Physician groups raise alarm over potential dearth of medical residents in July due to visa delays

Delays in processing visas may leave some U.S. hospitals short-staffed if residents are not available to start training July 1. (AmerisourceBergen)

Seven major physician groups sent a letter to Immigration Services on Wednesday raising the alarm about how delays in processing visas may disrupt medical residents who are scheduled to start their training at hospitals around the country in July.

The groups sent the letter to the director of U.S. Citizenship and Immigration Services expressing concern about the repercussions of delays in H-1B visa processing and the impact on patient care. The letter said non-U.S. international medical graduates who have accepted positions in the U.S. are facing increased scrutiny of prevailing wage data and in some cases have reportedly had their applications denied.

Graduate medical education training programs in the U.S. start on or before July 1. “When incoming medical residents are delayed or visas are denied, it is not only disruptive to training programs, but it impacts patient care as teaching hospitals rely on these medical residents to provide care,” the groups said in the letter.

At the Basset Healthcare Network in Cooperstown, New York, six of 10 incoming internal medicine residents are international medical graduates who depend on those H-1B visas to work at the medical center, says Douglas M. DeLong, M.D., an internal medicine physician and geriatric specialist, in an interview with Fierce Healthcare.

Those residents are scheduled to participate in a weeklong orientation in three weeks before beginning work caring for patients around July 1, says DeLong, who is chair-elect of the Board of Regents of the American College of Physicians, one of the seven groups that signed the letter. He says he got a call from Bassett’s residency program director worried that 60% of the incoming internal medicine residents may not be able to start work because of delayed visas.

Douglas M. DeLong
Douglas M. DeLong, M.D.

“We rely on those residents,” DeLong says. “It’s not just a problem in Cooperstown, New York, but a problem across the country.”

The letter was also signed by the Alliance for Academic Internal Medicine, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians & Gynecologists, the American Psychiatric Association and the Council of Academic Family Medicine.

Immigration Services did not respond to a request for comment from FierceHealthcare on the delayed visas.

Immigration Services is requesting additional evidence and in some cases denying applications that use data from the Association of American Medical Colleges (AAMC) Survey of Resident/ Fellow Stipends and Benefits Report, the groups said. The Department of Labor has data on most occupations, including physicians, but not on medical residents. As a result, the department has previously approved the use of AAMC resident stipend data for these purposes, the groups said.

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Approximately one-quarter of non-U.S. international graduates training in the U.S. do so on H-1B visas. The impact if visas for these residents are delayed or denied is significant to the physician workforce, the groups said.

The physician groups asked Immigration Services to expedite review of pending H-1B applications for international medical graduates who have been accepted to training programs to avoid unnecessary delays and uncertainty over their entry into the country. They urged the Department of Labor to continue to accept AAMC resident stipend data for prevailing wage determinations.

 “We understand that the U.S. has a legitimate public interest in conducting careful reviews of applications for visas from foreign nationals and non-U.S. IMGs [international medical graduates] cannot be automatically assumed to be exempt from such scrutiny. We hope you can reach an appropriate balance that allows non-U.S. IMGs to contribute to U.S. healthcare service needs without subjecting thfirem to unnecessary delays in the absence of specific and credible evidence,” they wrote.

Copies of the letter were also sent to the Department of Homeland Security and the Department of Labor.

“It’s so time-sensitive,” DeLong says. If visas are delayed for residents, “it’s really unclear exactly how we’re going to cope. We’ll take care of patients, of course.”

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This isn’t the first time physician groups have worried about international residents and doctors securing needed visas to work in the U.S. Concerns began last year under the Trump’s administration’s immigration ban. In 2017, there was a great deal of nervousness about whether non-U.S. citizens would be able to get the visas they need to work in the U.S. by the July 1 deadline when residency programs begin, leaving some hospitals feeling pressure to reject medical student candidates from other countries during the Match process.

Those concerns were lessened this year until residency program directors began hearing the news of visas being delayed for incoming residents.