VA faces delays filling physician posts

Many Veterans Affairs Medical Centers depend heavily on international medical graduates to staff their physician ranks. But a cap on the commonly used H-1B visa has forced some VA facilities to postpone putting these physicians to work until Oct. 1, when work visas will become available for fiscal 2005.

The delays are putting additional strain on the VA health care system, which is already experiencing physician shortages, particularly among specific specialties. Experts say that without an act of Congress to expand the visa supply, H-1B visas for 2005 could be devoured even more rapidly than in 2004, when the allotted 65,000 were gone by Feb. 17.

The previous annual limit had been set at 195,000, but pressure from growing unemployment within the technology sector brought the cap down to 65,000.

"It is true the 65,000 annual limit on H-1B visas has adversely affected VA recruitment," said Karen Fedele, public affairs specialist for the Dept. of Veterans Affairs, in an e-mail. "There is a shortage of physicians in most categories, and the non-citizen physician can be a critical part of VA's care."

Most IMGs work in the United States under an H1-B technology professions work visa or a J-1 student visa. Physicians renewing H1-B visas were not affected by the limit, and those working at educational institutions were exempt. But VA hospitals were not free from the cap.

"This was never an issue until now," said Robert Aronson, an immigration attorney and partner of Inger & Aronson in Minneapolis. "We never got close to the 195,000 cap. It's only since Oct. 1, 2003, that [people] started thinking about it."

Aronson said he was aware of several situations at the VA in which staffing was disrupted because of the lack of H-1B visas. While the Veterans Health Administration, which oversees VA medical centers, declined to comment for this story, several human resource employees confirmed that the cap had forced them to leave some physician positions unfilled.

Typically, training for medical residents ends June 30, with new hires starting July 1. Because there are no H-1B visas available until Oct. 1, VA hospitals with IMG physician candidates can't start them until the H-1B visas for fiscal 2005 are issued.

As of the end of fiscal 2003, Fedele said, the VA employed 9,381 full-time physicians and 5,147 part-time physicians. As of Sept. 20, 2003, there were 1,438 non-U.S.-citizen physicians working for the VA. Over the past five years, the VA has hired anywhere from 100 to 200 IMGs annually who are applying for H-1B visas.

Fedele, spokeswoman for the Dept. of Veterans Affairs, gave this illustration of the situation. "Among the specialties that are most difficult to recruit are radiological and surgical," she said in her e-mail.

"When VA cannot obtain a visa for a radiation oncologist or an anesthesiologist, access to cancer care and surgical care may be compromised."

Meanwhile, hiring U.S. medical graduates, who are not constrained by visa limitations, has become increasingly challenging, said Bill Booher, executive director of the National Assn. of VA Physicians and Dentists.

"They have not had a pay increase other than cost of living in 13 years, and it's very difficult to attract quality doctors when you are not being competitive in pay or benefits," he said.

A bill to raise VA physician and dentist salaries was introduced this summer and is expected to be sent to the Senate for a vote in early September. According to the bill, income for some specialties lag behind the market as much as 35%. The bill would raise pay for VA physicians and dentists to within 10% of an average private or academic salary. For example, annual pay for a VA internist with 10 years experience could climb from $142,682 to as much as $156,200.