Trump's visa freeze sidelines immigrant doctors

• About a quarter of the U.S. physician workforce are immigrants. Rural communities especially depend on immigrant doctors to fill workforce gaps.

State of play: The Citizenship and Immigration Services this winter started freezing the processing of immigration benefits like work authorization extensions for people already in the U.S. from 39 countries.

• The change has affected work authorization renewals, green card processing and naturalization.

Where it stands: Visa holders have a grace period allowing them to continue working in the U.S. after applying for a renewal. For the common H-1B visa, that period is 240 days.

• But the freeze has scrambled arrangements, forcing doctors to take unpaid absences from their jobs. They can legally stay in the U.S. if their employer continues to sponsor them.
• Immigrant doctors caught in the squeeze now either have to return to their home countries, immigrate elsewhere or stay in the U.S. unable to work.

What they're saying: "Even with us, there is [a] severe shortage," one Ohio-based doctor told Axios. "Can you imagine any physician loss, how it will impact the society here?"

• He and others interviewed were granted anonymity to discuss their immigration status due to fear of retaliation.

Patients already are feeling the fallout. The Ohio doctor said his clinic patients had to be rescheduled to other doctors when his work authorization ran out in February.

• Those patients may have to wait months for a new appointment, he said. Other doctors picked up his on-call shifts, stretching their own workloads.
• The American Medical Association wrote to the Department of Homeland Security that one doctor estimated their work suspension left more than 900 patients without sufficient care.
• "It's not just an immigration issue," said a Michigan doctor whose work visa runs out in July. "It's a patient care issue that's hiding in plain sight."

Doctors whose work permits remain valid for now worry they're not performing at their best.

• "I'm stressed. Sometimes I cannot sleep at night," a doctor in western Pennsylvania said. "When I come to the hospital and I work on my cases ... I feel kind of lost."

Zoom in: Another doctor in residency in an underserved area of Pennsylvania said it was difficult to schedule patients for follow-ups in the weeks before his work authorization expired last month.

• "Some of them were, like, doc, I'm going to see you in three months," he said. "Deep in my mind, I knew [they] might not."

The other side: Homeland Security told Axios the freeze is necessary because officials believe the Biden administration didn't properly vet visa holders from the 39 countries in the first place.

• The department didn't respond when asked how long the pause would last, or if it's considering a broad national interest exemption for physicians, as the AMA and American College of Physicians have urged.
• A January memo says individuals may qualify for exemptions, but doctors said they haven't figured out how to apply.

Between the lines: Other policies are also making it harder for hospitals to sponsor international physicians, including a $100,000 H-1B visa fee.

More than 20 lawsuits have already been filed by health workers and others affected by the freeze.

• The Ohio-based doctor said he's thinking about going to court but expects the cost to top $5,000 — and he's without an income for the time being.

What we're watching: Canada and other countries are trying to recruit these doctors away from the U.S., offering incentives like fast-tracked permanent resident status.