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Hot off the press: we can manufacture all the PPE, drugs and ventilators in the world but it is of no use if we do not have enough doctors. And we won't, especially in medically underserved areas, when #COVIDăŒ19 cases surge there.
https://www.acpjournals.org/doi/10.7326/M20-4103 @Bhavsonani 1/
A problem unique to USA is that a large chunk of US physicians languish on visa (>100000, maybe close to 200000) and that means they cannot work at places other than approved, which is a problem when the pandemic is surging in different parts of the country at different times. 2/
Moreover, these international medical graduate (IMG) physicians are more likely to be working in medically underserved and rural areas, which will easily be overwhelmed by the virus. These hospitals are already underprepared for the pandemic due to a doctor shortage. 3/
IMGs are just as likely as American/ permanent resident physicians to contract the virus and get sick or disabled or die or suffer from job loss due to their employers' financial losses. The difference is that these things would increase likelihood of deportation for the IMG. 4/
IMGs have only 60 days to start another position and to complete visa transfer with interviewing, state licensing, credentialing etc is next to impossible in that time frame. If an IMG is disabled from COVID, they cannot continue to work and would risk deportation. 5/
Worse, they cannot avail of any disability insurance. If they die, their dependent spouses and children would also have to uproot their lives from this country. Times are already tough for frontline IMGs with child care, home quarantine with minimal local family support. 6/
So in addition to the routine temporary furloughs and quarantines that compound physician shortages when cases of COVID-19 surge, many areas will permanently lose their IMG physicians, with no quick way to replace them, especially during a pandemic. 7/
Once this happens, many more Americans will die and not be able to seek the medical care they need in the next several years. In fact, the recent executive order to halt new temporary work visas makes things worse (many won't be able to return if travel for family emergencies) 8/
Moreover, >10000 practicing IMGs have been working in the US for years and already have approved permanent residency petitions but have to wait DECADES to assimilate due to rules set in 1990 that allow only 140000 spots each year for all, and only 7% per country. 9/
These "temporary" workers have not replaced any Americans from their jobs. The system for physician immigration simply does not allow it. All IMGs have to undergo residency training in the US to work here. They work in places where Americans will not. 10/
The bar is set so high during residency application itself, that only a few IMGs get through and that too only for a few select specialties that are less popular amongst Americans. IMGs have to do so much more for a spot on the same program than a citizen. 11/
In fact, patients taken care of by IMG internists in hospitals, despite being sicker, had lesser mortality than those taken care if by American medical graduates (AMGs). https://www.bmj.com/content/356/bmj.j273 @ashishkjha thank you for doing this study. 12/
IMGs have proven their worth and contribute to the economy without assurance of social security. Other than taxes (of which they pay more, compared to a citizen earning the same), they also bring an average of 13 jobs to their community as opposed to "stealing American jobs". 13/
& the administration rewards these docs with anti-immigrant rhetoric, a lifetime of servitude with constant uncertainty and risk of losing their careers that they fought so hard to build. This amounts to a perverse systemic discrimination against an underrepresented minority. 14/
Hence, if these disillusioned physicians somehow get through the pandemic unscathed, there will be a mass exodus of IMG physicians from the US if the system remains unchanged. ('if a pandemic cannot make Americans realize our value, nothing will"). 15/
All of this would mean the US physician shortage will get even worse. And not even a single public health expert I know is raising a stink about this. Why?? Because physician immigration is too complex to understand and to explain to stakeholders, immigration reform is taboo..16/
and IMGs are too fearful and docile. Well, this IMG has decided that he has had enough. I'm done feeling bad about asking for what IMGs deserve or pointing out that the endless visa purgatory that some have to go through is arbitrary, unfair and systemically discriminatory. 17/
So if as an American physician, taking care of COVID-19 patients stresses you out, imagine what your IMG peers are going through. Talk to them, make efforts to understand the broken system. Talk to your leaders to make change. @CMSSmed @aahcdc @ACHEConnect @TheCHAUSA 18/
Do this for the future of your country's health. Urge Congress to pass S.3599/H.R.6788 to "unbench" ~15000 physicians who could remain in visa limbo until they die/retire and S.948/H.R.2895 that ensures an IMG pipeline for the future of underserved areas without the limbo. 19/
Most healthcare organizations support these. Without them, the future of American healthcare is bleak and its pandemic response will be even more atrocious. The first step to fixing the problem is acknowledging the existence of a problem. Make your lawmakers acknowledge it. 20/
Lawmakers have a poor understanding of the healthcare shortage and the effect the pandemic has on this shortage. They understand physician immigration even less. Talk to them and make them "get it". They won't listen to IMG constituents who may never be granted franchise. 21/
Make your privilege count! Your one word is equivalent to me beating the drums about this for months.
Also, if you have facts to prove my fears wrong or an alternative solution, then DM me or comment. I welcome it. 22/
Also, if you have facts to prove my fears wrong or an alternative solution, then DM me or comment. I welcome it. 22/
@ASlavitt @ScottGottliebMD @DrSidMukherjee @RobbieForChange @Covid19Docs @WSJhealth @NYTHealth @NPRHealth
Thank you @ACPinternists @AmerMedicalAssn @ahahospitals @SocietyHospMed @IDSAInfo @NRHA_Advocacy @WearePAHA for your advocacy.
Thank you @ACPinternists @AmerMedicalAssn @ahahospitals @SocietyHospMed @IDSAInfo @NRHA_Advocacy @WearePAHA for your advocacy.
@londyloo @HelenBurstin @erickmessias8 @EricTopol @RWalensky @DrJeanneM @subailey @SDECoxHealth @tsaiduck77 @slkanter @HealthyLivingMo @MORuralHealth @PeterHotez @CarlosdelRio7 @kevinmd @Craig_A_Spencer @DanRather @paulkrugman @atrupar @somedocs @BldCancerDoc @JosGilbertoMon1
@FollowMercy @NOSORH @DavidJSkorton @kavitapmd @alevine014 @DimitriosHASDIC @tomwhalen @CandidCIO @ChrisDVanGorder @SinaiCEO @drpatesblog @Randy_Oostra @StuartMarcusMD @ColleenKannaday @RalphJohnsonII @RodHochmanMD @KBrown_Piedmont @Akram_Boutros IMG physicians need your help!
@KYHospitals @StElizabethNKY @UK_HealthCare @healthyky @LHCCKY @kymedicalnews @AARPKY @AHL_Magazine @BaptistHealth @BHLexington @LTCrevolution @CHFSKy @KYMedAssoc we need your help to convince the Senate majority leader about these bills!
