The United States health care system is struggling with an acute shortage of doctors. What does that have to do with immigration? The short answer is: Quite a lot. The longer answer leads us to an inescapable conclusion that our immigration policies are failing us. They are putting obstacles in the way of bringing highly skilled and trained physicians from other countries to the United States to address the shortage we face. We’ve put together a list of frequently asked questions to explain these issues.
How severe is the shortage?
The Association of American Medical Colleges (AAMC) estimates that we’ll face an unprecedented shortage of up to 120,000 physicians by 2030. (Read more in “The Complexities of Physician Supply and Demand: projections from 2016-2030.”) The largest gap, of between 33,800 and 72,700 physicians, will be for non-primary care specialties. The AAMC also estimates a shortage of between 14,800 and 49,300 primary care physicians.
Much of the demand for health care services comes from a growing, aging population: “We must start training more doctors now to meet the needs of our patients in the future,” said Dr. Darrell G. Kirch, MD, president of the AAMC.
This shortage will be felt most deeply in rural and medically underserved communities that already struggle to get access to adequate health care. According to a recent report by the American Immigration Council, more than 247,000 doctors with medical degrees from foreign countries practice in the United States. This report highlights “the critical role foreign-trained doctors play regionally, in underserved communities, in rural areas, and in providing primary health care.”
Why Do foreign-trained physicians focus on medically underserved areas?
Due to certain visa requirements and restrictions, an International Medical Graduate (IMG) often must practice in underserved communities for a certain period of time before they are allowed to stay and work in a purely “work visa” status or to be able to get a green card. An IMG who entered in a J-1 visa status is subject to the two-year home residency requirement, which must be met or forgiven through a waiver.
One very popular and successful program is the Conrad State 30 program which allows J-1 medical doctors to apply for a waiver of the two-year home residency requirement by agreeing to be employed in a Medically Underserved Area (MUA) or Health Professional Shortage Area (HPSA) for at least three years.
That sounds like a good solution. What’s the problem?
It’s all in the numbers. The Conrad 30 program is administered by each state’s Department of Health and allows a limit of 30 waiver slots per state each year to qualified IMGs. This is just not enough in high-demand states such as New York, where the demand for a Conrad waiver is more than double the allotted 30 waiver spots. Those who are here are filling a critical need, but there’s more to be done.
The larger problem is that we have outdated and insufficient immigration laws to address the increasing shortage. An IMG physician comes to the United States, (often with spouse and children), completes residency training in a specific state or area, and starts to build a life for themselves. They receive no promise to be able to stay or work or provide a life for their families. If an IMG cannot get a waiver he/she cannot get work authorization in the United States and must return to his/her home country.
Think about this – they have moved very far from home, often with dependent family members, invested significant time and money to get additional training beyond what was required at home and yet live under enormous. Against that uncertainty, we are now seeing a decline in the number of foreign-trained physicians interested in practicing here.
Consider the type of situation described in this recent profile done by Public Radio International about the highly skilled medical doctor, Dr. Consuelo Lopez de Padilla, with 15 years of practice under her belt in her home country of Venezuela, who must now complete another medical residency training in the United States but has not been accepted into a program that would allow that to happen. You can read the full article here.
How else are immigration laws and policies failing us?
The demand for foreign-trained doctors will only increase as the population ages and faces an increasing need for affordable healthcare in the United States. This will happen sooner rather than later. The Association of American Medical Colleges found that the demand for doctors will continue to outpace supply, leading to a projected shortfall of between 46,100 and 90,400 doctors by 2025, many in primary care, accelerating through 2030. These shortages are compounded by the fact that large numbers of doctors will be retiring in the next few years.
Yet U.S. immigration policies significantly limit the ability of these doctors to immigrate to and practice in the United States. As policy-makers debate what immigration reforms would best serve the national interest, they should keep in mind that foreign-trained doctors are already taking the lead on providing care to many communities across the United States.
How can immigration laws be changed to help with the doctor shortage?
As a part of the multi-pronged approach recommended in its report, the AAMC supports federal incentive and programs such as the Conrad 30 Waiver.
Congress is considering proposed legislation (S. 948) to renew and improve the Conrad 30 Program, but frankly even that falls short. You can read more about the proposed legislation in our advisory. We need a more flexible Conrad 30 Program that is responsive to the demand and community needs for healthcare nationwide, so if one state doesn’t use its 30 waiver slots, they can be transferred to high-demand states such as New York, and California. Neither current law nor existing proposals include such a provision.
Other U.S. immigration laws are also creating barriers to many IMGs from countries such as India where the green card backlog means that they can face a 10-to-15-year wait before they can even apply for their green card. This puts them in a holding pattern and a work visa/ temporary status limbo in the United States even as they continue to serve our neediest communities and help solve our physician shortage problems.
The need for high-quality health care in the United States has been well documented. Congress must act, and in this case, it should be lowering the wall to enable physicians to enter and deliver their much-needed services.