As an immigration lawyer, I’ve seen the problem from a different angle.
Why was the situation so dire that veterans faced months-long waits to see Veterans Affairs physicians? It's not exactly a secret that the VA faces a severe shortage of physicians. More than 800 job openings are listed on the VA website.
There are many reasons why it is so hard to recruit physicians to work for the VA, including challenging patients, dwindling financial resources and uncompetitive salaries.
As an immigration lawyer, I've seen the problem from a different angle. International physicians represent 26% of the doctors training in America's teaching hospitals. These doctors fill leftover teaching hospital slots not used by doctors educated in American medical schools.
Most of these foreign doctors come to the U.S. on J-1 visas and must get a state health agency or a federal agency waiver in order to remain in the U.S. after they complete their training. Every state and four federal agencies have programs to sponsor these doctors to work in medically underserved communities and populations. One of those federal agencies is the VA, which has sponsored J-1 physicians for many years.
Given that more than one-third of America's internal medicine physicians are international physicians (and close to half of geriatricians serving older veterans), you might presume that the VA places a high priority on its J-1 waiver program. But the VA is perceived by most lawyers as being one of the riskiest immigration bets a doctor can make.
There are a number of reasons the program is so unpopular, including:
The VA will not file a J-1 waiver until the last six months of a doctor's training. By that point, most J-1 doctors have found jobs. For those doctors willing to wait on the VA, if something goes wrong in the process, there is no time to find an alternative job.
The VA requires re-advertising a position every three years until a doctor gets to the point of becoming a U.S. citizen. But obtaining citizenship can take more than 10 years, and if a U.S. citizen applies for the job, the foreign-trained physician can be out of a job.
The VA's internal J-1 approval process is extremely cumbersome, requiring approvals from multiple offices and months of waiting.
The VA should decentralize its waiver program and allow each hospital to manage its own application process. Hospitals should be able to decide how they document recruiting, when they will file J-1 waivers and if they will re-advertise positions after a doctor has been hired. The VA Central Office should then sign off if the VA medical center's director has certified that it has followed federal requirements.
Congress can authorize more money to address the VA physician shortage, but without reforming the dysfunctional J-1 waiver program, the problems will remain.
Greg Siskind is an immigration lawyer based in Memphis.
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