Having once been in their shoes, I can attest to the difficulty of this pathway. After completing medical school in England, I was accepted into a fellowship and research program at Duke University that was designed to lead to permanent residency. Even on this relative fast track, I endured years of jumping through hoops, paperwork, and waiting for the unknown. It's definitely not a process for the uncommitted.
Years later, Vituity colleagues and I advocated for the recruitment and sponsorship of highly qualified international physicians seeking permanent residency in the United States. These efforts culminated in 2015 with the launch of our Visa Candidate Program.
In today's post, I'll share why sponsoring visa candidates creates a win-win for promising physicians and their employers, plus Vituity's approach to the process.
Challenges for Visa Candidates
To practice in the United States, all international medical graduates must meet strict requirements:
- Certification by the Educational Council for Foreign Medical Graduates (ECFMG), which requires a thorough transcript review and demonstrated English proficiency.
- Passage of the United States Medical Licensing Examination.
- Completion of a residency in the United States (even if they previously completed one in their home country).
About half of these international medical graduates enter the United States on visas, typically as J-1 Exchange Visitors or H-1B Temporary Workers. In order to remain in the country after their training, they must find an employer who will sponsor them and provide a path to permanent residency. Some must also meet additional requirements, like working in a federally designated healthcare shortage area.
For international medical graduates, qualifying to practice in the United States can add several years to a medical education. The costs of certification, exams, and visas can also be significant. It's a safe bet that those who choose this course possess a high degree of determination and drive.
Unfortunately, it doesn't always pay off. Relatively few employers are willing to undertake the financial and administrative burdens that go along with sponsoring an international physician's permanent residency petition.
In most cases, the employer must initiate the permanent residency process on behalf of the physician and absorb all associated costs. This typically requires them to demonstrate to the Department of Labor that the international physician is fully qualified for the job and that his or her employment is not a detriment to the domestic physician workforce. The cost of this lengthy process can exceed $10,000 in legal and administrative fees.
A Case for Sponsorship
Despite the costs involved, I think there are compelling reasons for any healthcare organization to consider visa sponsorship for highly qualified physician candidates.
One factor is the looming physician shortage. The Association of American Medical Colleges is predicting a shortfall of 91,500 doctors by 2020, with about one-third of these unfilled positions in primary care. At the same time, healthcare coverage is expanding, and our population is aging. There's a very real danger that we will not have enough physicians to meet the growing demand for services.
Coupled with this trend is the declining popularity of generalist practice among American medical students. Medical school debts have reached oppressive levels, and generalists typically earn a fraction of what their specialist colleagues do. In addition, generalists shoulder a disproportionate share of the administrative burden brought on by healthcare reform. So it's no huge surprise that US medical school seniors filled just 44 percent of family medicine residency slots and 49 percent of internal medicine slots in 2015. In both cases, international graduates made up most of the balance.
Healthcare organizations are already feeling the effects of these trends. This is particularly true as in the realm of hospital medicine. America's "fastest growing specialty" is still increasing too slowly to meet the demands of employers, many of whom hope hospitalists will help them to boost core quality metrics.
Employing visa candidates may help to alleviate the hospitalist shortage (and the physician shortage in general). Most hospitalists train as internists or family physicians — disciplines where international graduates now comprise a majority of residents. In addition, physicians on visas are uniquely incentivized to work in healthcare shortage areas where recruitment is most challenging.
The advantages of sponsoring international physicians go well beyond the pragmatic. These physicians bring valuable diversity to the workforce. (UCLA is currently recruiting residents from Latin America in order to boost the number of Spanish-speaking physicians in California.)
And finally, employer sponsorship provides an avenue to attract and retain top talent to an organization. The sponsor's assistance is likely to breed loyalty in the participating physicians, motivating them to give back to the organizations.
Vituity actively seeks to employ well-qualified visa applicants either directly or in conjunction with a client organization (depending on the candidate's visa requirements). The program allows physicians to practice full- or part-time while pursuing permanent residency status. Upon obtaining a green card (permanent residency), these physicians become full Vituity partners.
Visa program participants receive a competitive benefits package that includes retirement; health, life, and disability coverage; professional liability insurance; and continuing education. In addition, Vituity covers all costs associated with sponsorship and the green card application process.
We view visa sponsorship as an investment in our organization's future. We believe that the Visa Candidate Program will provide a win-win-win for promising physicians, our partnership, and our client hospitals for years to come.
If you're a highly qualified international physician interested in joining a physician partnership, we invite you to call 1-800-842-2619 to learn more about the program.