Congress Could Ease International Medical Graduate Restrictions

May 24, 2013

Research shows the value of international medical graduates practicing in the U.S. and now Congress wants to help increase their numbers.

The percentage of international medical graduates (IMGs) that make up the physician workforce in the United States has increased dramatically over the past 50 years. In 1963, IMGs represented slightly more than 10 percent of the U.S. physician workforce. Today IMGs make up a quarter of it, according to the AMA.

Still, the physician shortage and the anticipated influx of newly insured patients in 2014 is leading members of congress to believe it is time to increase the number of IMGs practicing here even further.

Just this week, the Senate Judiciary Committee approved the bipartisan "Gang of Eight" immigration reform bill.  The committee’s approval of the bill, introduced in April and dubbed The Border Security, Economic Opportunity, and Immigration Modernization Act, will send it to the full Senate for consideration. 

The bill includes provisions addressing two common visas international medical graduates obtain to train and practice in the United States: The J-1(exchange visitor) visa and the H-1B (temporary worker) visa.

The H-1B visa is the most preferred visa by IMGs, according to The United States Medical Licensing Examination (USMLE) website. IMGs may obtain an H-1B visa if they are undertaking teaching or research or they are performing direct patient care, provided several conditions are met. The H-1B visa is hard to obtain, and can be granted for a maximum of six years. During that time, however, the visa holder may change their legal status to a permanent resident if he meets certain requirements. 

The J-1 visa is for physicians who participate in U.S. clinical training programs, and it is the most common visa for IMGs, according to the USMLE website. One of the requirements for obtaining the visa is a statement confirming that the physician will return to her home country after completing training. Often the visa holder is required to return home for two years before reentering the United States in another visa category, according to the USMLE website.

Here’s more information on the bill’s provisions that relate specifically to the J-1 and H-1B:
• The bill would permanently reauthorize the Conrad 30 waiver program, which allows states 30 waivers each year exempting physicians with a J-1 visa from returning to their home country after training. To be eligible for the waiver a  J-1 visa holding physician must agree to work in a health professional shortage or medically underserved area, in addition to meeting other requirements. The bill would also increase the number of Conrad 30 waivers each time 90 percent of waivers are filled nationally, according to the Association of American Medical Colleges.
• The bill would increase the annual cap on the number of H-1 B visas for foreign workers in specialty occupations from 65,000 to 110,000, according to Modern Healthcare.

Making it easier for IMGs to practice - and stay - in the United States could be especially helpful in improving access to primary care in areas where the physician shortage is felt most deeply. IMGs are more likely than U.S. medical graduates to practice in medically underserved areas and they comprise more than 30 percent of the primary-care workforce, according to a 2010 position paper put forth by the AMA-IMG Section Government Council. 

Those trends have continued more recently. A similar position paper put forth by the AMA in 2013 noted that IMGs are typically more willing than U.S. international medical graduates and U.S. medical graduates to practice in remote, rural areas through J-1 visa waiver requirements. The report also noted that in 2011, the top five specialties among physicians with J-1 visas were internal medicine, pediatrics, family medicine, general surgery, and psychiatry.

Do you think the physician shortage will help usher in changes making the path to permanent practice in the U.S. for IMGs easier? Should it?