A successful transition from the Trump administration will be essential as America braces itself for record-breaking hospitalizations and mortality due to SARS-CoV-2. Beyond the COVID-19 Task Force of the Biden Administration, new Department of Homeland Security (DHS) leadership will also play a vital role in assuring our health care workforce’s capacity. Recently, the Biden Administration announced Alejandro Mayorkas as his pick to lead DHS. His choice signaled a move to reinstate stability after a series of rotating DHS leadership. Ironically, the DHS pick could also be a part of the solution to prevent further instability of the U.S. public health system, hit hard by the coronavirus pandemic.
Under the Trump Administration, the U.S. Immigration and Customs Enforcement is proposing to eliminate “duration of status” for certain classes of nonimmigrant visas, including J-1 visas. Under this policy, F, J, and I nonimmigrants would be admitted to the United States for a fixed, four-year maximum period, and they would be required to apply for an extension of stay should they need more time to complete their training. Replacing the current “duration of status” policy with a specific end date and the additional requirement to extend this end date annually is not feasible for many foreign front-line workers participating in medical residency and fellowship programs. Taken together, the proposed rule would effectively make pursuing fellowship training difficult for many J-1 physicians as completing a fellowship in addition to a residency can take 5-7 years. Trainees can apply for an extension, but wait times, and bureaucratic delays could hinder the process.
As an academic neurologist and educator, I have seen firsthand the value of foreign medical graduates. Earlier this year, the National Resident Matching Program placed 4,222 non-U.S. international medical graduates into training positions. To make it into a United States residency program, applicants undergo a long and challenging journey consisting of many clinical hours, strong research contributions, and stellar board scores. They often speak additional languages and provide cultural perspectives important for a growingly diverse population. Despite the plight, many become faculty members and academic leaders in the field. However, according to the Educational Commission for Foreign Medical Graduates, the “rule change could have an immediate and devastating impact on health care.” The proposed rule is also being opposed by many academic medical societies such as the American Academy of Neurology (AAN), the Accreditation Council for Graduate Medical Education (ACGME), American Hospital Association (AHA), American Medical Association (AMA), and Association of American Medical Colleges (AAMC).
The professional journey of Alejandro Mayorkas is an example of the American dream, realized by opportunities, a respect for diversity, and ultimately societal contributions. He has a long and successful career from that of a Cuban refugee who arrived with his parents in the 1960s to obtain one of the country’s highest offices. Mayorkas was first appointed by President Bill Clinton in 1998 as the United States Attorney for the Central District of California and became the youngest United States attorney. He later served as the Director of U.S. Citizenship in 2014 and Immigration Services and Deputy Secretary of Homeland Security under the Obama Administration. If confirmed, he will weigh into a proposed policy that, if passed, could have horrific impacts on the plight of foreign medical graduates as well as disastrous working conditions for health care workers that may be short-staffed.
To be sure, the American health care system is, in many ways, broken. To build back better, we can no longer settle for the status quo. The global cooperation of medical education, while critical, will not completely solve the crisis of health care access. However, foreign medical graduates are an essential part of our health care system.
We are living in a time of multiple crises, exacerbated by longstanding health disparities, a widening economic gap, and a devastating pandemic for which we must leverage our assets. DHS is currently in the process of reviewing open comments; including physicians in the proposed DHS rule will only do great harm. Immigration policy will be a high priority of the Biden administration. I hope Mayorkas, as an immigrant himself, recognizes the value that foreign medical graduates provide to health care.
Teshamae Monteith is a neurologist.
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