The Plight of the Immigrant Physician By Amar Sunkari, MD

The Plight of the Immigrant Physician

By Amar Sunkari, MD

I have been a practicing physician in hospitals for more than 10 years now and in the United States for more than 15 years. During this time, I have abided by the law, contributed to communities in professional and nonprofessional capacities, paid my share of taxes and followed every rule US immigration has set forth. My children were born here and are US citizens. Every asset I own is in the US. I have experienced and shared the same adversities, joys and problems as everyone else in the communities in which I have lived, from surviving hurricanes to local fundraisers for good causes.

Yet, I am years away from getting a green card, let alone US citizenship. I am an alien national and will be for at least the next 10 years. It means that every time I cross the border, I have to visit a consulate to get a visa and go through an immigration check. I am expected to always carry all of my immigration papers with me. Each time I leave this country, whether I can return or not hangs by a thread.

This is not just my story, but is the story of thousands of Indian doctors who have migrated to the US. The reason is many of us have entered the US under a J1 waiver to serve in national interest areas

(medically underserved areas) for 3 to 5 years. That commitment has resulted in us often being separated from our wife, husband and/or children. This is the rule book.

During this last year with COVID-19, we worked just like the rest of the healthcare workers, risking our lives in fulfilling our professional duty to care for the sick. However, it also meant that if we lost our jobs, we would have to exit the country within 15 days, leaving everything we earned and own behind. Alternatively, if we got sick and passed away, our spouses and kids would be kicked out of the US because they are on dependent visas. Our closest kin wouldn't even get to see us or say goodbyes in our last moments.

We are capable professionals and have the resources to start our own practices and businesses that can create and employ others; but because we are on visas, we aren't allowed to do that. Instead, we end up working as an “employee” for other employers. Imagine trying to explain this to patients who ask us “Do you have a clinic where I can come and see you?”. They often are incredulous when we try to explain it to them. We get requests from staffing professionals requesting us to fill an urgent need, but we cannot take advantage of those opportunities because our visas are tied to the place of practice and we are not allowed to work anywhere else. Often employers know this, and some use it to their advantage.

The situation exists for two main reasons. First, physicians are included in the same category as any other master’s degree job professionals, called EB2. This wasn't the case until a law was passed moving physicians from immigration category EB1 to EB2. Now other professionals such as multinational company managers and scientists have priority over physicians. Second, there is a green card cap (limit) on immigration based on country of origin. There are 65,000 H1B visas issued every year, most of which are taken up by Indian or Chinese nationals, often software professionals. Yet only 7,500 green cards can be issued per country. The result is that physicians on EB2 visas are stuck in the EB2 queue that gets longer every year.

It is estimated there are roughly a quarter million physicians in the USA who are Indian immigrants. The green card backlog is about 300,000 for Indian immigrants which is manyfold higher than all other nations combined. About a quarter of the entire US healthcare workforce are immigrants.

There have been attempts to address these issues, but little headway has been made because these attempts are often attached to far more popular, widely-debated and controversial issues such as DACA. Hence, Indian physicians are trying to raise awareness and gather support to address our plight. We are asking US lawmakers to be fair, meaning recognizing our efforts, contributions and the sacrifices we have made and will continue to make.

If you believe there is merit to what we are requesting, please help us in making these points to legislators and policy makers.

Amar Sunkari, MD is a member of the Bexar County Medical Society.