Rural care could see impact from tighter visa rules

Where it stands: Rural areas are more than three times as dependent on immigrant doctors than what's expected given their overall immigrant populations, researchers wrote this week in JAMA Internal Medicine.

• "As our population ages, we're going to have a crisis where we need more and more humans to help support our people who are sick," said Manav Midha, lead author and a medical student at Mt. Sinai Icahn School of Medicine.
• "I'm concerned about those inflows."

The big picture: Rural parts of the country have a harder time attracting young doctors and are more prone to physician shortages.

• They've closed gaps in the past by turning to foreign-born and internationally trained clinicians: Congress has for more than two decades allowed up to 30 immigrant physicians a year in each state to stay in the U.S. after finishing their residencies, if they practiced in a rural or underserved area.
• Many health systems also sponsor H-1B visas as a way to attract professionals with specialized skills.
• About 1% of all doctors practicing in the U.S. have an H-1B visa, and the percentage of physicians with the visa is nearly two times higher in rural counties than urban ones.

Where it stands: President Trump last year dramatically increased the H-1B visa fee to $100,000 from about $3,500. Medical groups say this will accelerate looming physician shortages.

• The American Medical Association and more than 50 other health care groups asked the administration to exempt health care workers from the new fee but haven't received a response, the AMA told Axios.
• The State Department last month also paused issuing immigrant visas for people from 75 countries. Workers from 69 of those countries make up 8% of the U.S. health care workforce, per a KFF analysis of available data.

There isn't yet data on how many foreign physicians are opting to go elsewhere because of visa restrictions or the administration's stepped-up deportations, but anecdotes suggest it could begin to weigh on the medical workforce.

• "I really hadn't thought so deeply about going back home before, but definitely it's been much more top of mind," Michael Liu, a Canadian medical resident working in the U.S., told NPR in November.
• Department of Health and Human Services spokesperson Andrew Nixon said concerns about immigration policies affecting rural health access are "without merit," and pointed to the $50 billion rural health fund Congress created in the last year's Republican budget law.
• "We will continue to support health systems in underserved, rural communities where it is desperately needed," Nixon said.

Zoom out: The immigration crackdown is hitting as more rural health providers struggle financially.

• More than 300 rural hospitals are at immediate risk of closing their operations entirely, a December report says.
• And health policy experts warn that the $50 billion fund isn't going to offset nearly $1 trillion in cuts to federal Medicaid funding over the next decade that were part of the budget law.

The intrigue: Federal health officials are increasingly promoting AI as a way to alleviate staff concerns in rural America.

• Centers for Medicare and Medicaid Services administrator Mehmet Oz said at an HHS event this week that AI-based avatars could help solve rural health workforce shortages by helping "catch the patient, customize to what their needs are" and then connect to a doctor.

What we're watching: The real impact of Trump administration immigration policies on doctors will start to become apparent in July, when new resident physicians start their jobs, said Eram Alam, a historian of medicine and an associate professor at Harvard University.

• She's watching to see how many international medical students apply for U.S. residency spots, and how many programs accept foreign-born doctors who require visa sponsorship.
• "Immigrant workers are on the front lines of all of the health care of this country in every single capacity," she said.
• If they stop coming to the U.S., "I think that we're just going to see slowly, the erosion of of the whole entire infrastructure," Alam added.

Go deeper: The immigrants caring for the nation's elderly are losing their jobs