Arizona doctor sees immigration bill as a hope for himself, others

Congress is debating whether to allow more foreign doctors to get into the country on temporary visas and whether to let more stay here permanently.

By Elaine Monaghan — Posted June 19, 2006

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For months now, Alok Sharma, MD, an Indian internist practicing in underserved Arizona, has been picturing his green card, a precious paper that would finally let his wife start her medical residency and give his family permanent status 10 years after arriving in the United States.

Lately he has had an even bolder fantasy: that he could start his own practice, something he cannot even imagine now with his temporary H-1b visa, which will expire in three years.

Now this physician couple's fate is in the hands of Congress, where the Senate breathed life into their long-shelved plans last month when it approved an immigration bill that could vastly improve Dr. Sharma's chances of making America his permanent home.

The measure would exempt specialists from a cap on green cards. It also would increase from 7% to 10% the portion of green cards handed out to skilled workers from any one country, helping Indian and Chinese doctors in particular because they have had to compete with so many hi-tech workers from their homelands, said Greg Siskind, a founding partner of a Memphis, Tenn.-based immigration law firm, who has studied the bill.

"I have lived and dreamed about this for the whole of the last six months," Dr Sharma said in an interview from Somerton, Ariz., where he serves as a staff internist at Sunset Community Health Center. Lobbyists are hard at work trying to ensure that the provisions survive lawmakers' negotiations to iron out differences between the Senate and House bills. The House version focuses on stemming the flow of illegal crossings rather than helping legal immigrants stay.

Dr. Sharma is with an ad hoc group of immigrants of various professions that won the Senate amendments aimed at securing their foothold here. Supporters of the provisions argue that the changes would help ease a shortage of specialists here, particularly in rural areas.

In addition to the green card provisions, the bill includes an increase in the number of physicians and people in technical professions who can enter the country on H1-b visas. It also would make permanent a special J-1 visa program that allows 30 immigrants into each state for graduate medical education, Siskind said.

Immigration "ground zero"

Paradoxically, on arriving in the United States as a legal immigrant, Dr. Sharma found himself in what he calls the medical "ground zero" of illegal immigration. The issue has touched every part of his professional life.

Dr. Sharma recalls a day five years ago when the border patrol brought a half-dozen men with hypothermia to Kino Community Hospital in Tucson, Ariz. The facility is near one of the spots used by "coyotes," people who smuggle illegal immigrants into the country.

Working in the emergency department at the time, Dr. Sharma tried to help raise one man's temperature, knowing it was hopeless.

"The crushing part of the story was that his brother was among the living. I can still remember how he just broke down and cried and cried, a 30-something guy. I asked him what he would do. He said I don't know, but we paid so much to get here and I'm just going to try to work to pay back the debt we incurred getting here."

Often a place to turn for the underinsured, uninsured and illegal immigrants, the hospital has since closed. This happened despite the efforts of Richard H. Carmona, MD, MPH, who was its medical director from 1994-99 and subsequently became the U.S. surgeon general. (See correction)

In recent weeks, Dr. Sharma has paid attention to the activity at San Luis, Ariz., 11 miles away from his clinic, where National Guard troops sent in by President Bush have been strengthening protections against illegal crossings.

But mostly these days Dr. Sharma is focused on his own immigration status, which currently robs his wife Poonam, who also is qualified as a physician in India, of a chance to work, and limits the future of their 4-year-old twin boys, Adi and Puru.

Without permanent residency status, he cannot take out a loan and his spouse is barred from following her profession because his visa allows him to bring his family but does not allow his spouse to work. He also is restricted in jobs he can take despite having trained at the prestigious Armed Forces Medical College in Pune, Maharashtra in India, worked five years in a mountain commando unit in the Himalayas and won a commendation, a rare honor for an Indian Army medic.

The fight ahead

As potential beneficiaries of the Senate bill, this family is far from alone.

"The Senate bill is great," Siskind said. "It's going to provide a lot of relief." But he predicted there would be a "knockdown, drag-out fight" with the House, where he said there were many opponents of all forms of immigration who would "do it to the doctors like they would to any other group."

But Siskind anticipates that the raft of pro-legal immigration provisions that impact physicians will survive the House-Senate negotiations, partly because they have support from prominent Senate Republicans Sam Brownback of Kansas and John Cornyn of Texas.

The American Medical Association hasn't taken a position on the legislation pending further study. Bernd Wollschlaeger, MD, chair of the AMA's International Medical Graduate Section, speaking for himself because the body has also not taken an official position, said the section always welcomed openings for IMGs to work in the United States through both visa programs, while taking care not to hurt health care access in their home countries.

"We consider that an opportunity to provide services for underserved medical areas," he said. Bearing in mind specialist shortages here, he added: "We should judge according to specialties and not country of origin."

Dr. Sharma feels exactly the same way. "I am enjoying my work as an internal medicine physician. I do the regular job any doctor does. There's no problem with that. But I cannot plan for my future or for the future of my family," he said.

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Easing immigration

The Senate immigration bill would make it easier for foreign doctors to come to the United States. It would:

  • Make permanent the Conrad 30 J-1 visa program that allocates immigrant physicians to medically underserved areas.
  • Increase the annual cap on H-1b visas, used by international medical graduates, to 115,000 from 65,000 and create an exemption to the cap for physicians certified based on postdoctoral training and experience in the United States.
  • Increase from 7% to 10% the portion of skilled workers of any given nationality that can get green cards.

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This story originally incorrectly reported that Kino Community Hospital had closed. The facility did not close but switched ownership and is now known as University Physicians Healthcare Hospital at Kino Campus. American Medical News regrets the error.

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