Foreign-born physicians struggle with visa processing change

Martin Krause, MD, remains a bit nervous about the last bureaucratic hurdle he has to face before he can finally begin his professorship and position of critical care at the University of Colorado-Denver-he has to return to his home country of Germany to physically obtain his H-1B visa from the U.S. consulate in Frankfurt.

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Krause, who is board certified in both anesthesia and critical care, considers himself lucky: his immigration lawyer filed his visa paperwork before the United States Citizenship and Immigration Services suspended the $1,225 premium processing for skilled worker temporary in April. 

“In a perfect world, I could have stayed in the country as we waited for final visa approval,” Krause says.  “Getting rid of the premium processing has made it more difficult than it already was.  When it comes to the American dream, it’s more difficult for foreign born physicians to live this dream.”

For Krause, this also means the university’s desired starting date for him on July 1 got pushed back to September 1.  For other physicians, starting dates remain up in the air.

 “While the impact to the overall (immigration) system is perhaps not that great, for the people it does impact, it’s a life-changing, totally disrupting kind of thing,” says Michelle Larson-Krieg, JD, director of international student and scholar services at the University of Colorado-Denver.

Prior to the change, foreign-born physicians and the places that employed them used premium processing to ensure that visa applications would be reviewed within two weeks. Without that option, processing takes anywhere from six to eight months. This becomes especially problematic because it adds more uncertainty and extra wait time in a long, bureaucratic process, which then may jeopardize their jobs.

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Before even getting a skilled worker visa, many foreign-born physicians first have to first apply for a Conrad Waiver, which removes the requirement that after their American residencies, they return to their home countries for two years before beginning practice here. Instead, they agree to work in underserved areas for three years, and then receive a chance to apply for a green card for permanent residence.

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But a key component of the Conrad waiver is that physicians who receive them must begin work within 90 days after receiving them. That 90-day period becomes questionable when physicians don’t know when and if they’ll receive the H-1B visas now that the premium processing has been suspended.

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 “Now, all of a sudden, no one’s sure what’s going to happen,” says Brad Hendrick, an immigration lawyer for Kaplan and Earnest in Boulder, Colorado, who represents several foreign-born physicians who are waiting for visa approval. “If (immigration services) is not going to be able to adjudicate an H-1B visa within 90 days of a grant of waiver, how are these physicians going to be in any way able to comply with the law?”

Robert Aronson, an immigration attorney in Minneapolis, Minnesota, who is a national expert on immigration for clinical providers, says he and his staff tried to file as many cases before the April deadline as they could, but they still have several physicians who are now in limbo, waiting. 

“No one’s asking for any special favors for physicians, but the basic issue is to just get those cases processed and approved so they can start working for the community that’s sponsoring them,” he says.

Peter A. Kahn, MPH, ThM,, masters in theology,  who is graduating medical school this month and who will be starting an internal medicine residency at Yale University, just published a research letter in JAMA, which looks at the distribution of H-1B physician visas in 2016. There were 10,491 foreign-born physicians who applied for H-1B visas last year, with New York, Michigan and Illinois having the largest number of applicants, representing 31% of all applicants, while North Dakota had the highest percentage of the physician workforce comprised of H-1B. 

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The top four sponsoring employers with H-1B applications comprised 10% of all applicants, and the largest employer was William Beaumont Hospital with 470 applicants. While any hospital or healthcare system is likely to be impacted by the change, there’s concern that some of the smaller employers in remote areas might be even more adversely affected. 

“We listed the top 30 institutions for H-1Bs,” Kahn says.  “At the bottom of our list might be a five person primary care practice; if we deny them two H-1B visas, that is a huge issue.

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“The common denominator, among all of these places, is that slowing down, delaying or potentially disrupting the H-1B pipeline, where ever it occurs, has the potential to dramatically impact patient care and the way that it is provided,” Kahn added..

Aronson says, for his clients who did not get their paperwork filed before the beginning of April, he’s asked immigration services to expedite those cases at their discretion. 

“If you ask for a case to be expedited, sometimes they do that, and sometimes they don’t, and they often don’t tell you if they’re even going to expedite it,” Aronson says. “There are massive pockets in this country that just don’t have enough physicians. This evokes a great deal of hardship.”

Krause, who is planning to take his board certification exams for neurocritical care later this year, says he has savings built up to live on while he goes through the process of visa approval in Germany. 

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“I have it easier, as my long-term girlfriend and I, we can travel during that time,” Krause says. “But for people in similar situations who have a family to provide for, that could be quite a problem.”

For other foreign-born physicians who are in American residencies, Krause advises them to save up enough money to live on, in case the visa approval process takes longer than they anticipate. 

“Maybe six months from now, the premium processing will (start up again), but I wouldn’t take my chances,” Krause says. “I would prepare for the worst.”

Krause also advises them to begin their job searches as early as possible, because it will likely become an even more difficult process.  “So many people come here to pursue their dreams,” Krause says.  “It would be nice if it would stay that way.”