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ACP to Homeland Security: Exclude J-1 Physicians From Visa Rule Change

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Proposed visa rule change would disrupt training and patient care

Nov. 6, 2020 (ACP) – The American College of Physicians and other leading physician organizations are urging the U.S. Department of Homeland Security to exclude physicians from a proposed visa rule change that would eliminate long-standing duration of status for certain nonimmigrant visa holders.

If finalized, this rule could affect more than 12,000 J-1 physicians and jeopardize patient care during the ongoing COVID-19 pandemic, explained Renee Butkus, ACP director of health policy. J-1 is the most common visa classification used by foreign national physicians to participate in U.S. graduate medical education.

The rule change, which was proposed by Immigration and Customs Enforcement, an agency of the U.S. Department of Homeland Security, was published in the Federal Register for public comment. Exactly when the rule will be finalized is not known, Butkus said.

During the comment period, ACP sent a letter to Chad Wolf, acting secretary of the U.S. Department of Homeland Security, outlining its concerns. ACP also joined forces with the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Osteopathic Association and American Psychiatric Association to reiterate these concerns. In addition, ACP urged the members of the Council of Subspecialty Societies to submit comments.

Physician training programs last one to seven years, depending on the medical specialty or subspecialty. The current “duration of status” provision allows J-1 physicians to extend their authorized stay in the United States for subsequent years of training at the same time that they renew their visa sponsorship annually via the Educational Commission for Foreign Medical Graduates/Foundation for Advancement of International Medical Education and Research, a rigorous review process that confirms their continuing eligibility, Butkus noted.

The proposed rule change, however, would replace “duration of status” with a specific end date and the additional requirement to apply through the U.S. government each year to extend this end date, she explained.

“If the proposed rule change is implemented for J-1 physicians, it will cause significant disruptions to the training of these physicians and to the patient care that they provide,” Butkus said.

Right now, more than 12,000 J-1 physicians are providing critical health care services at an estimated 750 teaching institutions as they complete their training, she said. “The role they play is especially critical as our nation battles the COVID-19 pandemic,” she said.

Under the new rule, J-1 physicians would have to apply for an extension through a U.S. Citizenship and Immigration Service (USCIS) Service Center or leave the United States each year and apply for the extension through a U.S. consulate abroad.

Neither option is ideal. Butkus noted, “The current published processing times for extensions at USCIS's five service centers range from five to 19 months, and regular, international travel during residency or fellowship programs is likely to disrupt training, and given the current pandemic, travel poses the risk of infection.”

The J-1 visas are issued for the program year (July 1 to June 30). J-1 physicians would potentially have a delay each year in getting a new visa approved or might even end up having to leave the country between visas, Butkus said.

“Since teaching hospitals depend on J-1 physicians to provide continuity of care, the proposed rule will cause severe disruptions to patient care,” she said. “The majority of residency/fellowship contracts are issued only three to five months in advance of the July 1 start of each new academic year. The proposed change would create an extremely difficult timeline and do so on a recurring, annual basis.”

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Back to the November 6, 2020 issue of ACP Advocate