State Department cap on EB-3 visas limits international relief for nursing shortage

International nurses hoping to apply for a green card to work in the U.S. will likely have to wait until 2025 before they can make the move due to a recently imposed cap on new EB-3 visa petition filings, advocates and immigration law experts warn.

The U.S. Department of State’s Bureau of Consular Affairs has announced in its May bulletin a visa retrogression for its EB-3 subcategory, which includes all occupations that require at least an associate’s degree but not a master’s degree.

Because demand for the subcategory’s green cards has hit its 40,000-green card annual limit for the fiscal year, only applicants with petitions filed earlier than June 1, 2022, may continue with their applications, according to the notice.

The news has sounded alarms for the American Association of International Healthcare Recruitment (AAIHR), a nonprofit advocacy group focused on international recruitment of foreign-educated healthcare professionals.

“American hospitals, particularly those serving rural populations, would have collapsed long ago without the contributions of international nurses,” Patty Jeffrey, AAIHR’s president, said in a recent release. “… Visa retrogression amounts to a catastrophic interruption of the stable flow of healthcare talent to the bedside, and it will be felt acutely by ordinary patients, from pregnant mothers to dialysis patients.”

EB-3 is the only application option available to the vast majority of international nurses, barring some advanced practice nurses that may have other visa options available to them, Chris Musillo, an AAIHR-affiliated immigration lawyer and managing partner at Musillo Unkenholt Immigration Law, told Fierce Healthcare in email comments.

The subcategory is largely dominated by IT workers, who are also in high demand, and is inclusive of a worker’s spouses and children, Musillo said. Further, the 40,000-person annual limit on EB-3 green cards has remained unchanged since 1990, he said.

Musillo expects that the 10-month timeline for applicants outlined by the department is likely to increase with a retrogression effective on day one of the 2024 fiscal year. As a result, international nurses who petition for a visa this summer are unlikely to enter the country before 2025 at the earliest, he said.

The State Department does not publish data on how many of its approved visa applicants are nurses, Musillo said, though he noted that there are roughly 150,000 new nurses joining the workforce every year and that 15% of the country’s total is educated abroad.

The green card logjam comes at a time when hospitals and other provider organizations across the country are desperate for more hands on deck.

Recent survey data from the National Council of State Boards of Nursing suggest that nearly 100,000 registered nurses left the profession during the COVID-19 pandemic and almost 800,000 more believe they’ll join them by 2027. Meanwhile, hospitals say their workforce expenses have increased more than 20% from 2019 to 2022 due to the shortage, which has forced some to limit care services.

“As COVID burnout and historic Baby Boomer retirements continue to squeeze hospital staffing, the international talent pipeline is more important than ever,” Jeffrey said.

Musillo said that the executive branch has no discretion when it comes to potentially increasing the annual cap. Because Congress is required to amend existing statutes, he and AAIHR pointed to the bipartisan Healthcare Workforce Resilience Act (S. 1024) (PDF) introduced during the last Congress as the most promising vehicle for change. The bill, which was widely supported by provider groups, would need to be reintroduced in the current session.

In February, the Senate Health, Education, Labor and Pensions Committee held a hearing to explore approaches to bolster the clinical workforce, though it largely focused on domestic programs such as expanding the Graduate Medical Education program, reviewing education requirements for nursing educators and increasing scholarships and student loan debt forgiveness.