John Commins, for HealthLeaders Media, June 10, 2013
Nestled in the massive immigration bill that's being debated now in Congress are a handful of provisions that could ease the process that allows foreign-born physicians to practice in underserved areas across the United States.
The sweeping Border Security, Economic Opportunity, and Immigration Modernization Act (S.744) is more than 850 pages long and covers everything from border security to passport fraud. However, the sections dealing with revisions to the Conrad State 30 Program for recruiting foreign-born, but U.S. trained physicians could be of particular interest to rural and urban hospitals and physician practices that have had little luck recruiting U.S.-born physicians for their underserved patients.
"I am excited about this bill for many reasons, but the section on physicians is particularly good," says Carl Shusterman, a long-serving immigration attorney based in Los Angeles. "We've had the Conrad program since 1994 which allows each state to sponsor 30 foreign physicians each year to go to rural and urban medically underserved areas where they can't get Americans to practice."
"All in all it is a good program and over 1,000 physicians a year do get placed in these underserved areas," he says, "but like any program there are a bunch of flaws that we have being trying to correct for 20 years and this bill would correct most of them."
Shusterman says it's hard to predict if the bill will pass in the hyper-partisan Congress, where immigration is a divisive issue. The bill recently passed the Senate Judiciary Committee on a 13-5 vote and floor debate could begin this week.
"The Senate introduced over 300 amendments to the bill but I don't think any of them were concerning the physicians' part of the bill. That is relatively non-controversial," he says.
"What is controversial is it legalizes 11 million people that are undocumented. That's where the problem is as far as this passing. In the Senate I can almost guarantee it will get one pass by the end of the month. The big debate is will it get 60 votes or 70 votes. There are about five Republicans who are definitely on board and pretty much all the Democrats but if they can get 70 they figure that will have an influence on the House. If they can get about 30-40 Republicans in the House to sign on it's going to be a done deal, but that is the big 'if' now in the House of Representatives.'"
Shusterman provided a synopsis of the reforms proposed in the immigration bill.
Proposed Changes to the J Visas and Waivers:
· The pending legislation would make the Conrad program a permanent part of the immigration law. J status for foreign-born physicians completing medical residencies/fellowships would be classified as a "dual intent" status, similar to H-1B and L-1s.
· A physician could no longer be denied J status on the ground that he or she did not intend to return to his country of origin. Spouses and children of J-1 physicians would no longer be subject to the two-year home residency requirement.
· The number of Conrad waivers available to a state could be raised in increments of five depending on the usage of waivers in various states during the previous year. In addition, the number of J waivers available to physicians working in academic medical centers outside of medically underserved areas could be raised by three per year under certain conditions.
· Physicians who received J waivers would no longer be required to work in H-1B status, but could work in any immigration status for which employment is authorized. To prevent foreign-born physicians from being exploited, J waivers would not be granted unless the physician's employment contract contained the following clauses:
1. The amount of "on-call hours" per week and the compensation for such;
2. The amount of malpractice insurance provided to the physician and whether the employer will pay for this;
3. All work locations, and a statement that the employer will not add work locations without the approval of the state or federal agency requesting the waiver;
4. The contract may not contain a "non-compete" clause.
2. The amount of malpractice insurance provided to the physician and whether the employer will pay for this;
3. All work locations, and a statement that the employer will not add work locations without the approval of the state or federal agency requesting the waiver;
4. The contract may not contain a "non-compete" clause.
· If a physician's J waiver were denied under the Conrad program because the state had used up all of its slots for the year, the physician could obtain a six-month work permit if he or she agreed to seek a J waiver from a state which has not used all of its J waivers. After that, the physician could extend his or her work permit from the time that the employer in the new state filed a Conrad waiver until the DHS either granted a change of status or denied the waiver application.
The proposed law also provides that when the U.S. Citizenship and Immigration Service determines that "extenuating circumstances" exist, the physician could change employers during the three-year required period of employment in an underserved area.
"This is important because some employers have taken unfair advantage of physicians who they have sponsored for J waivers," Shusterman says. "For example, some employers have failed to pay a physician at the prevailing wage or have insisted that a physician work outside of the designated medically-underserved area for 40 hours per week. If the physician does not claim 'extenuating circumstances,' he or she needs not only to complete the 3-year period in a medically underserved area, but also an extra year for each termination."
The proposed law would also do away with an impractical requirement that the physician begin working within 90 days of receiving the J waiver. Instead, the proposed law would require physicians to start working in 90 days only after the latter of the following three dates: 1) After the J waiver is approved; 2) After completion of graduate medical education or training; or 3) After receiving nonimmigrant status or an Employment Authorization Document.
Proposed Changes to H-1Bs and Green Cards
When a physician completes his or her residency/fellowship in cap-exempt H-1B status, and an employer has submitted a cap-subject H-1B petition on his behalf, his H-1B status would automatically be extended to Oct. 1st so that the physician does not become out-of-status or unemployable between July and October. However, if the physician's H-1B petition is rejected, denied or revoked, his or her status and employment authorization would terminate after 30 days, Shusterman said.
Physicians who qualify for National Interest Waivers by completing the five-year service requirement in a medically-underserved area or for the Veterans Administration would be granted green cards without regard to numerical limitations. This would occur whether a physician completed the five-year requirement before or after the enactment of the (Comprehensive Immigration Reform) bill.
The spouse and children of a physician would also be exempt from numerical caps whether the physician obtains a green card through an NIW or through Program Electronic Review Management, Shusterman said.
Per-country limitations would be eliminated for the employment-based green card categories, which would dramatically reduce the time that it now takes physicians born in India to qualify for green cards.
"All of these changes would make it considerably easier for internationally trained physicians to work and live in the United States, enhancing the overall number of physicians at a time when doctors are in short supply," Shusterman says.
http://www.healthleadersmedia.com/content/COM-293056/Immigration-Bill-Lowers-Hurdles-for-ForeignBorn-Docs?goback=%2Egde_2442148_member_250693402
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