Heroes or aliens: The hidden dichotomy of immigrant physicians

Heroes or aliens: The hidden dichotomy of immigrant physicians
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The COVID-19 pandemic has placed an enormous toll on health care resources in our country. The most irreplaceable of these are our health care workers. 

The doctors in vanguard of our COVID-19 warzones are performing a great service for our country, putting in long and dangerous hours as the first line of defense against the pandemic, often with inadequate protective equipment. They are rightfully heralded as “heroes.” 

Most Americans do not realize that many of these heroes were not born here. And they need more than just our gratitude. 

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The term “alien physicians” refers to foreign nationals who complete their graduate medical education or medical residency in the U.S. after graduating from medical schools outside of the U.S. Approximately half of all alien physicians who apply are accepted into a U.S. medical residency training program, which lasts from three to seven years depending on the specialty. 

The U.S. makes a large investment in these doctors. The Centers for Medicare and Medicaid spends $12-14 billion a year on graduate medical education, and about a quarter of those currently in a residency or training program in the U.S. come from abroad. Approximately one in four doctors practicing in the U.S. today came in as alien physicians. 

The immigration policies for training and hiring alien physicians are complex. They enter the U.S. and train on a time-limited visa, which must be renewed frequently. The most commonly utilized visa provides no direct path to permanent residency and requires the “visitor” to travel back to his or her country of origin upon completion of training for a minimum of two years. An alternative visa option allows the alien physician to work in an underserved region and/or hospital in the U.S. for a period of three years; only then can they apply for permanent residency. Within the current immigration system, it can take over a decade to become permanent U.S. residents post-training.

As a result, alien physicians disproportionately serve rural and urban underserved communities in the U.S. They are essential to providing competent health care to these communities, many of which were already suffering from a severe shortage of doctors even before the worst pandemic in a century amplified this crisis, leading to hospital closures and reduced access to health care for millions of Americans. 

The immigration policies that govern alien physicians are challenging for the physicians and may work against the best interests of patients. Because of the strict restrictions placed upon them by their visas, alien physicians are restricted in their clinical practice to the facility listed on their visa and are forbidden from working at multiple hospitals. Further, the visa limits their scope of clinical practice limited to their specialty. As a result, they are unable to work in other hospitals and in settings where their skills could make a difference. We witnessed these consequences earlier this year when New York hospitals, under the siege of COVID-19, asked physicians across the country for help, and we are seeing the same phenomenon now locally in multiple pockets of the country.  

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These policies also put undue pressure and stress on alien physicians, including myself. Most of us have spent nearly a decade or more in the U.S. in education, training and practice, and we consider the U.S. to be our adopted home. We believe we belong in the communities we so proudly serve. Yet we struggle for legal acceptance and recognition while our families are at risk of being deported if our hospitals close or if we are stricken by a prolonged illness. 

Some may argue that U.S. medical schools should train American citizens only, or that government funds should not support alien physician’s graduate medical studies. The fact is that there are not enough doctors graduating from American medical schools to bridge the ever-increasing gap between demand and supply of physicians, especially in our underserved areas. 

Alien physicians trained by accredited U.S. programs and serving American communities should be given the highest priority for review and acceptance as permanent residents, irrespective of their country of birth. Allocating unused green cards from previous years would help the U.S. immigration system maximize its investment in training highly skilled immigrant doctors. 

Given the COVID-19 pandemic and the exacerbated needs in both local health care systems and the communities they support, the new Congress should put this issue at the top of its plans to reform our immigration system. These doctors have served on our front lines and made irreplaceable contributions to American health. The U.S. should reciprocate with security and acceptance. 


Abhimanyu Mahajan, MD, MHS is an alien physician. He is an assistant professor of Neurological Sciences and a movement disorders neurologist at Rush University Medical Center, Chicago. He is a Public Voices Fellow with The OpEd Project. These views expressed in this article are his own.