Recent policy changes to visas and physician residencies are disrupting the healthcare workforce.
Immigrants make up 27% of physicians and surgeons, 22% of nursing assistants and 16% of registered nurses in the U.S. Foreign physicians and clinicians are an important part of the healthcare workforce, often working in underserved and rural areas.
But recent policy changes have made it more difficult for healthcare providers to come into the U.S. and put a strain on hospitals trying to hire them.
Visas
Foreign clinicians generally enter the country on two types of visas: H-1B and J-1. The J-1 is a temporary visitor exchange visa with a two-year home country return requirement. The H-1B visa is a temporary professional worker visa for a specialty occupation with “dual intent,” meaning visa holders can apply for a green card while on H-1B status, and requires employer sponsorship. J-1 visas are commonly used by international medical graduates to enter the U.S. for residency or fellowship training, while H-1B visas are often used by state-licensed physicians for employment in clinical practice.
This year, the federal government has made several policy changes to both visa types.
In May, the White House limited travel from seven countries and banned travel from 12 others — this included temporary pauses on interviews for J-1 visa applications. In June, a strict social media screening policy was implemented that required all applicants to set their accounts to public.
“President Trump will always put the safety of Americans first, and it is a privilege, not a right, to study in the United States,” a White House spokesperson told CBS News in May. “Enhanced social media vetting is a commonsense measure that will help ensure that guests in our country are not planning to harm Americans, which is a national security priority.”
The pause ended June 18. Most U.S. residency programs begin July 1, meaning international medical graduates affected by visa delays had only a short window to secure appointments and enter the country.
This year, U.S. residency programs have accepted 6,653 international physicians, but about 1,000 have not yet secured visas. Although federal officials said the application pause has been lifted, some physicians cannot schedule visa appointments because their embassies have not reopened them. Some have been told their applications need more vetting, and others were denied visas because they are from countries with a travel ban.
This pause is estimated to put hundreds of foreign-born physicians who were accepted into U.S.-based medical residencies in “visa limbo.”
On Sept. 19, President Donald Trump issued a proclamation imposing a $100,000 payment to accompany any new H-1B visa petitions starting Sept. 21. Federal officials said the decision was made to address “systematic abuse” of the visa program they say has disadvantaged American workers.
The new fee could add millions in labor costs for systems recruiting foreign-born physicians. Rochester, Minn.-based Mayo Clinic, Cleveland Clinic and Memphis, Tenn.-based St. Jude Children’s Research Hospital are some of the industry’s top sponsors of H-1B visas. Mayo has more than 300 approved visas.
A few days later, the Trump administration reportedly began considering exempting physicians and medical residents from the fee after healthcare industry groups raised concerns.
“One of the short-term strategies used by U.S. hospitals to address personnel shortages is the use of foreign-trained healthcare workers,” the American Hospital Association said. “The AHA is reviewing the recent memo from the Department of Homeland Security and evaluating the potential impact of these policy changes on hospitals and the communities they serve. We will also work with the administration to stress the importance of including healthcare personnel in potential exemptions to these changes.”
On Sept. 25, the Department of Homeland Security released a proposed rule for H-1B visa applicants that would change the current process of conducting random selections to a weighted selection process. This would generally favor applicants with higher skills and higher wages. The weighted selections would be based on an individual’s wage level, with higher wages weighing more heavily.
The impact on residencies
Hospitals have been closely monitoring visa delays and travel restrictions, as these have disruptive effects on thousands of international medical school graduates scheduled to begin residency in the U.S.
Residencies across the nation tend to begin July 1, but delayed visas have left some programs without their residents. These delays did leave some hospitals — particularly safety nets in low-income communities — short-staffed after senior residents left in June. Foreign-trained physicians make up roughly 1 in 6 medical residents and fellows at U.S. teaching hospitals.
Some hospitals are attempting to fill open spots with backup candidates, but this is usually only an option for institutions that hire residents directly. Others must request waivers — an administratively complex and time-sensitive process — to release matched residents and fill spots.
