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Foreign-born health care workers should be allowed to join the fight against COVID-19

Visa restrictions and outdated immigration laws are keeping health care professionals from serving more U.S. patients

On April 30, 2020 Senators Durbin (D-IL), Perdue (R-GA), Young (R-IN) and Coons (D-DE) announced the Health care Workforce Resilience Act, a bipartisan bill that would address the shortage of health care workers by expediting the green card process for doctors and nurses ready to join the fight against COVID-19. For more information on the bill and FWD.us’ statement, read here.

More than 29% of active physicians in the U.S. are foreign-born non-U.S. citizens.

On April 23, 2020, a proclamation from President Trump went into effect, banning new immigrants from coming to the United States, arguing that they “present risk to the U.S. labor market.” Despite the President’s attempt to shift blame, immigrants are in fact filling millions of critical roles as frontline essential workers combatting the COVID-19 crisis – but many more individuals could join the effort and save lives if our laws and policies allowed them to do so.

The President’s executive order follows on the heels of earlier immigration restrictions on doctors that make it impossible for some foreign-born health care professionals, particularly physicians, to contribute their training and skills to combat the COVID-19 pandemic and serve U.S. patients.

Rather than preventing essential frontline health care professionals from treating patients and saving American lives, the Trump Administration should immediately take steps to reduce restrictions on visa holders who are ready and willing to join the fight against COVID-19 in the U.S. right now. Congress has a critical role to play, too – it can strengthen America’s health care workforce by modernizing programs that allow foreign-born health care professionals to work temporarily in and then live permanently in the United States.

The current restrictions are preventing doctors from being able to go where their skills are most-needed at a time when access to health care professionals for many communities is literally a matter of life or death.”

Challenges

A sizable population of foreign-born physicians are already living and working in the United States and supporting the COVID-19 response. In fact, more than 29% of active physicians in the U.S. are foreign-born non-U.S. citizens. Our existing immigration laws and policies limit their ability to work where and how they are most needed when they come to the U.S.

Many foreign-born physicians are working in the U.S. on a temporary “nonimmigrant” visa such as an H-1B. H-1B visa holders are only allowed to work for the employer sponsoring them, filling a specific job at a specific worksite, all of which is detailed in their labor condition application filed with the Department of Labor, as well as their petition with the U.S. Citizenship and Immigration Services (USCIS).

This means that H-1B holders are generally not allowed to work, even temporarily, in different geographic locations or worksites other than the one listed on their filings. This prevents doctors on H-1B visas from relocating to hard-hit regions, or even working in other departments within their own hospital. While these provisions are generally intended to ensure fair pay for U.S. citizens and foreign-nationals working in the U.S., the current restrictions are preventing doctors from being able to go where their skills are most-needed at a time when access to health care professionals for many communities is literally a matter of life or death.

For example, an infectious disease specialist working at Johns Hopkins Hospital in Baltimore on an H-1B visa would not be able to temporarily assist Memorial Sloan Kettering Hospital in New York to address the overwhelming number of individuals seeking life-saving treatment for COVID-19. Even within their own hospitals, doctors who are approved for a certain specialty or within a certain department are concerned that they might violate the terms of their visa if they work in a different area. In the midst of a national crisis, these visa restrictions trap professionals on the sidelines when they could be supporting critical response efforts and saving patients’ lives.

Across all visa types, immigrant workers are concerned about maintaining their legal status and their work authorization during this unprecedented pandemic. As all but five states have implemented some sort of shelter-in-place order, combined with the closure of USCIS offices across the country, immigrants in temporary “nonimmigrant” status face significant challenges to completing immigration requirements and submitting materials necessary to maintain their status, as well as crushing uncertainty about whether and when their filings will be processed.

Even post-coronavirus crisis, Americans in need of medical care will undoubtedly be harmed unless the current restrictions are lifted, because many qualified medical professionals will struggle to secure a visa in the first place. This is due to the limited number of H-1B visas available (in FY21, there were 275,000 applications for only 85,000 spots), the extraordinary wait times for green cards (more than a decade in some cases) and limited opportunities for medical school graduates to stay in the country after finishing their education and training, not to mention the difficulty of navigating state and local licensing requirements.

Without action, the U.S. will not only lose physicians who could help fight the COVID-19 crisis and save American lives today, but will continue to lose them in the long-term, as foreign-born health care professionals seek work in other countries, such as Canada or Australia, which have more welcoming immigration programs.

The Trump Administration, through the Department of Homeland Security (DHS) and its components like USCIS, should take immediate steps to allow immigrant health care professionals to help fight COVID-19 and save American lives.”

Solutions

The Trump Administration, through the Department of Homeland Security (DHS) and its components like USCIS, should take immediate steps to allow immigrant health care professionals to help fight COVID-19 and save American lives. Many of the steps we recommend are adapted from immigration lawyer and former chair of the International Medical Graduate taskforce Greg Siskind, who recently outlined an extensive list of action items for the Administration to this effect.

1. Waive deadlines and automatically renew status/work authorization for those with status expiring soon. First, we must provide flexibility and certainty for foreign-born health care professionals living and working in the United States today. For all individuals whose status is set to expire soon, USCIS should waive all pending deadlines and automatically renew their legal status and work authorization for at least three months after the end of the President’s declared national emergency. This is not unprecedented, as in fact the State Department announced action like this on April 2 to extend status for J-1 visa holders with upcoming expiration dates so they can complete their education and training. Immigrants should not be forced to sacrifice their health, safety, or compliance with national guidelines in order to meet immigration deadlines.

2. Waive bureaucratic requirements, prioritize filings for health care professionals. For health care professionals specifically, the goal should be to enable medical professionals to work where they are needed most as quickly and efficiently as possible. Federal agencies should prioritize adjudicating filings from health care professionals, and waive requirements that would delay issuing work authorization, including fees, interviews, and items like supplemental forms.

3. Allow health care professionals on H-1B visas to temporarily work at different worksites or for different employers if supporting COVID-19 response. USCIS should also issue guidance or implement new policy allowing health care professionals on an H-1B visa to serve at a different worksite or work for a different employer; recognizing the critical importance of ensuring the food supply, a similar policy was just announced for H-2A workers in agriculture.

To address the immediate shortage, Congress should pass the Healthcare Workforce Resilience Act, a bipartisan bill that recaptures unused visas and makes them immediately available to qualified doctors and nurses ready to start working.”

These steps would address some limitations of current policy, but broader steps are needed to address the national shortages America faces for doctors and nurses. This requires streamlining the permanent residency process for health care professionals, many of whom have to wait years, or even decades, to receive a green card.

4. Pass the Healthcare Workforce Resiliency Act to expedite green card process for physicians and nurses. To address the immediate shortage, Congress should pass the Healthcare Workforce Resilience Act, a bipartisan bill that recaptures unused visas and makes them immediately available to qualified doctors and nurses ready to start working.

5. Extend and expand the Conrad-30 Program to retain U.S.-trained physicians. To direct professionals to U.S. communities with the highest need, Congress should extend and expand the Conrad-30 program, which allows international medical graduates to begin working in the U.S. after finishing their training here, instead of having to return home for two years, so long as they commit to working in a rural hospital for five years. This program is a key tool for retaining physicians who were trained in the U.S. and will save countless lives.

6. Drop Supreme Court appeal to end DACA and pass the American Dream and Promise Act to provide certainty to DACA and TPS recipients. Finally, it’s important to note that more than 40,000 Deferred Action for Childhood Arrivals (DACA) recipients and 11,600 Temporary Protected Status (TPS) holders are serving courageously in frontline health care occupations during this crisis. Ending these programs in the midst of a national emergency would deal a catastrophic blow to efforts to fight the pandemic and further devastate the economy, and will cost lives. Failing to provide a pathway to this population, especially as the U.S. is at risk for future pandemics, could be extremely harmful to the health of every U.S. resident. The Administration should drop its appeal to the Supreme Court to end the DACA policy, and the Senate should pass the American Dream and Promise Act so DACA and TPS holders can finally secure legal status.

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