Congress Keeps U.S. Doctors Sidelined while Championing International Doctors

Doctors

Doctors

Congress, immigration advocacy groups and immigration lawyers are urging the Trump administration to increase the number of foreign-born doctors to alleviate the alleged medical responders’ shortage during the coronavirus pandemic. Minnesota Democratic Senators Amy Klobuchar and Tina Smith, along with colleagues in the House and Senate, wrote to U.S. Citizenship and Immigration Services requesting that the agency resume premium processing for international medical school graduates (non-U.S. citizen international medical graduates) who are seeking employment-based H-1B and J-1 visas. On March 20, USCIS announced that because of COVID-19, it would suspend premium processing.

According to the letter, more foreign-born doctors would increase health care availability, especially in rural areas, through the Conrad 30 Waiver Program, which allows U.S.-trained foreign medical school graduates to stay in the country as long as they practice in underserved areas. The “30” refers to the number of doctors per state that can participate in the program.

Traditionally, foreign national doctors who trained in the U.S. must return home for two years after their provisional period has ended before they can reapply for a new visa or permanent residency. Last year, Senators Klobuchar, Susan Collins (R-Maine) and Jacky Rosen (D-Nev.) introduced legislation to extend the Conrad 30 program through 2021. The Conrad State 30 and Physician Access Reauthorization Act, S. 948, has 15 cosponsors, eight Republicans, six Democrats and one Independent.

Americans are united in their desire to do all possible to end the spread of coronavirus. But a reality dose is in order. There are U.S. doctors ready to work who Klobuchar, Collins, Rosen et al appear to be ignoring. National Resident Matching Program (NRMP) data shows that each year since 2011 up to 2,000 current year medical school graduates and prior year graduates did not place into a medical residency at a teaching hospital. Without that residency, they cannot practice medicine.

But in that same ten-year period, more than 36,000 non-U.S. citizen international medical graduates (IMGs) received residency positions – spots that are largely funded by U.S. taxpayers through Medicare dollars. In fact, the number of non-U.S. citizen IMGs has increased each of the years since 2011, from 2,721 to more than 4,222 in 2020.

A sensible solution to the imbalance between overseas and U.S. doctors would be to reduce the number of residencies available to non-U.S. doctors which should increase residency slots for U.S. doctors.

American medical school graduates have worked hard, often taking on tremendous debt loads to earn their undergraduate and M.D. degrees. An unmatched Georgetown University School of Medicine graduate who I’ll call Dr. X, and who I interviewed for this column, told me that to obtain his medical degree he took on $50,000+/year in federal student loans to pay for his education. The cost of a medical degree at GUSOM is even higher today.

With an interest rate of 6.7 percent, Dr. X’s student loans accrue interest at more than $25,000/year and have ballooned to an aggregate that exceeds $460,000, a sum he’s unlikely to retire if he’s unable to work as a physician. Dr. X passed his U.S. medical licensing exams and has extensive medical volunteer experience, as well as other health services experience. Still, without residency, Dr. X can’t practice.

Yet, just since 2011, 36,000 foreign-born doctors are practicing throughout the U.S. even though the federal government has no regulatory authority to oversee the quality of medical education in India, Pakistan, China and Iran, the home countries of the majority of these incoming doctors.

Not only is the existing system and the proposed congressional effort to increase the total number of foreign medical practitioners unfair to American doctors, it’s unjust to the sending countries. In this current pandemic, doctors are needed in their home countries. For instance, India reported a shortage of 600,000 doctors which means that there is one government doctor for every 10,189 persons versus the World Health Organization’s recommended ratio of 1:1,000.

American doctors have the reasonable expectation that upon earning their medical school degrees, and passing their licensing exams, they’ll be able to practice their chosen profession. To shut U.S. doctors out while hiring foreign nationals violates America’s social contract with its citizens, and is a gross injustice.