Doctors and other health care workers who are not U.S. citizens are facing a second challenge as they fight one of the worst pandemics the nation has ever seen: Ensuring their paperwork will allow them to work in the United States.
The nation can ill afford to lose any health care workers right now, yet foreign-born doctors, nurses and other workers could lose their jobs and their right to remain in the United States if their papers aren’t in order.
It’s a growing problem, say health care professionals.
“Health care workers are being drawn away from their vital work, instead busy with lawyers and human resources personnel at their hospital, working on renewing their immigration filings,” said Leon Rodriguez, the former director of the United States Citizenship and Immigration Services (USCIS).
More than 3 million of the country’s 18 million health care and social workers are foreign-born, according to a report by the Migration Policy Institute.
People already in the United States must fill out work permit applications to serve in hospitals, and keep up that paperwork going forward.
Doctors who’ve finished a residency program in the United States and wish to transition to full-time work are on the front lines of both the pandemic and the growing visa application backlog.
According to the Educational Commission for Foreign Medical Graduates, 11,000 foreign-born doctors entered residency programs in 2017, leaving them on track to graduate this summer.
Doctors participate in residencies under an academic visa, but to take on full-time jobs a majority transition to the H-1B visa, the most common type of semi-permanent foreign worker visa.
It’s unclear how many of the 11,000 foreign-born residents set to graduate in 2020 want to stay in the United States to practice medicine, but in 2018, 8,731 H-1B visas were requested for general medical and hospital workers, according to Labor Department data.
The work visa application process was changed for fiscal 2020, but for doctors transitioning from their residency, there are still multiple obstacles, including a massive backlog of cases that means USCIS can take up to nine months to adjudicate an application.
USCIS has simplified some processes, notably allowing petitioners to submit previously existing biometrics rather than coming into the agency to re-scan their fingerprints, and waiving the “wet signature” requirements on a key work permit application form.
But the agency, which imposed restrictions on H-1B applications last year, has not lifted those restrictions, even for medical professionals, this year. For instance, USCIS took away the possibility of “premium processing,” a one-time payment of $1,440 to expedite adjudication, and has yet to announce a return to the popular measure.
The American Immigration Lawyers Association (AILA) filed a lawsuit against USCIS earlier this month, demanding the agency extend all filing deadlines that come due while services are restricted on account of the emergency.
Another group affected by the application slowdown are foreign medical workers trained abroad who have been accepted into U.S. residency programs.
Those doctors might never be able to take their positions given delays at U.S. consulates and embassies. Jennifer Minear, the president-elect of AILA, said there are around 4,000 doctors waiting for their visa interviews to come to the United States.
“The new crop of residents are supposed to start on July 1, and those academic medical centers that have residency programs rely on those medical residents to provide medical care. They’re not just training, they’re also treating patients,” said Minear.
According to the State Department, which closed routine visa interviews on March 20, medical personnel can still apply for visas, as their applications are considered an urgent matter.
“Examples of an urgent matter include air and sea crew, and medical personnel, particularly those working to treat or mitigate the effects of COVID-19,” reads the department’s advisory on COVID-19 suspensions.
But Minear said that order puts the onus on each mission abroad to regulate when and how it vets medical applicants, rather than a top-down directive opening the door to those doctors.
“It’s more, ‘Go talk to the post and they’ll see what they can do,’ ” said Minear.
Health care workers who rely on programs like Deferred Action for Childhood Arrivals (DACA) or Temporary Protected Status are in an even more difficult position.
The Supreme Court is set to decide the legality of President Trump‘s 2017 rescission of DACA, a decision that could render its more than 800,000 beneficiaries effectively undocumented.
According to the Center for American Progress (CAP), a progressive group that advocates in favor of DACA recipients, around 29,000 DACA beneficiaries work in the health care sector.
In a rebuttal of CAP’s report, Steven Camarota, a writer for the Center for Immigration Studies, which supports reducing legal and illegal immigration, said the 29,000 DACA health care workers are a small fraction of the country’s health workforce, and that unemployed Americans in the health care sector could make up for any lost DACA workers.
According to the Bureau of Labor Statistics, the United States will require at least 200,000 more people to join the nursing profession each year until 2026 to keep up with demand.
Fiona McEntee, an immigration lawyer in Chicago whose clients include nurses with DACA, said that simplifying medical practitioners’ immigration application processes is also an issue of fairness.
“It breaks my heart chatting to them, knowing what they’re doing, how they’re putting their lives on the line every day to protect Americans and then in return they have to worry about this,” said McEntee.