Expediting the H1B Visa Process to Improve Rural Healthcare

Although the worst phase of the pandemic appears to be fading, the U.S. still faces a critical shortage of healthcare workers, especially in rural areas. Despite being home to over 20% of the U.S. population, less than 10% of physicians practice in rural areas, causing this already devastating shortage to disproportionately impact rural Americans. One solution to this challenge is remarkably simple: allow more foreign-trained doctors to enter the workforce through expedited H1B visas.

The H1B visa is a non-immigrant visa that allows U.S. employers to temporarily hire foreign workers in specialty occupations and is commonly used in the healthcare sector to fill workforce gaps. This is different from the J-1 visa, which is designed for cultural exchange programs that encompass education, research, and other specialized training. Due to its nature as an exchange program, most J-1 visas are bound by a two-year home country obligation that requires the visa holder to return to their home country for at least two years after completing their exchange program in the U.S.. In a healthcare setting, this obligation can be devastating to patient well-being, especially for patients who have established longitudinal care with a single physician. The H1B visa application process does not include a home country obligation and can provide rapid, efficacious reform.

Both J-1 and H1B visas have become more difficult to obtain, as delays and complications over the past decades have led to processing bottlenecks and missed opportunities, a practice that will undoubtedly jeopardize patient care and accessibility if continued. We especially felt the harms caused by these delays in the early phase of the pandemic when physicians such as Dr. Hussain were desperate for relief on the COVID frontlines.

While some U.S.-born physicians may be hesitant to relocate to rural areas, according to data from the Journal of Rural Health, many foreign physicians are willing to fill these gaps, especially in primary care. This idea already works! Consider the Conrad State 30 J-1 Visa Waiver Program. This program allows foreign medical graduates who have completed their medical training as J-1 visa holders to waive the two-year home residency requirement that is typically required for J-1 visa holders. In exchange for the waiver, physicians agree to work in a medically underserved area in the US for at least three years. Since 1994, this program has placed over 15,000 physicians in rural America, many of whom have remained there since.

Applying a similar initiative to the H1B visa process could be a tremendous step toward ameliorating the growing care shortage. Additionally, by adding more physicians to the healthcare workforce, there will be less need for midlevel practitioners to provide care beyond the scope of their training.

Unfortunately, the H1B visa process has become increasingly backlogged in recent years, causing delays of several months or even years for visa applications to be processed. As of January 2021, the average processing time for H1B visas was approximately eight months, and some cases have been pending for over a year.

Some American doctors may be concerned that an influx of foreign medical graduates could lead to an oversupply, resulting in additional job competition and downward pressure on salaries. However, this proposal specifically advocates for initially placing beneficiaries of this revised H1B visa policy in rural areas where the current shortage is most dramatic, largely because most US-trained physicians choose to practice in suburban or urban areas. 

Several lawmakers have proposed legislation aimed at reforming the H1B visa process to address the backlog of cases. In 2021, U.S. Sen. Dick Durbin introduced the H1B and L-1 Visa Reform Act of 2021, which seeks to address issues with the H1B visa program, including wage levels, fraud prevention, and the protection of US workers. While this legislation is a step in the right direction, more needs to be done. President Biden issued an executive order promising and reforming the legal immigration system, however H1B visas were not specifically mentioned.

In this era of hyper-partisanship and as we approach an election year, both parties can find common ground on this issue. Republicans can provide tangible social benefits to rural areas that primarily vote red, Democrats can fulfill longstanding promises on immigration reform, and Libertarians will appreciate a market-based solution that allows freer movement of labor across borders.

As trainees of the medical system and as the children of immigrants to this nation, we call on Congress and the Executive Branch to prioritize expediting the backlog of H1B visas to deliver improvements in rural healthcare.

Aamir Hussain is a dermatology resident physician in the DC Metro Area. Umayr Shaikh, MPH is a medical student at Georgetown University.