new policy to advocate on behalf of clearing this backlog for physicians who have applied for permanent resident status. The AMA is continuing to track bill language added to the U.S. Department of Homeland Security (DHS) fiscal year 2019 House Appropriations Committee bill that is intended to provide additional flexibility related to the per-country caps on highly skilled workers under the H-1B visa program.

Earlier this summer, the AMA sent a letter to the director of USCIS urging the agency to expedite review of pending H-1B visa applications by non-U.S. international medical graduates who have accepted positions in U.S. graduate medical education programs which begin on or before July 1.

The AMA received reports that USCIS was requesting additional evidence and in some cases denying visa applications that use data from the Association of American Medical Colleges (AAMC) Survey of Resident/Fellow Stipends and Benefits Report. Shortly thereafter, the DHS Office of Academic Engagement began working closely with USCIS to quickly resolve each of the remaining cases of medical residents applying for H-1B visas using wage data from the AAMC's Stipends and Benefits Report.