A recent change to immigration policy may keep thousands of foreign medical school graduates from beginning their residency programs on time in the U.S., leaving medical professionals fearful that clinics and hospitals may face a shortage of doctors.
Experts said Chicago area emergency rooms could see an increase in patients who were unable to receive cheaper, more timely care elsewhere.
The shortages could start as soon as this summer.
Beginning April 3, U.S. Citizenship and Immigration Services will temporarily remove the option to pay for expedited processing, known as “premium processing,” for H1-B visas. Those are temporary work visas that allow U.S. employers, in this case the hospitals and schools that train medical residents, to sponsor foreign employees in specialized fields.
The suspension, which the agency said will last six months while it works through a backlog of applicants, is unrelated to the executive order travel bans that President Donald Trump has proposed to keep nationals from six mostly-Muslim countries from entering the U.S.
For future medical residents, the change makes it nearly impossible to obtain both a professional license to practice medicine in Illinois and a visa to authorize entry to the U.S. in the weeks between being accepted into a program and starting the job.
For schools and hospitals, it means that significant portions of their incoming class of residents will not be present at the end of June, when most programs begin their training.
“It’s just a very desperate place for some programs, and program directors, to be right now,” said Dr. Suja Mathew, governor of the Northern Illinois Chapter of the American College of Physicians and Chair of Medicine for the Cook County Health and Hospitals System. “We wonder if the applicants that have been matched really have a realistic possibility of beginning training with us on time.”
Local doctors are particularly concerned about what the impact could be in the field of internal medicine, which relies heavily on foreign medical graduates to fill thousands of positions. In 2016, roughly one-third of incoming residents who filled internal medicine residency positions through the National Resident Matching Program were graduates of foreign schools.
“Each year we take about 22 residents in internal medicine, and probably 20 of the 22 are international graduates from different parts of the world,” said Dr. Nkemakolam Iroegbu, residency director for internal medicine at Presence Saint Joseph Hospital in Chicago.
Iroegbu estimated that three quarters of the residents he trains are in the U.S. with H1-B visas. He said these trainees provide primary care at Presence St. Joseph Hospital, as well as at neighborhood clinics where they are required to see patients each week.
“We could be dealing with a situation where we don’t have residents to take care of our patients both in our clinics and as well as our hospital for months to come,” Iroegbu said.
He said the shortage of physicians will translate to longer wait times for appointments, and ultimately could mean that people who are unable to get timely medical care will flood emergency rooms in hospitals throughout the Chicago area.
Some medical professionals also fear that the visa change, as well as general uncertainty over immigration policies in the U.S., could diminish the quality of candidates who seek to train in the U.S.
“The H1-B allows us to attract very high-quality applicants from around the world. It is a very desirable visa,” Mathew said. “And it also keeps people eligible for other avenues towards legal immigration later.”
Mathew and Iroegbu noted that foreign medical graduates who complete residency training in the U.S. often end up moving to underserved rural areas where there is a high need of primary care physicians. They work at hospitals that continue to sponsor their employment through H1-B visas, and later may become eligible for green cards.
Mathew said the best and brightest foreign graduates may now have second thoughts about applying for U.S. residency programs.
“Can they trust that if they were to begin their training here, that they would be allowed to complete their training here?” she said. “It is a period of great uncertainty for immigrants, even immigrants who are coming here to gain training but also to help us serve our patients.”
Citizenship and Immigration Services will still allow H1-B visa applicants to request expedited processing, but the applicant will have to prove that they meet certain criteria. Mathew said this introduces a level of uncertainty to the process that the medical field cannot withstand.
Mathew and Iroegbu said programs such as theirs may be forced to apply for a different visa type, known as the J1, which may allow trainees to come on time. However, this visa type requires immigrants to return to their home countries for two years upon completion of training. That could could leave rural and underserved communities that rely on a supply of these doctors in the dark, both said.
“I hate to think what it would be like without that pipeline,” said Dr. Iroegbu. “I can just see a disastrous five to ten years projection.”
Odette Yousef is a WBEZ reporter. Follow her at @oyousef.