Despite Challenging Climate on Immigration, the Outlook for Work Visas may be Improving for Foreign Pathologists

With significant budget cuts being proposed to many of the federal programs essential to healthcare workforce development, immigration options are often looked to as a potential staffing solution. But given the current climate related to immigration policy it is unclear how well things will fare in this area.  

While the Trump Administration has prioritized addressing illegal immigration, it has generally spoken favorably about the need for skilled workers to come to the United States. That said, the administration’s messaging has not been consistent with regard to legal immigration. For example, Immigration and Customs Enforcement recently cancelled scores of visas for foreign students on F-1 and J-1 visas nonimmigrant visas. According to the Associated Press, “more than 1,200 students at 160 colleges, universities and university systems have had their visas revoked or their legal status terminated since late March.”  These visa cancellations have raised concern among employers that rely on a pipeline of foreign students (many of whom become employed in information technology, engineering, and healthcare) for skilled labor needs. In a more recent development, however, the Administration has reported reversed course on these visa cancelations.  

As a large portion of U.S. pathology residents are not U.S. citizens, ASCP has reached out to the Educational Commission on Foreign Medical Graduates, which evaluates all international medical graduates and deems them eligible for U.S. residency programs, to determine if any international medical graduates or physicians with H-1B non-immigrant status have been impacted. So far, their understanding is that none have had their visas cancelled. 

That said, there are some bright spots to report.  

First, several bills have been introduced in Congress to address the Conrad 30 program, which provides a waiver of the two-year home residency requirement to which international medical graduates are subject. The program allows states to provide approximately 30 waivers per year of the two-year home residency requirement, provided they practice medicine in a rural or underserved area. ASCP is a supporter of this program. 

Representative Michale Lawler (R-NY) introduced the Doctors in our Borders Act, HR1201, on February 11. In addition, Senator Amy Klobuchar (D-MN) and Representative David G. Valadao (R-CA) introduced on February 25 the Conrad State 30 and Physician Access Reauthorization Act, S 709/HR 1585, in their respective chambers of Congress. All three of these bills would reauthorize and expand the number of waivers the Conrad 30 program can provide. 

In the past, it has been challenging for pathologists to secure waivers from the Conrad 30 program, because of the limited number of waivers available and the preference provided to primary care providers. But recently, the U.S. Department of Health and Human Services, one of several federal agencies offering waivers, expanded its program so that there is no longer a numerical cap on the number of waivers it will provide. According to one immigration expert ASCP consulted, this should lessen demand on state Conrad 30 requests enabling more specialists, like pathologists, to secure J-1 waivers so they can work in the U.S. states. As a result, ASCP is hopeful that the Conrad 30 program, especially if expanded as proposed under the recently introduced legislation, will be increasingly relevant to addressing the shortages of pathologists. 

The bipartisan legislation extends the program for three years and would increase current state allocations from 30 to 35 physicians per year. It would also provide flexibility to expand the number of waivers in states where demand exceeds that limit.  

More than three dozen healthcare associations and organizations penned a letter calling on House and Senate leaders for action on a bill bolstering foreign-born physician recruitment to underserved regions. 

The letters—which include the American Medical Association, the American Hospital Association and the Association of American Medical Colleges as signatories—speak to the Conrad 30 Waiver Program and its role in alleviating the nation’s worsening clinical workforce shortage. 

It allows foreign students who come to the U.S. for medical training to immediately begin practicing in the U.S. by forgoing visa requirements that would force them to return to their home country for at least two years. In exchange, program participants are required to work full-time for at least three years in a medically underserved community.