International medical graduates are having a difficult time moving to the United States for their residency programs due to a slowdown in the H-1B visa application process, affecting nearly 4,000 individuals, the American College of Physicians wrote in a letter to U.S. Citizen and Immigration Services (USCIS) officials Wednesday.

The letter, written in conjunction with the American Academy of Family Physicians, the American Academy of Pediatrics, the Alliance for Academic Internal Medicine, the American Psychiatric Association, the American College of Obstetricians & Gynecologists, and the Council of Academic Family Medicine, pressed immigration officials to let doctors into the country. It cited “imminent healthcare repercussions of delays in H-1B visa processing” among the reasons to process the new doctors’ applications more quickly.

“When incoming medical residents are delayed or visas are denied, it is not only disruptive to training programs, but it impacts patient care as teaching hospitals rely on these medical residents to provide care,” the organizations wrote. “…For at least one internal medicine training program, 60% of incoming medical residents are on H-1B visas so the impact of a delayed start and possible denials would be devastating to their physician workforce capacity.”

– Nearly 4,000 international medical graduates have been accepted to US residency programs

– But the Trump admin has delayed, denied many visas

– Physician groups are urging immigration officials to let the young doctors in pic.twitter.com/Pdbx9kGztI — Dan Diamond (@ddiamond) May 30, 2018

The Trump administration has been quietly targeting the H-1B visa program in recent months, affecting thousands of documented, highly-skilled foreign workers and their spouses hoping to immigrate to the United States. The program was first placed under review in April 2017 after President Trump signed the “Buy American, hire American” executive order, which cracked down on legal immigration in favor of hiring U.S. citizens first.


Since then, H-1B applicants, many of whom work in the tech and medical fields, have reported a spike in “requests for evidence” or RFEs — notices sent by USCIS probing applications and dragging out the process.

As Quartz reported in January, attorneys for H-1B applicants are suspicious and concerned about the swell in RFEs. USCIS data shows that RFEs have increased some 40 percent between January and November 2017, compared to the same time period in 2016.

In a 2016 survey, 42 percent of program directors in U.S. hospitals cited “visa status” as an important factor in deciding whether or not to interview applicants, meaning that those still in the middle of the application process could be hurt by the growing number of RFEs.

International doctors play a crucial role in providing comprehensive care to rural individuals and families. Foreign doctors who are H-1B recipients frequently practice in areas most American doctors avoid for personal and professional reasons. According to The New York Times, about 25 percent of all physicians practicing or training in the United States are from a foreign country, but in rural areas and some inner cities, that share is significantly higher.


In an op-ed for The Hill in March, Dr. Rao Kamran Al, a doctor in the United States since 2000 and current advocacy chair for the Association of Pakistani Physicians of North America, warned of a potential shortage of physicians in the future.

“If current retirements continue and patient populations grow, our nation will need to find upward of 90,000 new physicians by 2025. In coming years, patients will be faced with either longer wait times or receiving care from doctors with a mediocre academic pedigree. Naturally, neither option is inviting,” he wrote. “Foreign medical graduates — the best of their accredited foreign medical schools — are an important part of this future planning.”

A delay in H-1B visa processing isn’t the only issue stopping international medical graduates from coming to the United States. In a October 2017 newsletter from the Association for Hospital Medical Education, the president of Educational Commission for Foreign Medical Graduates, William W. Pinsky, voiced concerns that future physicians might be deterred from coming to the country due to Trump’s views towards immigrants.

“I think the timing of the [executive orders] and the fluid nature of the situation were

significant challenges for both U.S. training programs and foreign national physicians applying to these [residency] programs,” he wrote, referring to Trump’s March 2017 executive orders barring immigrants from certain Muslim-majority nations and increasing vetting of all visa applicants.

“[The executive orders] created a context of uncertainty and anxiety for many, at a time of high-stakes decision-making,” he added. “…If U.S. immigration policy causes physicians and programs to make different choices — choices that reduce the number of international physicians entering U.S. GME — this could have a negative effect on health care in the United States.”