More and more Americans are getting older and requiring more care. It is estimated that by year 2030, one in every five Americans will be at least 65 years old and by year 2020, four out of every ten patient visits will be by baby boomers. The U.S. population is also expected to grow by more than 50 million by year 2025.
In the midst of this growing and graying of the population, studies project a shortage of 125,000 doctors by year 2025. Meanwhile, almost half of the country’s physicians are at least 50 years of age. Since the education and training of a physician takes more than ten years, higher medical school enrolment will not be enough to ensure an adequate supply of doctors.
The U.S. has relied on international medical graduates (IMGs) to help meet its healthcare needs. At present, over a quarter of the nation’s physicians are IMGs who come from127 countries, most of whom were originally from India, the Philippines and Mexico.
To become a U.S. physician, an IMG faces a lengthy and complicated process that is fraught with uncertainty. Aside from having to pass the U.S. Medical Licensing Examinations and be certified by the Educational Commission for Foreign Medical Graduates, the IMG must complete a graduate medical education (GME) program in the U.S.
The IMG must be “matched” to his desired program, which could be very competitive depending on the field of medical specialty. Residency programs usually take anywhere from three to eight years. Furthermore, the IMG must obtain a license from the state medical board of his employing hospital. But before an IMG can join a residency program, unless he is a lawful permanent resident or a U.S. citizen he must be in a visa category that allows employment or training.
The immigration aspect of IMG recruitment carries with it a long history of restrictive regulations. Immigration policy was initially favorable to migration of IMG’s but things later changed and immigration rules were adopted that hampered the recruitment of many talented IMGs. Perhaps, herein lies the key to meeting the looming shortage of doctors.
For instance, the J-1 visa for exchange visitors, which is used widely used by IMGs to join residency programs, requires the IMG to depart the U.S. for two years upon the completion of his GME, or obtain a waiver of the requirement.
Compliance with the 2-year home residence rule is needed before the IMG can apply for permanent residence or change or adjust his status to another work-authorized non-immigrant status such as H-1B. The home residence requirement applies even if the IMG is eligible for an immigrant visa through marriage to a U.S. citizen.
The IMG can try to get a waiver from an interested federal government agency or a state health department or agency under a program which allows 30 waivers to be issued to IMGs annually. This is called the Conrad 30 program and it has come to be the source of 90% of waivers obtained by IMGs.
To be granted a waiver, the IMG generally would be required to work at an underserved geographic area and in a primary care specialty. Even then, given the limitation on the number of waivers under the Conrad 30 program, unless the number of waivers is increased or the home residence requirement is altogether eliminated, thousands of IMGs wishing to practice permanently after their GME will continue to face uncertainty and deal with the possibility of gong back to their home countries after years of valuable U.S. training.
The immigration reform bill now pending in the Senate contains several provisions that would end the current restrictions and make it easier for IMGs to become lawful permanent residents. Hopefully, they will be passed.