Just a few months ago, the future appeared promising and certain for Sunil Sreekumar Nair. A British citizen, he was completing a residency in internal medicine at a Brooklyn hospital and had accepted a job in a hospital near Fort Smith, Ark., a rural area with a severe shortage of doctors.
Then the Trump administration announced that it was suspending the 15-day expedited process to obtain an H-1B visa, a program that allows U.S. employers to temporarily employ foreign-born workers in specialty fields such as medicine and information technology. Now Nair may not receive his visa for at least eight months, long after he is supposed to show up for his new job in Arkansas.
The Arkansas hospital has offered to keep the job open for him, but Nair isn’t even sure he’ll be able to stay in the country after his original visa expires with the end of his medical residency in June.
“To say I am frustrated would be an extreme understatement,” Nair said.
In addition to suspending the expedited application process, President Trump in April ordered a review of the entire H-1B program.
The uncertainty swirling around the H-1B program is creating problems for parts of the country that have difficulty attracting American physicians.
“For us, this has been a very positive program that has brought health care to areas of Wisconsin that would otherwise go without,” said Lisa Boero, legal counsel for the immigration program at the Marshfield Clinic Health System. Marshfield Clinic operates more than 50 facilities in central and northern Wisconsin.
Hospitals in distressed urban neighborhoods also rely on foreign-born graduates of medical schools to fill residencies that might otherwise go vacant.
“Who else is going to do the work if we lost them?” asked Conrad Fischer, director of the medical residency program at Brookdale University Hospital and Medical Center in Brooklyn, where Nair is chief medical resident. “We would have to close down.”
This year, for the first time in five years, the number of applicants for H-1B visas dipped below 200,000. However, immigration experts say it’s too soon to attribute that drop to Trump’s policies or anti-immigrant and anti-refugee rhetoric in the United States.
The Migration Policy Institute, a Washington think tank, says U.S. patients are being treated by about 230,000 foreign-born doctors. That amounts to about a quarter of the country’s physician workforce.
A study published in April found that federal officials granted permission for nearly 10,500 physician jobs to be filled by foreign-born doctors with H-1B visas in 2016.
According to that study, New York state had the highest number of H-1B physician slots approved in 2016, with 1,467. If those slots were all filled by H-1B visa holders, they would represent about 2.5 percent of the total number of doctors doing clinical work in the state.
In North Dakota, the approved H-1B slots represent a greater percentage of the total number of practitioners, nearly 4.7 percent. “They are vitally important to our state,” said Courtney Koebele, executive director of the North Dakota Medical Association.
The current vice president of the association is a former H-1B visa holder. Born in Lebanon, Fadel Nammour completed a medical residency in gastroenterology in New Jersey under a short-term visa called a J-1. He was supposed to return home after his studies. But he wanted to stay.
In 2002, Nammour was offered a job with a health plan in Fargo and received an H-1B visa, which cleared him to stay in the United States for up to six years. In Fargo, he married a local woman, had three children, obtained a green card, bought a home, became a naturalized U.S. citizen in 2010 and opened his own practice in 2013.
If the H-1B program ever launched an advertising campaign, Nammour could be its face.
“We aren’t taking jobs from Americans,” Nammour said. “We are filling jobs that Americans weren’t taking and providing a service that North Dakota needs.”
Pope Moseley, dean of the medical college at the University of Arkansas for Medical Sciences, said that the university, which had 86 slots for H-1B visa holders in 2016, used the visa program to recruit pioneering researchers from around the world.
“Sometimes the people who are driving that pioneering clinical science are people who require the H-1B visa,” he said. “We want to get the best people possible who can help us develop new treatments, and this visa program helps us do that.”
The Trump administration has promised greater scrutiny of the H-1B program. Immigration advocates worry that the president’s order to review the H-1B program might lead to fewer visas, but they also acknowledge that he has highlighted problems that need fixing.
In 2015, about 113,600 H-1B visas were issued. More than half, 85,000, were chosen by lottery. Medical residents, as well as doctors who work at nonprofit research institutions, universities and government research facilities, are not subject to the lottery, and there is no cap on how many of them can receive visas in a year.
Critics such as Sara McElmurry with the Chicago Council on Global Affairs, a nonpartisan group that researches public policy issues, complain that the overall H-1B system allocates visas based on chance rather than on the country’s economic needs, lumping IT workers and accountants together without considering the country’s economic needs.
That’s the same point Trump made in talking about why he ordered the H-1B review.
“Right now, H-1B visas are awarded in a totally random lottery — and that’s wrong,” he said.
More perplexing to critics on all sides is why the Trump administration in April suspended expedited 15-day “premium processing” for H-1B applicants, the action that has put Nair and others in limbo. (In the past, the expedited service cost applicants an additional $1,225.)
James Volk, a vice president with Sanford Health, which employs about 50 doctors with H-1B visas in clinics across North Dakota, said at least two doctors whom Sanford has hired are hung up in the visa process instead of seeing patients.
The suspension affects not only those with job offers but also those hoping to begin medical residencies. Students in their last year of medical school learn in March where they have been accepted for residencies, which generally begin in July. Many of them may find that they have to give up those slots if they don’t receive their H-1B visas in time.
According to the Association of American Medical Colleges, 18,000 foreign-born medical residents are now training at U.S. hospitals and clinics. Many are in the country under H-1B visas.
The suspension took effect two weeks after it was announced. Bolero of the Marshfield Clinics said that gave her just enough time to submit expedited applications for all her incoming foreign-born medical residents.
But if expedited processing isn’t restored, she said, her health system may not be able to offer residencies to foreign-born doctors in the next class of medical students.
“I am anticipating we will have significant problems next year because the timing just doesn’t work for the health-care industry,” she said.