For months Dr. Jinendra Satiya has faced fears on the front lines of a deadly pandemic, treating coronavirus patients.
But now the doctor, on a fellowship at a Boston hospital, is facing a new anxiety: that new immigration restrictions could make it harder for him to stay in the country.
Satiya is one of thousands of foreign doctors who came to the United States on a visa that recently landed in the Trump administration’s crosshairs.
A proposed rule could make it more difficult to renew J-1 exchange visitor visas, which allow scholars, doctors and others to live temporarily in the US while they study or receive training.
On the surface, it may sound like a small bureaucratic move. But Satiya and organizations representing doctors across the country warn it could affect medical care for Americans at a time when the country needs resources to fight the coronavirus pandemic.
For Satiya, 30, who grew up in India and came to the US in 2016, it also throws his immediate future in the US into jeopardy.
“You are anxious, you are nervous, you’re stressful,” Satiya said about waiting to see what happens with his visa. “But you know, you keep on doing what you’re doing. You go to work every day … you see your patients … and you just hope for the best.”
What the visa change would do
Satiya is one of about 12,000 doctors who are foreign nationals in the United States on a J-1 visa, according to the Educational Commission for Foreign Medical Graduates (ECFMG). Visitors on J-1 visas are admitted to the US for the length of their training program – for doctors, it’s typically a one-year contract at a hospital, renewed annually for the duration of their residency.
When physicians on J-1 visas complete their competency reviews and get their contracts extended for another year, they then apply for visa renewal through the ECFMG.
But under the proposed rule, the annual visa renewal would require an additional step – applying through US Customs and Immigration Services. That processing time could take 5 to 19 months, according to the USCIS website, and interrupt doctors’ ability to continue working at their hospitals.
The Department of Homeland Security, which oversees USCIS, says the change is needed for federal officials to more closely monitor these visitors while they are in the US to address “a potential for increased risk to national security.”
“This regulatory change, which will establish a fixed period of admission for F, J and I nonimmigrants, aims to help DHS enforce our nation’s immigration laws and promptly detect national security concerns, while protecting the integrity of these nonimmigrant programs,” a DHS spokesperson said in a statement.
The ECFMG and other major medical organizations around the country have asked the DHS to make an exception for medical trainees.
The DHS is seeking public comments on the rule and has received more than 23,000 of them so far.
Some argue the rule would protect American jobs
Foreign medical graduates like Satiya go through an extensive selection process to get their positions in the US, providing the talent and expertise President Trump has said he wants in the country’s immigrants.
Public comments responding to the DHS proposal include testimonials from medical educators concerned about the potential impact. Other commenters have argued that during a period of high unemployment it’s not fair to displace thousands of qualified American medical school graduates with residency training positions for foreign doctors.
But the numbers suggest that American physician jobs aren’t threatened by foreign medical graduates. Almost 94% of graduates from US medical schools in 2020 were matched with a residency, according to data compiled by the National Resident Matching Program, a private, nonprofit organization that seeks to provide a fair mechanism for matching budding doctors with residency positions.
And the Association of American Medical Colleges projects a shortage of up to 139,000 physicians in the US by 2033.
Dr. John Andrilli, program director for Internal Medicine Residency at Mount Sinai St. Luke’s and Mount Sinai West in New York City, said he fills a third of his annual 42 slots with foreign medical graduates. But he gets 6,000 applications from abroad, he said.
“We really are getting the best and the brightest from around the world,” Andrilli said. “So it doesn’t make a lot of sense to me why this change would happen.”
Critics fear it would create chaos
The ECFMG fears that if the rule change is approved, many foreign doctors may look to do their residencies in other countries instead of the US.
“There are other opportunities for training around the world where they could go,” said Dr. William Pinsky, president and CEO of ECFMG.
Pinsky said he shares the concerns of those who worry about national security and want to make sure visa recipients are in the country for their allotted time. But he added, “having diminished access to health care is as much a security risk as anything else, frankly … So this is creating a problem when there’s not a problem.”
Slightly more than half of J-1 physicians choose internal medicine, which boosts the primary care workforce. And many J-1 physicians work in rural or underserved areas, filling a need not met by American medical graduates alone, according to ECFMG.
Tracy Wallowicz, an assistant vice president at ECFMG, said the change would create “unnecessary chaos.”
“I’ve been at ECFMG for 25 years. And I have never been told of a J-1 physician overstaying (their visa),” she said.
For Satiya, the rule change could upend his thriving medical career in the US. He completed residencies in Miami and New York City before coming this year to Boston, where he specializes in liver diseases at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School.
Satiya spent the early weeks of the pandemic as a chief resident in New York facing fast-changing information about how to fight the virus along with the scarcity of PPE, ventilators and available hospital beds. Like all health care providers, he went through a wide range of emotions on a daily basis.
Now he faces a new uncertainty. But he’s trying to remain positive.
“We take something known as the Hippocratic oath (to do no harm) … and we all felt like we were living this oath out, you know, in the middle of this pandemic,” he said. “We’re all, at the end of the day, very proud to be able to serve the American community in these troubled times.”
Correction: This story has been updated to correct Dr. John Andrilli's title. He is program director for Internal Medicine Residency at Mount Sinai St. Luke's and Mount Sinai West in New York City.