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The Trouble With Visas for Foreign Physicians in North Texas

Strict requirements, long wait times, and a limited number of visas make recruiting foreign physicians tough in a physician-strapped region.

Dr. Arun Badi, a native of India, came to the United States in 1999 on a student visa. Badi already had a medical degree when he was accepted at the University of Utah to study for his Ph.D. He’d received his M.D. from the Armed Forces Medical College in Pune, India, and selected Utah to continue his ear, nose, and throat and sleep-medicine research because of the program’s advanced technology.

Badi conducted research in Utah with his American peers, testing artificial hearing by placing computer chips in different parts of animal brains. That, he says, later evolved into testing hearing applications on human subjects. Badi was able to stay in Utah on an E-B1 visa—such visas grant employment-based, permanent residency in the United States—that had been sponsored in 2001 by the National Institutes of Health. In addition to researching and writing for scientific publications, Badi taught classes as an adjunct professor at the university.

“But because I could not take the cold, I really wanted to move to Dallas,” recalls Badi with a laugh. “And I wanted to get into sleep medicine” in North Texas. Now, years later, Badi owns his own practice for ENT and sleep medicine on Dallas’ Forest Lane and has become a U.S. citizen. “Collectively, I’ve spent more years in the U.S. than in India now,” he says. “My kids were born here. My family is here. I say that India is my mother country, but America is my adoptive mothership.”

While some foreign-born physicians like Badi receive permanent work visas to practice in North Texas, many others are not as fortunate. As a result, capable foreign physicians are unable to work here, despite a current shortage of doctors in Dallas-Fort Worth. According to a 2015 report by Merritt Hawkins, a physician search and consulting firm, there are 12,938 physicians in North Texas. That means North Texas has an average of 202 physicians per 100,000 residents, or fewer than what the World Health Organization says is the national average of 226 physicians per 100,000 residents. In order to close this gap and achieve the national average, 1,526 more doctors would need to be practicing here. In Dallas, this shortage contributes to the current wait time of roughly 10.2 days for patients to be seen by a doctor, the report states.

Scott Edwards, president of Adaptive Medical Partners, an Irving-based physician placement firm, says the demand for Texas physicians is outstripping the supply. “Texas is the second-most populous state in the country,” Edwards says, “but we’re ranked No. 45 in physicians per capita.” As is the case in the state’s rural markets and in other big metros, he adds, the Dallas market has felt the shortage, with its big hospital systems needing more physicians.

Currently, 30 percent of the practicing physicians in DFW are foreign-born, according to Mac Stewart, a partner at the Dallas office of Hall, Render, Killian, Heath & Lyman, an Indianapolis-based healthcare law firm. But the area could use more. So, to fill the void, physician recruitment firms have been offering their services to push North Texas practices into taking more foreign physicians.

For example, Tim Ketterman, director of recruitment for Adaptive Medical Partners, says that, over the past two years, his firm has placed 30 foreign physicians in DFW and Texas as a whole. The company, which contracts with local healthcare organizations, has placed foreign physicians from places like India, Pakistan, and Canada in private clinics and federally qualified health centers. Within Texas, AMP has placed physicians in cities like Mineral Wells, Wichita Falls, Electra, and Knox City, in addition to Dallas and Keller.

Data from Merritt Hawkins shows 9,390 foreign physicians residing in Texas, about 3,880 of them in North Texas. And, there are a number of visa options available for these physicians. For example, Badi’s E-B1 visa is usually given to immigrants with extraordinary potential to contribute to certain sectors of the U.S. economy. In Texas, though, immigrant physicians who hope to become licensed more typically go through one of the following processes: the J-1 visa, the H-1B visa, or permanent labor certification.

According to the U.S. State Department, a J-1 visa is an exchange visitor waiver granted to individuals who participate in work-and-study-based programs. It’s the most common visa that international medical students use for education. After completing their graduate medical studies, J-1 visa holders are required to return to their home country for two years to “transmit the knowledge they gained in the U.S.” before coming back to this country.

When it comes to physicians, the entire country is in “a shortage scenario,” Ketterman says, including Dallas-Fort Worth.

H-1B visas, meantime, are for foreign physicians intending to work here for a maximum of six years. Michael Kim, who specializes in foreign immigration at law firm Hall Render, says the H-1B visa is designed for specialty occupations requiring the equivalent of a U.S. bachelor’s degree or higher, such as physicians, accountants, and engineers. There’s an annual cap of 65,000 H-1B visas per year nationally, but experts say they don’t believe there’s a geographic cap limiting the number of visas in Texas. According to an April survey by the American Medical Association, nearly 345 physicians come to Texas on H-1B visas on average each year. And, holding an H-1B is required if the physician wants to become a permanent resident down the road, Kim says.

Finally, physicians hoping to find permanent work in North Texas must apply for employment-based, permanent residency status via a permanent labor certification process (or PERM). Kim says PERM is the most common route to permanent resident status, and it’s up to the physician’s employer to decide who to sponsor and the timeframe for initiating the sponsorship.

These visa processes are long, arduous, and tedious, taking months to complete, with no guarantee physicians can permanently practice in North Texas, Kim says. Badi, the Dallas physician, argues that more visas should be open to foreign physicians in order to benefit patients and the local economy. “The U.S. recognizes [physicians as performing] valuable work,” says Badi. “I believe we work harder, and want to give back to the community we’re in.”

Ketterman, with Adaptive Medical Partners, points out that the problem with foreign recruitment is complicated, with every model projecting different results—so much so that experts don’t have a solid grasp on feasible solutions. When it comes to physicians, the entire country is in “a shortage scenario,” he says, including Dallas-Fort Worth. But reforming the visa process isn’t necessarily the answer, he contends; it’s more about the number of visas granted each year. “The process is less of an issue than the caps that have been imposed,” he says.

Ultimately, the experts believe, well-trained foreign physicians could help North Texas by filling vacant positions. And patients would be grateful, no matter where the doctors got their start. “Some patients may care, but most don’t care where the doctors are coming from,” Ketterman says. “If you’re putting in 11 to 12 years or more of your life to practice medicine and have a ‘Dr.’ title in front of your name, [patients are] inclined to trust them.” 

Olivia Nguyen is the editor of D CEO Healthcare and a D CEO associate editor.

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