The State Department website published the guidelines, making it clear that doctors intended to treat patients with COVID-19 were exempt from Trump’s proclamation. On the same day, many of the residents contacted by ProPublica said that all of a sudden they had received visa approval. “A fantastic backtrack, since my visa had been rejected by email three days before,” said one of the doctors. But in less than five countries, however, consulates do not approve doctors’ visas …
This article was published in English by ProPublica on July 17th
While hospitals across the United States are gearing up for a difficult six-month period – with the first wave of coronavirus still in full force and worried about a second wave in the fall – some of them have serious staff shortages due to a wrong change in immigration policy and its inconsistent implementation.
A proclamation issued by President Trump on June 22, blocking the entry of most immigrants with a work visa, coincided with the time when hospitals were waiting for a new class of resident doctors. Hundreds of young doctors failed to begin their time shift in hospitals.
Trump’s order included H1-B visas for highly skilled workers, which is used by some doctors practicing abroad who receive visas for places of residence. The order says doctors “involved in medical care for individuals who have contracted COVID-19 and are currently hospitalized” should be exempt from the order, but delegated the issuance of guidelines to the state and homeland departments. Security. These guidelines have been short to come and inconsistent.
Many consulates began approving medical visas this Thursday after ProPublica asked the State Department for the reason for the delay. Others say they are still waiting for help from the guidelines.
In hospitals where many of the residents have visas, even a few weeks’ delay in arriving in the United States creates a staffing crisis. Doctors and administrators fear that the repercussions will have an effect at the end of the year — leaving them with more work than they can do and poorly prepared even before the second phase of the virus breaks out.
ProPublica is aware of 10 of these medical residents stuck abroad because of problems with H1B visa. Six of them had received the emergency post directly from the consulate for visa approval, but when they arrived for interviews they were told that their visas could not be approved. Three were still awaiting approval of their visa by the Department of Homeland Security, a necessary step before a visa receives approval from the consulate. One of the residents had received approval for the application, but was denied an emergency interview by the consulate because of the proclamation. All of these doctors were intended for hospital jobs to treat patients with COVID-19.
On Thursday, the State Department website released the guidelines, making it clear that doctors intended to treat patients with COVID-19 were exempt from Trump’s proclamation. On the same day, many of the residents contacted by ProPublica said that all of a sudden they had received visa approval. “A fantastic backtrack, since my visa had been rejected by email three days earlier,” said one of the doctors. But in less than five countries, however, consulates did not approve doctors’ visas.
The Committee of Interns and Resident, an affiliate of the Service Employees, has as many as 250 of these doctors who have been stranded abroad. Over 150 of them have an H-1B visas … (The others had seen visas not included in Trump’s proclamation, but cannot receive approval because their consulates are still closed due to the pandemic.) Union President Jessica Edwards he indicated to ProPublica that while those numbers seem limited, each intern is responsible for the care of thousands of patients.
In 2017, there were 2,532 medical residents with H1-B visa, according to the Journal of the American Medical Association — as much as Trump’s ongoing restrictions on legal immigration tend to discourage hospitals from applying for “visas” in these past few years. But the impact is heavily concentrated in less prestigious hospitals that tend to use residents from abroad.
At one of New York City’s hospitals with low-class clientele, nearly half of the next group of doctors are stuck outside the country, various agencies have confirmed to ProPublica. A hospital in a large Midwestern center told ProPublica that “a good half” of its first-year doctors had managed to leave on time. In Deep South, a region currently overburdened with COVID-19 cases, a doctor who was ready to begin his service told ProPublica that he was one of 10 residents still waiting for visa approval in early July. All hospitals and doctors spoke to ProPublica on condition of anonymity because they fear they endanger their visa application.
ProPublica also spoke to more experienced doctors who have the same problem — including an infectious disease specialist stuck from starting a job in a West area of the United States where COVID-19 cases are growing.
Where there are not enough new residents to replace third year residents, there are serious staffing problems.
At New York City Hospital, a doctor told ProPublica that only after 10 days of short-staffing, a resident had called and said he was exhausted. The doctor described a recent shift in which there were only two junior residents available, compared to the typical six. Even by making residents work as individuals instead of teams of two, they were unable to cope with the admission of new patients.
“Patients had to stay there waiting (in the emergency department) to finish the residents with their first admissions, and then to be able to see them,” said the doctor. “At the end of the shift, I checked the computer and saw written notes at 10pm, 11pm. And these residents have to go home and then come back again at 6:30 in the morning. “
Even in hospitals with fewer COVID-19 cases, staffing is a bigger problem than it was before the pandemic. Some hospitals are undergoing “growth of non-COVID patients” who could not receive treatment for chronic conditions such as heartache during the lockdown and which are now deteriorating, as a doctor from one of these hospitals with deficiency told ProPublica staff. And since the protocols do not allow doctors to go back and forth between COVID-19 and non-COVID-19 patients, hospitals need to have many more doctors available in order to maintain a level of staffing in both lanes.
If someone gets seriously ill, who cares for him? A hospital administrator said to ProPublica: “I have my poor residents running all over the place to make sure each patient is properly visited. And the residents are good people, but unfortunately there can only be one per seat. “
Some of these problems will be resolved as soon as residents receive visas that are arriving late and can report to work. But it will take weeks, if not months, to get them on board. The Midwestern hospital anticipates that residents who are due to arrive will not be able to take work until mid-August. In the meantime, they work with under-capacity services and use fourth-year students instead of residents.
Hospitals are used to the efficiency of the summer gap, while new interns learn to make themselves useful. This year, it may persist until autumn — when we expect a second wave of corona virus infections.
“I am truly concerned that in three months,” said the medical administrator, “we will have a number of interns who are simply exhausted as we prepare for the worst part of the fall, flu and season of COVID.
Quest doctors have already had to struggle through the first phase of COVID-19 this spring. Furthermore, at the hospitals most severely affected by visa suspension, residents who end up taking unworked jobs are often in possession of an H1-B Visa now with an uncertain future. Trump’s ban has not lifted visas for those who are already in the United States, but if they leave the country what – what they must do if they change jobs – the possibility of returning is uncertain. Some doctors interviewed by ProPublica were already in the United States before the pandemic and returned home, in part to obtain approval for the visa for the new job. A doctor remained in India while her husband was unable to reach her from the United States.
Another doctor from India who now works in the United States told ProPublica: “My parents, they are (in India) alone, and both are in their 70s. At some point, they’ll probably get the infection. ” And if that happens, the doctor intends to leave the United States to take care of them – “and if I don’t return, it means I don’t return. Right now I really don’t care. “
The sense that the United States does not appreciate them is exacerbated among the residents who experienced the first wave of COVID-19 and are now overworked and concerns about the uncertainty of the visa, to ome said that other countries will facilitate the situation for doctors who emigrate, while the United States leaves them in limbo.
“We are not appreciated at all for what we do,” the New York City resident said. And what else can you do besides sacrifice your life? “
Strongly regimented shifts of residence can be difficult for those who have H1-B visas even in the best case. Doctors know in mid-March if they have been “paired” with an American hospital, where they are expected to begin work in early July. DHS often takes longer to approve applications for H1-B. Employers can pay to secure a decision within five days – but DHS ended its process of anticipating March 22 due to COVID19 and didn’t reopen it until June 8.
Shortly thereafter, Trump issued his proclamation blocking entry to the country on many types of visas, including H1B.
Many of the people who come to the United States as residents come with different types of visas, the J-1, and are not subject to Trump’s proclamation, although some have had trouble getting an appointment at the consulate due to the COVID-19 pandemic . But doctors do the same job regardless of the types of visas. If anything, doctors with the H-1Bs are more qualified than those with the J-1s, because they must complete the three stages of the very heavy Licensing Medical Exam before starting residences. Residents with the H 1-B visa were practitioners in their home country who worked with new graduates from United States medical schools.
A first blockade of immigration to permanent immigrants, which passed in March, contained large exemptions for medical workers. When noises of a ban ai work visa began to be heard in late spring, immigration lawyers and hospitals expected it to contain the same provisions. Instead, the June Proclamation only mentions doctors who had to work with patients in hospitals because of COVID-19.
All residents who spoke to ProPublica showed that the United States government pointed to them. Some were told by consular officers that they were probably exempt. But until the Department of State guide-lines were published, they had to put their visas into the “administrative process” – an endless pattern.
ProPublica saw the image of a shape given to one of the visa applicants who informed him that he was in a suspended state. The form is usually used to get more information from the applicant. In this case, however, a consular officer had modified the form indicating that what consideration would be taken not before the “implementation procedures” for the visa ban had been prepared.
Doctors in limbo have formed groups of WhatsApp to stay informed and as a form of support, but the dialogue has proved inconsistent in the implementation of the ban. Some consulates, such as those in Serbia, Russia, and the United Arab Emirates, have approved the H1-B visa of doctors as exempt. Asked why such an inconsistency, the State Department told ProPublica: “Those applicants who believe they are qualified for a state exemption. Presidential Proclamation 10052 must check the website of the nearest Consulate or Embassy regarding the current service status. How the various systems are managed depends on the consular section “.
A doctor who had applied for it went to the State Department for assistance and received an email response from an employee on July 10. The clerk said that as far as they knew, the consular affairs office had given regulations to consulates and embassies to proceed with ban-exempt visas. (The agency declined to comment on that email)
On Thursday, the same person who applied had received a second email from the same employee. The rules weren’t rushed, the clerk admitted, but the case was resolved.
But some countries have not yet changed their procedures. A doctor stuck overseas told ProPublica that they had sent a second email to the consulate on Thursday morning. “He gave me the same answer,” said the doctor, “that they are still waiting for directives from the State Department.”
Dara Lind writes for ProPublica on immigration policy in Washington, DC. The article has been translated by Salvatore Rotella