The medical mess

It seems odd that 12,000 foreign doctors can get residencies in the U.S. but 2,000 U.S. medical graduates cannot.

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There’s a COVID-19 pandemic and a projected doctor shortage of 139,000 in the U.S. by 2033 (and possibly 55,000 primary care doctors by 2023).   Meanwhile, 2000 American medical graduates can’t get residencies, which means that they cannot practice as doctors.  On the other hand, the U.S. Immigration Service is proposing to make it harder for foreign doctors in residence to keep their positions, putting 12,000 of them at risk of being told to go home.

It seems odd that 12,000 foreign doctors can get residencies in the U.S. but 2,000 U.S. medical graduates cannot.  While it’s certainly possible that the students without jobs are not well qualified while all the foreign applicants are, one would think that the government could improve the hiring situation for the U.S. graduates.  For example, the hiring procedure for U.S. medical graduates could start in June 2020 for employment in June 2021, with employment offers going out in September 2020, so that by the end of October 2020 we could identify the graduates without jobs.  Offers to foreign students could not be made until the end of November 2020.  The residency hospitals would be given a choice between taking one of the remaining Americans (and getting a bonus from the government) or taking one of the foreign students and paying an amount equal to the bonus.  One might expect that this would solve most of the problem.

Meanwhile, there’s the issue of the new immigration rules which may be imposed on the foreign medical immigrants.  The same rules would be imposed on other immigrants as well, but imposing them on the medical immigrants harms our country in a time of pandemic.  The problem appears to be that the medical immigrants can only get a visa for one year, and they would then have to apply for a renewal, which would take 5 to 19 months for the immigration service to approve.  Then the immigrant would either be illegal here or have to go home.  This is a stupid situation when the medical immigrant came to the U.S., with the immigration service knowing that the immigrant would need to spend three or four years in residency, even if the initial residency were only for a year.

The solution?  The visa for the first year should be conditionally for four years.  After ten months in the U.S., the immigrant should file papers with the government, showing where he is living, his telephone, email, and so on, plus papers showing that he had been accepted for another year or more of residency.  His visa would be good so long as he could show that he had sent the papers to the government.  (He could email them to the government and receive a receipt).  The government might reject the papers, but it would be up to the government to take steps to send the immigrant home, if that was the decision.  The immigrant could stay on and try to obtain residencies absent an act by the government.  
The “new rules” make the medical immigrants victims of government bureaucracy for absolutely no reason.  So long as the medical immigrant must keep in contact with the immigration service, there’s really no great danger that he will become “illegal.”  A medical graduate is not going to put his future in jeopardy by failing to obey immigration rules, so long as they can reasonably be followed.  The only reason why a foreign medical student in residency would want to stay in the U.S.  is if his residency were renewed.  Otherwise, he would go home or to another country.  Making it practically impossible for him to renew his residency doesn’t benefit the U.S. when we have a doctor shortage with a worse one projected for the future.  (The Harvard Business Review says that the problem isn’t a shortage but disorganization.  Yet until the disorganization problem is solved, we’ll still need more doctors).

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