What’s the news: The AMA is telling the Trump administration that allowing international medical graduates (IMGs) and their families into the U.S. on J-1 and H-1B visas is in the country’s best interest.

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“The U.S. health care workforce relies upon health professionals and scientists from other countries to provide high-quality and accessible patient care,” AMA Executive Vice President and CEO James L. Madara wrote in a letter to U.S. Secretary of State Mike Pompeo and Acting Secretary of Homeland Security Chad Wolf.

“During this pandemic, it is more critical than ever to ensure that the U.S. has a fair and efficient immigration system that strengthens the American health care system and advances the nation’s health security,” Dr. Madara added.

The letter is in response to a June 22 Trump administration proclamation suspending the entry of foreign individuals into the U.S. until Dec. 31.

The proclamation does allow entry for persons who “are involved with the provision of medical care to individuals who have contracted COVID-19 and are currently hospitalized; [or] are involved with the provision of medical research at United States facilities to help the United States combat COVID-19.”

These exemptions, however, are far too limited—particularly for IMGs who were scheduled to start their medical residency training July 1.

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“This carve out is too narrow and fails to exempt a large portion of the IMGs that come to the U.S. to practice in a wide range of medical specialties,” Dr. Madara’s letter states. Nearly 30% of medical residents in the U.S. in 2017 were IMGs, with about half on nonimmigrant visas, such as H-1Bs.

Additionally, the carve out fails to include spouses and dependent children of J-1 and H-1B physicians by exempting their J-2 and H-4 visa-holding family members from the immigration ban.

“The spouses and children of our physicians, who are entering the U.S. to provide critical health care to patients across the U.S., should not be separated from one another, especially during a global pandemic,” Dr. Madara wrote, adding that the immigration ban disproportionately affects IMGs who are parents and whose training may take three or more years to complete.

“Parent IMGs who are able to enter the U.S. to help treat COVID-19 patients, per the carve out, may be forced to make the impossible decision of leaving behind young children for years or coming to train in the U.S.,” the letter says. “To force mothers and fathers to choose whether to be separated from their children and spouses, or take a position treating some of America’s sickest patients, in some of our most underserved areas, is unfair.”

Why it’s important: The suspension may exacerbate delays in visa processing that resulted from the COVID-19 related worldwide closure of U.S. consulates and could cause IMGs to arrive at their training hospitals months late.

This could lead to IMGs losing their residency slots—leaving U.S. hospitals short staffed in the middle of a pandemic. This would also have a disproportionate negative impact on areas of the country with higher rates of poverty and chronic disease where non-U.S. citizen IMGs play a critical role in providing health care.

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“The AMA believes that any delay in the commencement of training programs will significantly compromise serving our nation’s most vulnerable patients at hundreds of … safety-net facilities across the U.S.,” Dr. Madara wrote, adding that nearly 21 million people live in areas of the U.S. where foreign-trained physicians account for at least half of the physician workforce.

“The entry of every IMG is in the national interest of the U.S. especially during the pandemic, when physicians are needed in every specialty now more than ever,” Dr. Madara added.

While the COVID-19 pandemic has compounded the urgency, the AMA has been advocating for years on physician visa issues. This includes opposing polices that create unnecessary stress for IMG physicians and their families and exacerbate the physician workforce shortage by limiting the ability of certain non-U.S. citizen IMGs to receive a visa or green card.

Learn more: A COVID-19 FAQ page offers guidance to IMG physicians and details AMA advocacy efforts on behalf of these professionals who are either currently licensed to practice in the U.S. or are seeking such licensure, and to help ensure that visa-related issues do not stop their ability to continue to care for patients during this challenging time.

Learn how the AMA opposed the administration’s decision to end the Deferred Action for Childhood Arrivals program and joined 32 other health organizations in an amicus brief to the Supreme Court.

News on all the AMA’s COVID-19 advocacy efforts and guidance can be found in the AMA's COVID-19 resource center, which offers a library of resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization.  

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