Changes Needed to Strengthen Immigrant Health Care Workforce, Senators Say

WASHINGTON — Senators on both sides of the aisle acknowledged Wednesday that the immigration system remains problematic when it comes to recruiting and retaining immigrant health care workers, but they disagreed on what needs to be done about it.

“Even as we face unprecedented shortages in our health care system, laws that limit the immigration of highly skilled health care workers have remained largely unchanged since the 1990s,” said Sen. Alex Padilla (D- California), chairman of the Senate Judiciary Subcommittee on Immigration, Citizenship, and Border Security, said during a subcommittee hearing on “Flatlining Care: Why Immigrants Are Crucial to Bolstering Our Health Care Workforce.”

“There are still significant backlogs in processing green cards for essential healthcare workers. There are annual caps for employment-based visa categories that have not been met, and caps per countries that should be updated to meet the demands of today’s healthcare industry,” he noted.

Workers face uncertainty

Padilla said he and fellow committee member Sen. Dick Durbin (D-Ill.) introduced the Citizenship for Essential Workers Act, which would allow essential healthcare workers who have worked during the pandemic to COVID-19 to apply for and obtain permanent resident status. The bill also allows applications for permanent resident status from parents, spouses and children of eligible immigrants who have died of COVID-19.

“Many federally recognized central workers we relied on during the height of the COVID-19 pandemic are still at risk of being uncertain about their legal status in America,” Padilla said. “In this hour of need, the United States is effectively discouraging potential healthcare workers from trying to come to work in the United States. That needs to change.”

But Sen. John Cornyn (R-Texas), a ranking member of the committee, didn’t see it that way. “I can’t imagine a way forward until we find a way to deal with the crisis at the border, which is basically a political issue because of the way asylum claims are processed,” he said. he declared. “At some point we will have tried everything except the real solution to the problem – which will break the deadlock – which is to solve the problem of capture and release and the broken asylum system at the border. So maybe we can take care of things” like the bills that affect immigrant health workers.

The experience of an immigrant doctor

Subcommittee members heard from Ram Sanjeev Alur, MD, a hospitalist at Marion, Illinois Veterans Affairs Medical Center. “I came to the United States in 2007 on a J1 visa as an exchange visitor from India for my medical residency training,” he explained. “Exchange visitors are generally required to leave the United States and return to their home country after completing their residency, unless they can obtain a waiver of this requirement through a commitment to work in a underserved area for 3 years. I chose to work in an underserved area and was lucky enough to get a waiver to stay in the United States.”

However, Alur said, he and his family had difficulty staying in the United States. “Doctors like me get a temporary work visa called H-1B,” he said. “The H-1B visa only allows us to work in a specified location. Any work outside of the specified location is considered a violation of a work permit.” He noted that during the pandemic, he was unable to respond to numerous calls for reinforcements for nearby hospitals because visa requirements did not allow him to.

“The H-1B visa allows me to legally stay in the country with my family due to my valid non-migrant worker status,” he added. However, “if I can’t work, we can’t stay. This lack of protection with death or disability on the front lines is every temporary visa worker’s nightmare. The H-1B visa makes also difficult for us to travel outside of The last time my wife and I saw our aging parents was in 2019… My application for permanent residence was approved in 2016 because it was in the national interest based on my work at the VA however we still have to wait for an immigrant visa number or green card to become available and I have been waiting 6 years, working 11 years and been in the country for almost 15 years. My wait could be another decade or more.

Legislative solutions

Sarah Peterson, an attorney at an immigration law firm in Minneapolis, described other problems with the system. The country’s doctor shortage “is well documented and continues to grow due to a variety of factors, including our aging population, which is increasing both the number of people seeking care as well as the number of doctors ready to retire.” , she said. “Over the next decade, more than two in five practicing physicians will be 65 or older. This crisis is only compounded by the growing COVID exhaustion of our frontline workers.

Additionally, “more than 95 million people live in health care shortage areas — that’s one-third of the United States,” Peterson noted. “That number will continue to grow. And by 2034, the United States will face a shortage of up to 124,000 doctors.”

Although current laws “provide for a small number of Conrad J1 [visa] waivers allowing doctors to stay in the US based on their work in underserved communities, each state only receives 30 Conrad J1 waivers each year, which is simply not enough. Additionally, our laws should encourage and reward international doctors who work in underserved communities by removing numerical quotas,” she added.

She advocated for passage of two bills, both sponsored by two parties: the Healthcare Workforce Resilience Act and the Conrad State 30 and Physician Access Reauthorization Act. The first bill would make previously unused immigrant visas available to nurses and doctors who apply for such a visa no more than 90 days after the end of the COVID-19 public health emergency, while the second bill legislation would give states the ability to grant Conrad J1 visa waivers based on need, rather than limiting them to a specific number.

“Last year alone, more than half of the states completely exhausted their supply of Conrad J1 waivers, leaving needy Americans without access to health care,” Peterson said. “Physicians who do not have a Conrad waiver in most cases must leave the United States potentially never to return.”

Padilla concluded the hearing by saying that Congress was capable of solving both the problems at the US border and the problems with immigrant labor. “We can do both and we have to do both,” he said. “For the 95 million Americans living in places where there is a shortage of healthcare professionals, we cannot afford to wait. It is not just health, but lives that are at stake. .”

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. Follow

Michael A. Bynum