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Home | News | Story: Doctors, Visas and the coming shortage

Story: Doctors, Visas and the coming shortage

We often think that if we are hurt, injured or sick that we will be able to see a doctor. From visiting a doctor’s office, to an unplanned stop at an emergency clinic, and even a trip to the hospital; it is a fact of life that there is going to be a doctor for us to see.

Even without medical insurance, or the ability to pay, there are still places like the RotoCare Clinic at Ysleta Lutheran Mission Human Care that will see you. We never stop and think about what would happen if there wasn’t a doctor to see you.

I remember a time when there were only one or two dermatologists here in El Paso.

If you wanted to see one, you had to take a trip out of town or wait an intolerable amount of time before your appointment. At one point, we only had one pediatric dermatologist.

I recently spoke with Dr. Sudheer R Gorla about the future shortage of doctors, as well as those who have come to this country to practice medicine.

The rules and laws governing immigration, visas and an individual right to stay within the United States are fluid. In the case of Dr. Gorla, he is one of six Pediatric Cardiologists in El Pas; five of the six – like Dr. Gorla – are from India.

Dr. Gorla’s education began in India, followed by pediatric cardiology fellowship training in Miami, Florida, before coming to El Paso to practice.

What does it take to become a practicing doctor in the United States?

“Once we are done with medical school back in India…what they have is they have a body called ECFMG, which stands for Educational Council for Foreign Medical Graduates, which kind of standardize the quality of medical education we get during our medical school,” Dr. Gorla shares.

“So, they have a standardized examination called the USMLE. Step One – USMLE, Step Two – you have to pass.”

The USMLE’s are the United States Medical Licensing Examinations. From the USMLE website, we find the following brief explanation of what these tests are:

The United States Medical Licensing Examination ® (USMLE®) is a three-step examination for medical licensure in the U.S. The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.

“You have to pass all these three examinations before you certified by this body, that your education is on par with the US medical education,” says Dr. Gorla. “Once you’re done with that, then obviously have to go through all these immigration’s, and we have to get a visa for you to be able to stay and get trained over here.”

These visas are where the problems begin for many.

****(please see correction at bottom of article)****

The list of that profession that qualify for an H1B visa is limited:

  • Accountants and Auditors
  • Architects
  • Biologists
  • Budget and Management Analysts
  • Chemists
  • Civil Engineers
  • College and University Educators
  • Database Administrators
  • Data Communication and Network Administrators
  • Economists
  • Electrical and Electronic Engineers
  • Financial Analysts
  • Graphic Designers and Artists
  • Industrial Engineers
  • Mechanical Engineers
  • Physicians and Surgeons
  • Sales and Distribution Managers
  • Software Engineers
  • Statisticians
  • Surveyors
  • Systems Analysts and Programmers
  • Teachers, Primary and Secondary Schools
  • Therapists

According to  the top ten jobs with the most H1B visas are computer related. So few doctors are given such a visa that they didn’t even make a list for 2016 (lastest figures released).

Just what does that mean? In part, I recently found out that there’s going to be a huge shortage of doctors coming soon.

Doctors are beginning to retire in larger numbers. That shortage is being met, in part, by the 250,000 plus practicing physicians that came to the United States via either the USLME’s or by beginning their education in one country and completing it here.

“You know, like many of the forging physicians, if not all of the foreign physicians and the biggest draw for us to come to United States of America is the advances in the field of medicine. The United States has always been the pioneer for all the advancement that happened in the field of medicine. And we as physicians are kind of enthusiastic in practicing the advanced medicine,” says Dr. Gorla.

“We come over here, getting trained in the United States of America. Once we’re done with our training, we always want to give back to the community that trained us. And that’s the reason why we stayed back and, uh, try our best to provide the services to the community of America, which has given life to us as physicians.”

That’s going to be important, embracing doctors from other countries who are willing to practice here, in the United States and El Paso.

“According to the American Medical Association data and the American Immigration Council data, also approximately 250,000 physicians or 30% of physicians that practice in America or foreign medical graduates and the majority of them are in medical branches like internal medicine and pediatrics,” Dr. Gorla said. “As the American population ages, these physicians play a very, very crucial role in providing care for the American people. And again, don’t forget about the fact that nearly 46,000 to 90,000 physicians are retiring by 2025.”

Other than the number of physicians retiring, we must also consider the number of rural communities that do not have a doctor at all.

In August of last year, Joseph Williams, a staff writer for US News and World Report, wrote about just that issue.  In Mr. Williams’ article, he quoted the 2012 National Rural Health Association report which said:

Twenty per cent of our nation’s population is rural, and rural counties are more likely to report fair to poor health,” the report says. “Rural Americans tend to be older and less well insured, and chronic disease prevalence, infant and maternal morbidity, mental illness, environmental and occupational injuries, and obesity are higher in rural communities.”

Then, a poll conducted by NPR published in May of 2019 says that one out of every four people living in rural areas said they couldn’t get the health care they needed recently. About a quarter of those said the reason was that their doctor’s office or clinic was too far or difficult to get to.

“I think it’s not an unreasonable idea to provide a separate track for physicians with regards to their immigration status. Let’s say have just like among 150,000 to 200,000 green cards that America gives out. Just putting like 10,000 or 15,000 just for physicians, dedicate them just with the physicians,” says Dr. Gorla, with his idea to help solve this problem.

“I think that will at least solve the issue from the healthcare side. I was just um, watching a video; I’m not sure which news channel was that. And it was mentioned that there was a community center in one of the remote areas of which has not seen a physician the past one year, which is crazy.”

Even worse, many of the physicians here are not sure – day to day – how long they will be allowed to stay, or if their permanent green card will ever be approved.

“The fear for Dr. Gorla, for any of us, is very real,” says Aziz abd Al-Amin. “When my status changed, and I am not a physician but a software engineer, I was told to update my paperwork and status. I did as instructed only to find myself on the wrong side of the myriad of federal agencies that address immigration and foreign nationals seeking to remain in this country.”

Aziz agrees with Dr. Gorla in that there needs to be a separate track for doctors who want to remain and practice in the United States.

“My partner, as just a personal example,” began Aziz, “comes from a small town in Kentucky. His mother still resides there, and she has been without a doctor for almost three years. Three years!”

In DC’s zeal to secure our borders and push aside one humanitarian crisis, they are helping to create another- a growing lack of doctors who are practising in the United States.

Dr. Gorla has the right idea in suggesting a separate track be created for physicians who want to practice here and build their lives here in the United States.

“I think it’s time that we, as Americans, acknowledged this and change our immigration rules and regulations,” said Gorla as our conversation drew to a close.

I agree with him.


Correction: June 17, 2019 at 7:42 p.m.

John Miano, JD, the author of “Sold Out” and Dr Ron Hira, Associate Professor and Interim Director of Graduate Studies at Howard University’s Department of Political Science were gracious enough to point out a few inaccuracies to my research and writing in the above article.

My hope, in adding this correction is to clear up any misinformation I may have inadvertently shared with our readers and listeners.

I wrote:

United States Immigration has a visa called the H1B visa is an employment-based, non-immigrant visa for temporary workers. For this visa, an employer must offer a job in the US and apply for your H1B visa petition with the US Immigration Department.

For example, let’s say Google or Apple wanted to hire a software engineer from outside the United States, they would first have to advertise that position within widely available media such as a newspaper or job recruitment site and look first for an American.

If an American cannot be found to fill the position, then the company may hire from outside the United States.  Once a candidate is identified and hired, then Google or Apple would then apply for the H1B visa on behalf of the future employee.

“The very purpose of the H-1B program is to replace Americans with cheap foreign labor. It is EXPLICITLY legal to for employers to replace the Americans they already have with H-1B workers and it is legal to pay those workers at the bottom 1/6 of U.S. wages,” writes John Miano. “That is how Disney, NY Life, Bank of “America,” Northeast Utilities, Southern California Edison, McDonalds, Toys R Us, Harley-Davidson, have been able to legally replace hundreds of Americans at a time with foreign workers under the H-1B program. And it is how companies that specialize in using the H-1B program to move jobs overseas hire nearly entirely H-1B workers for technology jobs.”

Mr Miano directed me to look at 8 USC 1182(n)(1).  After his email, and after my reading of 8 USC 1182(n)(1), I began to do further research on the topic of how broad the H-1B visa program is, and who can obtain a visa under that program.

“The H-1B visa program,” related an individual I spoke with at the U.S. Citizenship and Immigration Service, “does not require you to first seek an American national for the position. You may hire whomever you wish so long as they meet the state requirements.”

I was sent the following link for further information on the subject.

In the end, a company does not have to attempt to recruit US workers at all.

“Your assertions above are inaccurate. H-1B program rules do _not_ require any recruitment of US workers (i.e., there is no labour market test). Google or Apple need not make any effort to advertise or actively recruit American workers before applying for an H-1B. In fact, they could replace US workers with H-1B hires, legally. And such cases are quite common. See news articles about Disney workers training their H-1B replacements the – same thing has happened at many other employers including Southern CA Edison and Univ of California,” says Dr Ron Hira.

Dr. Hira also wrote that, “this is an extraordinary weakness in the program’s rules and protections for workers. Unfortunately, you’re not alone in making such a mistake, but your readers/listeners should be made aware of the truth through a correction.”

My final error was in my reading of the H-1B visa caps. I wrote the following:

According to the United States Citizenship and Immigration Service on April 15, 2019, the USCIS reached the congressionally-mandated 65,000 H1B visa regular cap for the fiscal year 2020. Their next step is to determine if they have enough petitions to meet the 20,000-visa limited cap for the advanced degree exemption, also known as the master’s cap

“Actually,” writes John Miano, “they fill the 20,000 cap first and then the 65,000 cap. Add in those not subject to the cap and the total is about 125,000 a year.”

From the link I was sent by the U.S. Citizenship and Immigration Services we find the following language:

The H-1B visa has an annual numerical limit “cap” of 65,000 visas each fiscal year. The first 20,000 petitions filed on behalf of beneficiaries with a U.S. master’s degree or higher are exempt from the cap. Additionally, H-1B workers who are petitioned for or employed at an institution of higher education or its affiliated or related nonprofit entities or a nonprofit research organization, or a government research organization are not subject to this numerical cap.

For further information about the numerical cap, see our Fiscal Year (FY) 2020 H-1B Cap Season page.

In order to remain transparent in my reporting I must admit to my errors in what I’ve write about the H-1B visa program. I hope I have corrected any confusion I may have caused.

I have extended an interview invitation to both John Miano and Dr. Ron Hira so that we all may be further educated on the matter of Immigration and the H-1B visa program.

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