Immigration issues: Visas and green cards

Non-U.S. citizen international medical graduate (IMG) physicians, residents and fellows help play a critical role in alleviating the physician shortage by providing health care to many Americans, especially in communities in need as they tend to choose primary care specialties and work in areas of the country with higher rates of poverty.

Nearly 21 million people live in areas of the U.S. where foreign-trained physicians account for at least half of all physicians.

2024

• On Jan. 16, 2024, the AMA sent a letter (PDF) in support of H.R. 6980, the “Directing Our Country’s Transfer Of Residency Slots,” or the “DOCTORS Act,” which would allow unused slots from the Conrad State 30 and Physician Access Reauthorization Act to be redistributed in the following fiscal year while ensuring that every state is still provided with 30 slots each year.

• On Dec. 19, 2023, the AMA submitted comments (PDF) to the Department of Homeland Security (DHS), U.S. Citizenship and Immigration Services (USCIS) on the proposed rule “Modernizing H-1B Requirements, Providing Flexibility in the F-1 Program, and Program Improvements Affecting Other Nonimmigrant Workers.”
• On Dec. 13, 2023, the AMA sent a letter in strong support for H.R. 6205 (PDF)/ S. 3211 (PDF), the “Healthcare Workforce Resilience Act”. This bill would recapture 15,000 unused employment-based physician immigrant visas from prior fiscal years (1992-2021) and would help enable U.S. physicians to have the support they need, and U.S. patients to access the care they deserve.
• On Sept. 22, 2023, the AMA sent a letter (PDF) expressing our support for S. 2719, the “Directing Our Country’s Transfer Of Residency Slots,” or the “DOCTORS Act,” which would allow unused slots from the Conrad State 30 and Physician Access Reauthorization Act to be redistributed in the following fiscal year while ensuring that every state is still provided with 30 slots each year.
• On Aug. 4, 2023, the AMA sent a letter (PDF) expressing our support for H.R. 4942, the “Conrad State 30 and Physician Access Reauthorization Act,” which would reauthorize and make targeted improvements to the J-1 visa waiver program in a manner that helps alleviate the shortage of physicians, especially in rural and underserved areas, and promote a more diversified workforce.
• On Aug. 1, 2023, the AMA signed onto a letter (PDF) supporting the Conrad State 30 and Physician Access Reauthorization Act (S.665/H.R. 4942 ). Continuation of the Conrad 30 Program is critical for specialties that train a high number of IMGs who come to the United States on J-1 visas to complete their residency. Without a Conrad 30 waiver, these visas require this category of IMGs to return to their country of origin for at least two years before applying for another visa or green card. The Conrad State 30 and Physician Access Reauthorization Act would reauthorize this crucial program for three years, make several targeted policy improvements, and permit the gradual expansion of the number of waivers granted to each state.
• On April 6, 2023, the AMA sent a letter (PDF) urging the Administration to allow more flexibility during public health emergencies in the worksite requirements governing where international medical graduates (IMGs) in H-1B status may practice.
• On March 14, 2023, the AMA sent a letter (PDF) expressing our support for S. 665, the “Conrad State 30 and Physician Access Reauthorization Act,” which would reauthorize and make targeted improvements to the J-1 visa waiver program in a manner that helps alleviate the shortage of physicians, especially in rural and underserved areas, and promotes a more diversified workforce.

• Submitted a Statement for the Record (PDF) to the U.S. Senate Subcommittee on Immigration, Citizenship, and Border Safety as part of the hearing entitled “Flatlining Care: Why Immigrants Are Crucial to Bolstering Our Health Care Workforce.” The AMA commended the Subcommittee for focusing on the critically important issue of physician immigration and workforce shortages and emphasized the importance of IMGs in addressing this shortage.
• Cosigned a letter in conjunction with 60 national medical specialty, hospital and patient organizations urging the House (PDF) and Senate (PDF) Judiciary Committees to pass the “Conrad State 30 and Physician Access Reauthorization Act,” which would reauthorize the Conrad 30 waiver policy for an additional three years. Under the Conrad 30 program, each state is allocated 30 waivers that exempt J-1 physicians from the requirement to return to their country of origin in exchange for three years of service in an underserved community.
• Sent a comment letter (PDF) to the U.S. Department of Homeland Security (DHS) in response to the Temporary Increase of the Automatic Extension Period of Employment Authorization and Documentation for Certain Renewal Applicants temporary final rule urging the Administration to extend the temporary automatic extension to IMG physicians.
• Submitted a Statement for the Record (PDF) to the U.S. House of Representatives Committee on the Judiciary Subcommittee on Immigration and Citizenship as part of the hearing entitled “Is there a Doctor in the House? The Role of Immigrant Physicians in the US Healthcare System.” The AMA highlighted the need for additional Medicare-funded residency slots, the importance of IMGs in combating our current and projected physician shortage, and the need to prioritize IMGs during the visa process.

• Sent a letter to the U.S. House of Representatives (PDF) and the U.S. Senate (PDF) in support of the “Conrad State 30 and Physician Access Reauthorization Act.”
• Sent a comment letter (PDF) in response to a U.S. Citizenship and Immigration Services (USCIS) request for input entitled “Identifying Barriers Across U.S. Citizenship and Immigration Services (USCIS) Benefits and Services.”
• Sent a comment letter (PDF) urging the U.S. Department of Labor (DOL) to rescind or revise their Final Rule titled “Strengthening Wage Protections for the Temporary and Permanent Employment of Certain Aliens in the United States.”
• Sent a letter to the U.S. House of Representatives (PDF) and the U.S. Senate (PDF) in support of the “Healthcare Workforce Resilience Act,” which would recapture 15,000 unused employment-based physician immigrant visas and 25,000 unused employment-based professional nurse immigrant visas from prior fiscal years as a way to bolster the U.S. health workforce and ensure patient access to care.
• Sent a letter (PDF) urging the DOL to review and revoke, modify or supersede their Final Rule titled “Strengthening Wage Protections for the Temporary and Permanent Employment of Certain Aliens in the United States.”
• Sent a comment letter (PDF) opposing DHS’s final rule titled “Modification of Registration Requirement for Petitioners Seeking to File Cap-Subject H-1B Petitions,” which would negatively impact H-1B physicians and impede on the ability to provide timely, accessible health care services to rural and medically underserved communities.

• Sent a comment letter (PDF) in opposition to DHS’s interim final rule titled “Strengthening the H-1B Nonimmigrant Visa Classification Program” which unfairly discriminates against H-1B physicians.
• Sent a comment letter (PDF) urging DHS to withdraw their proposed rule titled “Modification of Registration Requirement for Petitioners Seeking to File Cap-Subject H-1B Petitions,” or exempt physicians from the proposed rule.
• Sent a comment letter (PDF) opposing DOL’s interim final rule titled “Strengthening Wage Protections for the Temporary and Permanent Employment of Certain Aliens in the United States,” which would have adverse consequences for H-1B physicians.
• 36 members of Congress sent a letter (PDF) to DHS Acting Secretary Chad Wolf in opposition to proposed changes to the Duration of Status regulations that would negatively impact J-1 physicians and the Conrad 30 program.
• Signed on to a comment letter (PDF) against DHS’s proposed rule “Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors, and Representatives of Foreign Information Media,” stating that it would disrupt J-1 physician training and worsen the U.S. physician shortage.
• Sent a sign-on letter (PDF) urging DHS to withdraw the proposed rule “Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors, and Representatives of Foreign Information Media” as it relates to J-1 IMGs.
• Signed on to a letter (PDF) urging U.S Immigration and Customs Enforcement (ICE) to exclude J-1 physicians from a proposed rule change eliminating “duration of status.”
• Published a resource guide (PDF) for IMGs following the Presidential Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak.
• Sent a letter (PDF) urging DHS to withdraw its modifications to the temporary exemptions for nonimmigrant students taking online classes due to the pandemic for the Fall 2020 semester so that medical students seeking to study in the U.S. on an F-1 visa could enter or remain in the country.
• Sent a sign-on letter (PDF) urging DOS and DHS to issue clarifying guidance related to the Presidential Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak by directing Consular Affairs to advise embassies and consulates that H-1B physicians and their dependent family members’ entry into the U.S. is in the national interest of the country.
• Sent a letter (PDF) strongly encouraging DOS and DHS to consider J-1 and H-1B IMGs and their families’ entry into the U.S. to be in the national interest of the country, so that these physicians can enter the U.S. in a timely manner and begin providing valuable medical services to U.S. patients and ease the burden on the U.S. physician workforce.
• Sent a letter (PDF) to the Senate in support of the Healthcare Workforce Resilience Act.
• Sent a letter (PDF) urging the Administration to allow J-1, H-1B and O-1 IMGs to be exempt from any future immigration bans or limitations so that these physicians can maintain their lawful non-immigrant status while responding to the urgent COVID-19 pandemic.
• Sent a letter (PDF) urging USCIS to temporarily extend visas automatically for one year and expedite approvals of extensions and changes of status for non-U.S. citizen IMGs practicing, or otherwise lawfully present, in the U.S.
• Sent a letter (PDF) urging the Administration to permit IMG physicians currently practicing in the U.S. with an active license and an approved immigrant petition, to apply and quickly receive authorization, to work at multiple locations and facilities with a broader range of medical services for the duration of the COVID-19 pandemic. The AMA also urged the Administration to expedite work permits and renewal applications for all IMG physicians who are beginning their residency or a fellowship, or are currently in training.
• Signed on to a letter (PDF) asking ICE not to change the “duration of status” model or exempt medical residents from the proposed rule “Establishing a Maximum Period of Authorized Stay for Students, Exchange Visitors, and Media Representatives.”
• Sent a comment letter (PDF) urging the DOS and DHS to open visa processing at embassies worldwide for physicians seeking to join U.S. residency programs on July 1, 2020, and publicly confirm that J-1 physicians are permitted to be redeployed to new rotations within the host training institution as needed to respond to the COVID-19 pandemic.
• Sent a letter (PDF) advocating on behalf of international medical graduates in which the AMA urged USCIS to reconsider its suspension of premium processing and instead expand the premium processing option to H-1B visas so that H-1B physicians can continue to provide invaluable health care to U.S. patients.