1 - I focus a lot of my practice on physician immigration. I chaired for many years the IMG Taskforce, America’s physician immigration bar organization, & I co-author 2 books on the subject. I’m working with IMGT members to get out ideas on what the agencies and Congress can do.
2- I’m going to start with @USCIS, but will also talk about @StateDept @ecfmg_J1, @SpoxHHS, the ARC, @DeltaRegional, @ICEGOV, and @USDOL. Then I’ll talk about what Congress needs to do.
3 - @USCIS can expedite Employment Authorization Documents and petition processing for all health care workers without the need to pay premium processing fees. That’s all petitions - H-1Bs, green cards, EADs, you name it. Ideally, 15 days or less on all.
4 - @USCIS and @statedept need to find two health care experts and make those persons the coordinators/points of contact for their agencies to ensure the agencies are doing everything they can in this fight for the lives of Americans.
5 - @USCIS needs to confirm that telecommuting (including providing telemedicine), does not trigger new posting requirements for H-1Bs and that if a doctor is meeting state law in providing this, USCIS won’t second guess the licensing requirement.
6 - @USCIS needs to accept digital signatures on apps. The agency needs to get with the times bc lawyers filing these cases are all working remotely and getting original signatures isn’t working. The change this week allowing copies of original signatures is good, but not enough.
7 - @USCIS - Automatically extend cases for late filers if the health care worker or the lawyer is in a city on lockdown or has asked businesses to close.
8 - @USCIS needs to approve H-1Bs without medical licenses if the hospital/medical facility provides a letter stating they won’t allow the doctor to be fully credentialed & start until he/she has the appropriate license. This will speed up the MD getting started serving patients.
9 - @USCIS should grant Employment Authorization Documents for H-4 spouses, even non-medical - where the spouse’s work is related to fighting COVID or is an essential industry.
10 - @USCIS should waive filing fees, including premium processing fees, for hospitals where residents/fellows want to take on extra work outside the training program to assist in fighting the pandemic.
11 - @USCIS should suspend all deadlines, including extensions of stay, for health care workers.
12 - @USCIS should expand the STEM occupation list to include nurses, doctors and other health science professionals so that F-1 nursing and medical students seeking post-graduation work cards can get an additional two years of work authorization.
14 - @USCIS should waive interviews in I-140-based adjustment of status petitions for health care workers to speed up completion of green card processing and make it easier for these doctors to have the flexibility to work where needed.
15 - @USCIS should allow H-1B change of status from J-1 status in hardship waiver cases. The current requirement of having to leave the country, get an H-1B visa at a consulate and then reentering is unworkable.
16 - @uscis should lift location and job description limitations on healthcare workers temporarily and promise employers there will be no penalty to employers or employees. This will obviously end when the crisis has passed.
17 - @USCIS should automatically extend all EAD/AP, H-1B, J-1, J-2s, etc for healthcare workers in 180 day increments without needing to leave the US and tag up at a consulate or port of entry.
18 - @USCIS should allow for the change of status to O/E/F status for those subject to INA Section 212(e). Right now, those doctors switching to one of these categories must leave the US, get a visa at a consulate and then reenter the US. That’s not workable right now.
19 - @DHSgov should grant TPS to people stuck in the US and grant expedited TPS-based work cards to health care workers.
20 - @USCIS should waive “Neufeld” requirements making it difficult for physician and nurse staffing companies to get doctors to needed locations.
21 - @USCIS should resume the premium processing program and waive processing fees for health care workers.
22 - @USCIS should accept any state physician license with a visa application versus a license from the state where the doctor will be working (this is consistent with a change just made by Medicare that does something very similar).
23 - @USCIS should approve H-1B applications without passage of USMLE 3 since the exam is not being offered because of the pandemic (hopefully, remote testing will become available).
24 - For J-1 waiver transfers, @USCIS should designate any COVID-19 related transfers during a physician’s 3 years of J-1 service to be per se extenuating circumstances.
25 - @USCIS should expedite changes of status to J-1 inside the US for medical residents/fellows and waive the need for biometrics.
26 - For employment authorization document applications filed by health care workers, @USCIS should waive biometrics requirements.
27 - OK, on to @ECFMG_J1 - Allow J-1 doctors to provide telemedicine.
28 - @ECFMG_J1 should expedite J-1 transfers for MDs going to work in coronavirus hotspots
29 - @ECFMG_J1 should issue DS-2019s even with a waiver pending and even if the doctor is hitting seven years.
30 - @ECFMG_J1 should relax rules regarding J-2 to J-1 switches.
31 - @ECFMG_J1 should allow DS-2019 extensions for doctors who expected to be able to take board exams that have now been cancelled or postponed.
32 - On to @CBP (I think I left them off the agency list at the top). @cbp (and @statedept) should provide a blanket exemption for health care workers from travel bans and border closures.
34 - @cbp should parole in MDs who can’t get visas
35 - On to @SpoxHHS - HHS has a J-1 waiver program for doctors going to underserved areas, but it is limited only to primary care and only rural clinics, community health centers and tribal health clinics. They should open to specialists and all types of facilities.
36 - @SpoxHHS decides what areas are Health Professional Shortage Areas & Medically Underserved Areas which makes little sense in a pandemic. The whole of America is a physician shortage area. HHS should declare the entire US a shortage area so any COVID area can recruit a J doc.
37 - Last night I was fairly critical of @statedept for not doing enough. Here are ten things the State Department could do. Yes, saying you’ll let the 4K J-1 doctors set to arrive in July is good. But if you really want more health care workers in the US, you can do these things
38 - The @StateDept J-1 waiver review division can expedite physician waiver cases. This is a multimonth process right now. They need to get these cases approved in a week.
39 - @statedept needs to empower @ecfmg to allow more flexibility for work settings for J-1s and give its blessing to all the changes recommended for @ECFMG_J1 above.
40 - The @statedept J-1 waiver review division needs to waive recruiting requirements applicable to J-1 waiver cases. That’s okay in normal times. These aren’t normal times and they’re slowing these cases down.
41 - The @statedept J-1 waiver review division needs to allow states to expand the people who can sign waiver recommendations to allow lower people to sign. Right now, the heads of agencies need to sign. That slows these cases down.
42 - The @statedept J-1 waiver review division should act as an interested government agency when a state has maxed out wiaver usage. For example, NY is out of Conrad 30 waivers. DOS should approve whatever NY asks for.
43 - The @statedept J-1 waiver review division should allow telecommuting which may be critical to serving COVID patients in their homes and reduce the risk of the spread of the virus.
44 - This is a big one, @statedept. You decided yesterday to allow H-2Bs and H-2As to get visas without interviews at a consulate. Do that for health care workers. No visa interviews. Allow applications to be submitted online and let your St. Louis office stamp the passports.
45 - @statedept - Parole in doctors filing physician national interest waiver based green cards so they can file their adjustment applications in the US. Work with @cpb and @uscis to have work cards waiting for them when they get her.
46 - @statedept - For MDs and RNs subject to travel bans because of having been in a coronavirus country, allow them to enter the US and quarantine in the US.
47 - On to the Appalachian Regional Commission and @DeltaRegional - Your agencies have the legislative authority (I know because I’ve researched the question) to issue J-1 waivers outside your regions. You should approve waivers anywhere in America that needs you.
48 - @ICEgov - Your agency manages I-9 compliance. You’ve done a good job relaxing some of the requirements which are making it much easier for health care employers to comply. Congratulations - The asks we had for you guys you proactively made. Well done.
49 - @USDOL - You need to suspend H-1B posting requirements until the crisis is over given the logistical nightmare many employers are facing now. You made a great accommodation on PERM this week. We know you have it in you.
50 - So that’s it for the agency asks. Now for Congress. The first is a long time coming. Pass HR2895/S948. This bill has vast bipartisan support and will make short and long term changes addressing the doctor shortage in the US and making the physician immigration system work.
51 - Congress - Several of the asks above (like TPS for health care workers) may be too much for the agencies to swallow. Force their hand. Everything I’ve listed above you can mandate.
52 - Congress - Any doctors and nurses going to the front lines should be put on a fast track for a green card or maybe even citizenship. They’re putting their lives on the line. We have a program to give MDs joining the military instant citizenship. Do the same for these heroes.
53 - Congress - Bring back a non-immigrant category for nurses. You let the H-1A sunset 20 years ago because you bought bogus research saying we no longer had a nursing shortage. And now look where we are. Here’s your chance to make this right.
54 - Last but not least for Congress - Require the expediting of the approval of nurse I-140 petitions and then parole in the nurses with immediate access to green cards. If green card categories are backlogged, allow them to work in the US on their EADs while they wait.
55 - And that’s the end. I appreciate my colleagues on the IMG Taskforce for their hard work helping with this list. We’re presenting these ideas through the normal channels to the agencies, but we need you to make your voices heard and demand these actions. It affects us all.
