While much of the drama surrounding the Trump administration’s immigration policy has centered on the so-called travel ban, changes to a specialized visa program may have a bigger impact on foreign doctors in the United States and the employers who hope to hire them.
Starting April 3, U.S. Citizenship and Immigration Services (USCIS) is temporarily suspending its expedited processing of H-1B visas, a primary route used by highly skilled foreign physicians and students to practice and train in the United States.
Under the existing “premium processing” system, foreign medical graduates – usually sponsored by a U.S. institution – pay an extra $1,200 when submitting an H-1B petition to ensure a response from USCIS within 15 days. Standard processing of H-1B applications takes 6-10 months. USCIS is terminating the expedited reviews for up to 6 months to address long-standing H-1B petitions and to reduce backlogs, according to a March announcement by the agency.
In the meantime, many foreign medical students and physicians will lose top training spots and jobs as their H-1B applications linger in the system, said Jennifer A. Minear, a Richmond, Va.–based attorney and national treasurer for the American Immigration Lawyers Association.
Jennifer A. Minear
“As a practical matter, the percentages of physicians coming into the U.S. who are accepted into residencies or fellowships, those are the top of the top for medical graduates around the world,” Ms. Minear said in an interview. “Most of them who stay afterward wind up working in underserved areas of the United States. It really doesn’t make much sense as a policy matter to create obstacles to attracting those people to the United States that would prevent them from getting here, obtaining U.S. education, and then remaining in the U.S. and providing urgently needed care to populations that would otherwise go without.”
Changing rules, uncertain futures
The H-1B processing change has left Amr Marawan, MD, unsure if a job offer may fall through and if he will be able to work in the United States at all over the next year.
Dr. Marawan, a native of Cairo, Egypt, will finish his internal medicine residency at the University of Tennessee, Chattanooga, in June and had planned to pursue a cardiology fellowship under a continuation of his J-1 alien physician visa. After the 2016 election, he decided instead to take a position as assistant professor of internal medicine at Virginia Commonwealth University in Richmond.
Courtesy Amr Marawan
Dr. Amr Marawan
Among his reasons: A J-1 visa requires foreign trainees to return to their home country for 2 years following the completion of their training. With that requirement, he said there would be a gap in his career progression and that he might face challenges returning to the United States.
However, if Dr. Marawan accepted the job at VCU and received approval to waive the 2-year home country requirement from the Virginia Department of Health and the U.S. Department of State, he could apply for a 3-year H-1B visa through the premium processing program.
To get the home country requirement waived, physicians must agree to be employed full time in H-1B status at a health care facility within a designated health professional shortage area, medically underserved area, or medically underserved population.
“The main reason I switched my plan was after the presidential election, there was a lot of talk about changes to visas, so I thought it might be better to take this step now and do the waiver and hopefully this will help me to be more secure while working in order to pursue my medical career,” Dr. Marawan said.
Like many foreign doctors, Dr. Marawan now faces a conundrum. His J-1 visa expires in June and his position at VCU is slated to start in July, but the premium processing program terminates in April. If forced to wait the typical 6-10 months for standard processing, he may lose the position.
“There’s no way we can finish the [state approval] before June,” he said. “And now if we wait and file the H-1B in June, it will take months to get approved. During that time, I cannot work.”
Immigration attorneys have been inundated with similar stories and concerns by physicians regarding how to move forward after the H-1B premium processing suspension, said Adam Cohen, a Memphis attorney. USCIS has delayed premium processing in the past, but not to this extent, he said.
This change “was dropped on us with no warning and it’s left us with less than a month to get all of these H-1B [applications] together,” he said.
While foreign physicians and students are scrambling to file their H-1B petitions before April 3, there is no guarantee that the applications will be expedited, Mr. Cohen added. It’s possible USCIS will be unable to get to every application and will simply refund the premium processing fee, he said. The applications would then be subject to standard processing.
USCIS says the suspension will help to address the accumulation of older applications, but the change will only shift the backlog, according to Washington attorney Allen Orr Jr.
Allen Orr Jr.
USCIS spokeswoman Carolyn Gwathmey said officials cannot speculate whether they will get to every application filed before April 3.
“As noted in the agency’s announcement, we will continue to premium process form I-129 H-1B petitions if the petitioner properly filed an associated form I-907 before April 3, 2017,” Ms. Gwathmey said in an interview. “We will refund the premium processing fee if the petitioner filed the form for an H-1B petition before April 3, 2017, and we did not take adjudicative action on the case within the 15-calendar-day processing period.”
Foreign medical students face rough road
Medical students applying for residencies and fellowships may also be detoured by the premium processing ban. Students who planned to train under an H-1B visa had to wait until Match Day on March 17 to file their H-1B petitions, Ms. Minear said. There is little chance they can complete all paperwork and state approvals needed in order to submit an H-1B application before April 3.
“What this really means is that physicians effectively cannot do their residencies or fellowships in H-1B status this year because they cannot file the petitions in time for a July 1 start date,” Ms. Minear said. “Effectively, what it does is force all foreign doctors who want to do residency or fellowship in the U.S. to do their training in J-1 status.”
A large number of foreign medical students already complete their training in J-1 status; however, many residency and fellowship programs agree to sponsor students in H-1B status as an attractive recruiting incentive for top talent, Ms. Minear said. Foreign doctors often prefer the latter status because they are exempt from the 2-year requirement to return home.
Foreign medical students matching to residency programs generally have the option to apply for a J-1 visa and can still train in the United States, said Matthew Shick, JD, government relations director for the Association of American Medical Colleges. He noted that the premium processing suspension will have a greater impact on faculty, scientists, and hospital staff.
However, medical students applying for J-1 visas also may experience processing delays because of President Trump’s March 6 Executive Order on immigration. A provision in that order increases uniform screening procedures for all visa classes and nationalities, while another provision suspends the Visa Interview Waiver Program. The suspension means that certain visa applicants seeking to renew a visa must be interviewed in person by a consular officer. The Hawaii federal court that blocked much of the that Executive Order did not halt the additional screening requirements or stay the Visa Interview Waiver Program rollback. Both provisions remain in effect.
Kristen Harris
“It is reasonably foreseeable, based on the portions of the Executive Order that remain in place and based on the on-the-ground reality of State Department officials and consular officer resignations and departures, that this year it will be more challenging than in prior years for an incoming Match applicant to arrive on time at their GME program on July 1, even with the J-1 path,” Ms. Harris said.
Taskforce requests carve-out
The IMG Taskforce is urging USCIS to exempt physicians from the premium processing ban. In a March 8 letter to the agency, the task force outlined examples of how IMGs benefit the country and described how application delays could harm patient care and impair U.S. medical institutions.
“The hope is that this would encourage a review and a rethink of that shift and that upon that review, H-1B cap exempt petitions would across the board be considered for continued premium processing,” Ms. Harris said in an interview. “And/or, perhaps a greater lead time than merely 4 weeks’ notice [would be granted] so that people may be able complete their obligations.”
A group of U.S. senators also has requested that USCIS reconsider the premium processing suspension as it relates to physicians. Sen. Amy Klobuchar (D-Minn.) said that the suspension will exacerbate physician shortages, particularly in rural areas.
“The [waiver] program has helped address chronic physician shortages in rural America and other underserved areas for over two decades,” Sen. Klobuchar wrote in a March 10 letter. “We understand USCIS is facing a backlog, but USCIS has addressed this problem in the past without suspending premium processing for Conrad 30 doctors. We have every faith that USCIS can address its administrative needs without sacrificing support to this successful, time-tested program.”
Ms. Gwathmey would not comment on whether USCIS would consider an exception to the suspension for physicians. As with all affected workloads, USCIS is cognizant of processing time sensitivities for IMGs who are applying to change their status to H-1B, Ms. Gwathmey said in an interview.
“USCIS will be monitoring this workload during the coming months and will evaluate any time sensitive impacts prior to the resumption of premium processing services,” she said.
Dr. Marawan meanwhile is exhausting all efforts to keep his job offer. He is considering the option of filing an H-1B application now, before his state approval comes through, in the hopes of securing premium processing, he said. However, the option comes with a catch. Foreign doctors can file an H-1B petition without a J-1 waiver, but they can’t request a change of status from J-1 to H-1B without leaving the United States unless they have the waiver. This means if Dr. Marawan’s petition is approved by USCIS, he must go back to Egypt to apply for an H-1B visa at the U.S. Embassy in Cairo.
But with increased security delays for visa applicants and reports of foreign travelers being denied entry at U.S. airports, Dr. Marawan said he is fearful.
“Once you step out [of the United States], you never know what’s going to happen,” he said. “Sometimes visas get struck. Sometimes there’s a lot of security checks. Egypt is not included in the travel ban, but it’s always hard. There’s a lot of stories of people who are rejected getting their visas for different reasons. It’s worrisome.”
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