While U.S. politicians and pundits continue to debate a variety of options for immigration reform, the lack of immigration options for qualified medical professionals becomes increasingly problematic. The increased demand for healthcare providers created by the Affordable Care Act has already, and will continue, to put intense pressure on the healthcare industry. However, without improving the industry’s ability to recruit overseas in a meaningful way, their staffing efforts are severely hampered.
In 2006, Massachusetts enacted its own mandatory healthcare initiative and as a result, the majority of the state’s residents have healthcare coverage. However, a recent study indicates that increasing the rate of coverage has significantly increased patient wait times to access physician care. Boston has the nation’s highest average wait time to see a physician of 45.4 days vs. the overall average of 18.5 days for the entire 15 major metropolitan markets surveyed. The study, which began in 1992 in preparation for national healthcare initiatives proposed under the Clinton Administration, concludes that “Access to healthcare does not always guarantee access to a physician”. To be fair, the study demonstrated that Boston already had the highest wait times in 2004 before mandatory health care was in effect in the state, however wait times increased even further in the subsequent 2009 and 2013 results. In 2013, Boston had the highest ratio of physicians to population of all 15 metro areas surveyed.
In November of 2013, the Rand Corporation proposed in their study that creating a new model of healthcare delivery, relying more on nurses and physician assistants, could eliminate the physician shortage expected to be caused by increased demand for healthcare under the Affordable Care Act. However, the American Journal of Medical Quality’s 2012 study already projected significant nursing shortages primarily due to the aging “Baby-Boomer” population and their increasing reliance on nursing care. Therefore, it seems that transitioning to a different healthcare delivery methods will only shift, rather than relieve the staffing shortages in the health care industry.
Without a significant influx of qualified healthcare professionals into the U.S. market to fill needed positions for nursing, and physician positions, as well as options for physical therapists, physicians assistants and other technical medical specialists, the healthcare industry will continue to have a shortage of qualified and available professionals which multiple studies have determined will have a detrimental impact the quality of care.
While the Affordable Care Act includes provisions to support U.S. Medical and Nursing schools that are expected to encourage enrollment, we believe that these efforts cannot possibly be enough to increase the physician and nursing population to meet demand without also consideration for removing barriers to hiring additional international medical professionals.
The primary visa types available to healthcare employers for global staffing are the H-1B skilled professional visa, the J-1 Exchange visitor visa, the TN (Trade NAFTA Visa) and E-3 visas for Australian citizens.
Most prevalent perhaps, H-1B visas are limited to 65,000 new visas per year (bachelor’s degree holders) and 20,000 for individuals with a U.S. advanced degree. The H-1B application process for this visa requires that the employer first prove that no qualified worker could be found for the position, and employers with U.S. worker shortages such as technology, finance, healthcare and engineering already rely heavily on international skilled professionals to meet their staffing needs and compete for these limited visas. An employer may qualify as “cap-exempt” as many hospitals associated with universities or not-for-profit research organizations may be, however, while this visa type is widely used for physicians, general nurses and physician assistants may not qualify under the skilled professional requirements for the H-1B visa as a four year degree is generally not required for those positions.
Widely used for International Medical Graduates, there is no limit on the number of J-1 exchange visitor visas that may be granted each year, however, many J-1 Exchange doctors are required to return to their home country for at least 2 years before applying to return to the US. A limited number of physicians who agree to work in medically underserved areas for at least three years may be eligible to receive a waiver of the 2 year home residency requirement. However, each state may only grant 30 such waivers per year under the temporary “Conrad 30” Program.
The TN visa is limited to professionals in certain categories enumerated under NAFTA and is only available to citizens of Canada and Mexico. The E-3 category, similar in many ways to the H-1B, is only available for citizens of Australia to work in the U.S. a “professional specialty” occupation.
With a few exceptions for world-recognized physicians, these are the only visa options available to health care organizations forced to look beyond the U.S. borders to fill needed positions. Overall, it appears that by focusing all of its efforts on Healthcare Reform at the expense of Immigration Reform, Congress may have created an equally large issue, a lack of educated medical professionals in the U.S. to keep up with the ever-increasing demand for quality healthcare.