Easing IMGs’ path to practice: What Congress should do

International medical graduates (IMGs) play a critical role in the delivery of health care services in the U.S., but they face numerous challenges to train and practice here.

There is much Congress can do legislatively, and that President Joe Biden can do administratively, to provide a smoother pathway for IMGs to continue to practice here and provide care to patients.

The care IMGs provide is desperately needed as the U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 (PDF), a report released by the Association of American Medical Colleges.

There are almost 325,000 IMG doctors practicing in the U.S., which accounts for around 25% of the physician workforce, according to the AMA Masterfile. 

Next week the AMA marks IMG Recognition Week to honor and celebrate IMG physicians who are a vital component of the U.S. physician workforce and the AMA. Register for “Considering a Fellowship?  Learn about FREIDA^TM, the AMA Residency and Fellowship Database,” an Oct. 17, 7 p.m. Central webinar sponsored by the AMA IMG Section.

The AMA highlighted the vital role IMGs play in the U.S. health care system and detailed the challenges they face in a statement for the record (PDF) submitted to the U.S. Senate Subcommittee on Immigration, Citizenship and Border Safety as part of a hearing entitled “Flatlining Care: Why Immigrants Are Crucial to Bolstering Our Health Care Workforce.”

“The AMA is committed to ensuring that there is proper access to physicians for all patients and that physicians are well supported in their role as leader of the health care team,” the statement says. “If immigration barriers for physicians are reduced, it will help to increase the number of physicians in the U.S., which will lead to healthier communities and ultimately a healthier country as access to much-needed medical care increases.”

The H-1B visa program was established by Congress to provide an avenue for employers to hire a skilled foreign worker in a specialty occupation. “H-1B physicians fulfill a vital and irreplaceable role,” the AMA statement says.

Yet IMGs with H-1B status face many restrictions in where they are allowed to work. If any employer needs them to work at multiple locations, they must complete a lengthy and costly petition process. The statement describes how, during the COVID-19 public health emergency, H-1B IMGs have been furloughed or seen their practice settings close and have not been allowed to work elsewhere at a time when their services are greatly needed.

“It would be greatly beneficial 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 and for other public health emergencies that may arise,” the AMA statement says.

Similarly, when physicians with nonimmigrant J-1 visas—which are for visitors involved in work or study programs—were surveyed in 2019, 63% of male respondents said visa and immigration concerns were among the top issues impacting their well-being.

Over the past two years, many IMGs have come close to, or completely missed, their residency start date, putting their training spot in jeopardy as U.S. Citizenship and Immigration Services average processing times have increased by 46% over the past two fiscal years and 91% since fiscal year 2014.

This could be mitigated administratively by granting premium processing rights or some other expedited processing for J-1 physicians, the AMA statement says.

These physicians are “already serving our communities and saving lives as we speak,” said Sen. Dick Durbin, chair of the Judiciary Committee, in his opening remarks at the hearing. “Many of them, unfortunately, due to the lack of available green cards, are forced to remain on temporary visas.”

The Illinois Democrat touted two bills he is co-sponsoring with bipartisan support, and they were among several discussed in the AMA statement.

The “Healthcare Workforce Resilience Act” (PDF) (H.R. 2255/S. 1024) 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 U.S. patients retain access to care. This bill, which is supported by the AMA, is co-sponsored by Durbin and Texas Republican Sen. John Cornyn.

The AMA supports the “Conrad State 30 and Physician Access Reauthorization Act” (PDF) (H.R. 3541/S. 1810), which would reauthorize the Conrad 30 waiver policy for an additional three years. The Conrad 30 program allows resident physicians working in the U.S. on J-1 visas to remain in the U.S. without having to return to their home country if they agree to practice in an underserved area. This Durbin bill has 13 Republican co-sponsors.

The “Physician Shortage GME Cap Flex Act” is bipartisan legislation the AMA supports that would provide teaching hospitals with an additional five years to set their Medicare GME cap if they establish residency training programs in primary care or specialties that are facing shortages. 

“Ensuring access to a robust, uninterrupted front-line health care workforce is critically important,” the AMA statement says. “The AMA believes that the U.S. should promote an increase of IMGs and that current IMGs should not be hampered by additional unnecessary regulations in the midst of working to recover from COVID-19.”

The AMA opposes immigration policies that create unnecessary stress for IMG physicians and their families—especially those that exacerbate the physician workforce shortage and further limit the ability of certain non-U.S. citizen IMGs to receive a visa or green card.

During the 2022 AMA Annual Meeting in Chicago, the House of Delegates directed the AMA to lobby Congress and the Biden administration so that the J-1 visa waiver physicians serving in areas with limited access to health services be given the highest priority in visa conversion to H-1B visas and in turn to green cards upon completion of their service commitment obligation and be exempted from the per country cap of H-1B to green card visa conversion.

The AMA has adopted a wide range of other policies to support IMG physicians, including a set of underlying principles on IMGs that drive much of the organization’s policy advocacy.

Check out this collection of resources from the AMA International Medical Graduates Section, including the IMG Physician Toolkit.