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Foreign doctors may lose U.S. jobs after visa program.

Much of the drama surrounding the Trump administration's immigration policy has centered on the so-called travel ban, but changes to a specialized visa program may have a bigger impact on foreign doctors in the United States and the employers who hope to hire them.

Starting April 3, U.S. Citizenship and Immigration Services (USCIS) temporarily suspended its expedited processing of H-1B visas, a primary route used by highly skilled foreign physicians and students to practice and train in the United States.

Under the existing "premium processing" system, foreign medical graduates--usually sponsored by a U.S. institution--pay an extra $1,200 when submitting an H-1B petition to ensure a response from USCIS within 15 days. Standard processing of H-1B applications takes 6-10 months. USCIS is terminating the expedited reviews for up to 6 months to address long-standing H-1B petitions and to reduce backlogs, according to a March announcement by the agency.

In the meantime, many foreign medical students and physicians will lose top training spots and jobs as their H-1B applications linger in the system, said Jennifer A. Minear, a Richmond, Va.-based attorney and national treasurer for the American Immigration Lawyers Association.

"The physicians coming into the U.S. who are accepted into residencies or fellowships ... are the top of the top for medical graduates around the world," Ms. Minear said in an interview. "Most of them who stay afterward wind up working in underserved areas of the United States."

Uncertain futures

The H-1B processing change has left Amr Marawan, MD, unsure about whether a job offer may fall through and whether he will be able to work in the United States at all over the next year.

Dr. Marawan, a native of Cairo, Egypt, will finish his internal medicine residency at the University of Tennessee, Chattanooga, in June and had planned to pursue a cardiology fellowship under a continuation of his J-1 alien physician visa. After the 2016 election, he decided instead to take a position as assistant professor of internal medicine at Virginia Commonwealth University (VCU) in Richmond.

Among his reasons: A J-1 visa requires foreign trainees to return to their home country for 2 years after the completion of their training. With that requirement, he said that there would be a gap in his career progression and that he might face challenges returning to the United States. However, if Dr. Marawan accepted the job at VCU and received approval to waive the 2-year home country requirement from the Virginia Department of Health and the U.S. Department of State, he could apply for a 3-year H-1B visa through the premium processing program.

To get the home country requirement waived, physicians must agree to be employed full time in H-1B status at a health care facility within a designated health professional shortage area, medically underserved area, or medically underserved population.

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"The main reason I switched my plan was, after the presidential election, there was a lot of talk about changes to visas, so I thought it might be better to take this step now and do the waiver, and hopefully this will help me to be more secure while working in order to pursue my medical career," Dr. Marawan said.

Like many foreign doctors. Dr. Marawan now faces a conundrum. His J-1 visa expires in June and his position at VCU is slated to start in July. But the premium processing program terminates in April. If forced to wait the typical 6-10 months for standard processing, he may lose the position.

"There's no way we can finish the [state approval] before June," he said. "And now if we wait and file the H-1B in June, it will take months to get approved. During that time, I cannot work."

Immigration attorneys have been inundated with similar stories and concerns by physicians regarding how to move forward after the H-1B premium processing suspension, said Adam Cohen, a Memphis attorney USCIS has delayed premium processing in the past but not to this extent, he said. This change "was dropped on us with no warning, and it's left us with less than a month to get all of these H-1B [applications] together," he said.

Foreign physicians and students are scrambling to file their H-1B petitions before the deadline, but there is no guarantee that the applications will be expedited, Mr. Cohen added. It's possible USCIS will be unable to get to every application and will simply refund the premium processing fee, he said. The applications would then be subject to standard processing.

USCIS says the suspension will help to address the accumulation of older applications, but the change will only shift the backlog, according to Washington attorney Allen Orr Jr.

"It's incomprehensible and indefensibly the reason why they are suspending the process," Mr. Orr said in an interview. "It's just creating a new backlog for no reason. The only line of visas that is being suspended for premium possessing are H-1B visas. ...The biggest impact of stopping this program [is that it] really hurts hospitals and American institutions."

Bureacratic challenges prevail

Medical students applying for residencies and fellowships may also be detoured by the premium processing ban. Students who planned to train under an H-1B visa had to wait until Match Day on March 17 to file their H-1B petitions, Ms. Minear said. There is little chance they can complete all paperwork and state approvals needed in order to submit an H-1B application before April 3.

"What this really means is that physicians effectively cannot do their residencies or fellowships in H-1B status this year because they cannot file the petitions in time for a July 1 start date," Ms. Minear said. "Effectively, what it does is force all foreign doctors who want to do residency or fellowship in the U.S. to do their training in J-1 status."

A large number of foreign medical students already complete their training in J-1 status; however, many residency and fellowship programs agree to sponsor students in H-1B status as an attractive recruiting incentive for top talent, Ms. Minear said. Foreign doctors often prefer the latter status because they are exempt from the 2-year requirement to return home.

Foreign medical students matching to residency programs generally have the option to apply for a J-1 visa and can still train in the United States, said Matthew Shick, government relations director for the Association of American Medical Colleges.

Medical students applying for J-1 visas may experience processing delays because of President Trump's March 6 Executive Order on immigration. A provision in that order increases uniform screening procedures for all visa classes and nationalities, while another provision suspends the Visa Interview Waiver Program. The suspension means that certain visa applicants seeking to renew a visa must be interviewed in person by a consular officer. The Hawaii federal court that blocked much of that Executive Order did not halt the additional screening requirements or stay the Visa Interview Waiver Program rollback. Both provisions remain in effect.

In the current climate, a move to J-1 status may not be the easiest shift, said Kristen Harris, a Chicago-based immigration attorney and advocacy cochair of the International Medical Graduate (IMG) Taskforce. "It is reasonably foreseeable ... that this year it will be more challenging than in prior years for an incoming Match applicant to arrive on time at their GME program on July 1, even with the J-1 path," Ms. Harris said.

Dr. Marawan, meanwhile, is exhausting all efforts to keep his job offer. He is considering the option of filing an H-1B application now, before his state approval comes through, in the hopes of securing premium processing, he said. However, the option comes with a catch. Foreign doctors can file an H-1B petition without a J-1 waiver, but they can't request a change of status from J-1 to H-1B without leaving the United States unless they have the waiver. This means if Dr. Marawan's petition is approved by USCIS, he must go back to Egypt to apply for an H-lB visa at the U.S. Embassy in Cairo.

Under these circumstances. Dr. Marawan said, he is concerned.

"Egypt is not included in the travel ban, but there's a lot of stories of people who are getting their visas rejected for different reasons. It's worrisome."

agallegos@frontlinemedcom.com On Twitter @iegal_med

Caption: MR. COHEN

Caption: MS. HARRIS

Caption: DR. MARAWAN

Caption: MR. ORR
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Title Annotation:PRACTICE ECONOMICS
Author:Gallegos, Alicia
Publication:Clinical Psychiatry News
Date:Apr 1, 2017
Words:1399
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