Small-town America braces for shortage of doctors after changes in visa policy
The New York Times
In Coudersport, Pa., a town an hour’s drive from the nearest Wal-Mart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.
In Fargo, N.D., a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.
In Great Falls, Mont., 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.
Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.
While the Trump administration is fighting, in the courts of justice and public opinion, for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple through the country.
In Montana, where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.
The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo. “I won’t have an income, I don’t know if I will afford rent, I don’t know where I will be,” she said. “It’s insane.”
The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.
Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee. A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to “work down the existing backlogs due to the high volume of incoming petitions.”
The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.
H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.
About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.
There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.
Sens. Amy Klobuchar, DMinn.; Susan M. Collins, RMaine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.
“Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America,” Ms. Heitkamp wrote in an email.
It was a North Dakota senator, Kent Conrad, who in 1994 proposed to relieve a shortage of doctors by tapping foreign physicians who have completed medical education in the United States.
His program waives the requirement that foreign doctors who graduate from residency programs in the United States return to their home countries for two years before working here. It lures such graduates to practice in underserved areas by offering them the chance to apply for a green card to live permanently in the United States after three years.
The program must be reauthorized by Congress every two years. Ms. Klobuchar, who twice has introduced legislation to make the program permanent, plans to do so again in the coming weeks.
Since the program’s inception, tens of thousands of foreign physicians have flocked to clinics and hospitals in Appalachia, the Mississippi Delta region, the Great Plains and elsewhere.
Many of them, such as Dr. Fadel E. Nammour, vice president of the North Dakota Medical Association, put down roots and never leave. The friendliness that he found in Fargo reminded him of his home country, Dr. Nammour said.
“We provide not only the care but also our leadership,” said Dr. Nammour, who is now a U.S. citizen. “The focus should be on making it easier to bring people in to cover the physician shortage we have.”