House Judiciary Committee Chair Bob Goodlatte (R, Va.) speaks during a hearing on June 18 to discuss the Strengthen and Fortify Enforcement Act. House leaders are focusing their reform package on border security. Photo by AP / Wide World Photos

Will House follow Senate on physician immigration reform?

The Senate bill includes reauthorization and expansion of a doctor visa waiver program, but House leaders will craft their own package.

By Charles Fiegl amednews staff — Posted July 15, 2013

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Following Senate passage of a broad immigration reform bill in late June, House lawmakers started drafting another version of legislation that also may include provisions to assist physicians from other countries seeking to work in the U.S.

The Senate bill would improve a visa waiver and green card program for physicians, which would boost access to health care services in areas where work force shortages exist, organized medicine groups said. The Senate voted 68-32 to approve the legislation, but House Republican leaders have vowed to not let that measure proceed any further, instead working on their own immigration reform legislation.

“The House is not going to take up and vote on whatever the Senate passes,” House Speaker John Boehner (R, Ohio) said during a June 27 briefing with reporters. “We are going to do our own bill through regular order, and there will be legislation that expresses the will of our majority and the will of the American people.”

Republicans have stated concerns about providing a citizenship process for individuals who entered the country illegally. The Senate bill contains such a process that involves fines, payment of back taxes and the passing of several years before one can be awarded citizenship. The bill would increase the number of people living in the U.S. by 9.6 million, according to the Congressional Budget Office.

A House bill will have to be grounded more in border security (the Senate bill would allocate $46.3 billion to strengthen the southern U.S. border) and have the support of the majority of the Republican House caucus as well as some Democrats, Boehner said. Republicans started the process by scheduling a July 10 conference to discuss the legislative way forward.

Early support for visa provisions


Issa (R, Calif.)

House members already have introduced and debated physician-related components of what could become an immigration package. House Judiciary Committee Chair Bob Goodlatte (R, Va.) and Rep. Darrell Issa (R, Calif.) have sponsored the Skills Visa Act, which includes numerous physician provisions found in the Senate bill. Lawmakers reported that measure out of committee without the support of Democrats on June 27. Rep. John Conyers Jr. (D, Mich.), the panel's top Democrat, and his colleagues have objected to the piecemeal approach to reforming the immigration system.

The Skills Visa Act and the Senate's Border Security, Economic Opportunity and Immigration Modernization Act of 2013 would, among other changes, permanently reauthorize the Conrad 30 program. Conrad 30 allows a physician to apply for a waiver of a two-year foreign residence requirement after completing a J-1 exchange visitor program. Physicians in the program must agree to practice in communities deemed to be health shortage areas.

The American Medical Association has supported immigration reforms to increase access to health care services.

“The AMA strongly supports the permanent reauthorization of the J-1 visa waiver program and other physician-related changes to immigration law included in the Senate-passed immigration bill as well as legislation adopted by the House Judiciary Committee,” AMA Immediate Past President Jeremy A. Lazarus, MD, said. “These bills will allow international medical graduates, often called IMGs, to continue providing much needed health care to people in communities across the country.

“IMGs play an integral part in American medicine, often joining physicians in practices serving patients in rural and low-income urban areas. We also support provisions that exempt physicians from green card caps upon completion of their service requirements, require more transparency in employment contract terms, create more waivers per state for academic medical centers and establish a mechanism to increase the number of visa waivers per state.”

Removed from an initial draft of the Senate bill were recruitment and hiring regulations that the AMA opposed. The provisions would have conflicted with current processes and dissuaded employers from hiring medical graduates with H-1B visas, according to the Association.

Non-U.S. doctors fill health care gaps

The approved Senate bill, if adopted by the House, would be a victory for foreign-born physicians seeking opportunities in the U.S., said Jayesh Shah, MD, president of the American Assn. of Physicians of Indian Origin. Physicians from other countries receiving training in the U.S. at times have not been allowed to stay to work. Provisions in the legislation would offer doctors more opportunities to practice medicine in the U.S.

“Immigration reform that removes the bureaucracy surrounding work visas will enable physicians from rural areas, inner cities and everywhere in between to provide critical health care to those who need it most,” Dr. Shah said. “This is an important step in the right direction, and we look forward to educating members of Congress on the need to have permanent reforms in place for critical work visas used by hospitals and physicians.”

The Assn. of American Medical Colleges also supports the Senate-passed legislation, said Matthew Shick, AAMC senior legislative analyst. The association has sought changes to improve conditions for physicians coming to the U.S. for residency training. For instance, legislation would expand the Conrad 30 program with the addition of three waivers per state for academic medical centers.

However, these reforms probably will not address physician work shortages or increase the number of physicians immigrating to work in this country, he added. Additional support for Medicare graduate medical education slots also is needed.

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Foreign-born workers in U.S. health care

Physicians and other health professionals from foreign countries represent a sizable portion of the health care work force in the U.S. The Migration Policy Institute, a Washington-based think tank, used U.S. Census Bureau data to conclude in 2012 that workers from other countries will continue to be needed to provide health services for decades to come.

Occupation Total work force Percent foreign-born
Physicians and surgeons 853,000 27%
Therapists 665,000 10%
Registered nurses 2,684,000 15%
Technologists and technicians 2,416,000 12%
Other health care practitioners and technical occupations 1,021,000 15%
Total health care practitioners 7,640,000 15%
Nursing, psychiatric and home health aides 2,193,000 22%
Other health care support 1,295,000 13%
Total health care support 3,488,000 19%

Source: “Foreign-Born Health Care Workers in the United States,” Migration Policy Institute, June 2012 (link)

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