The government's decision to pause processing of visa applications will extend the waiting period for health systems counting on clinicians coming from abroad to fill openings in their workforce.
Because applications for employment-based skilled worker visas have reached the annual limit, the State Department’s Bureau of Consular Affairs announced a pause starting May 1 on processing applications with petitions filed after June 1, 2022.
As a result, international nurses petitioning for a visa will likely face double the typical processing time of nine to 12 months, said Chris Musillo, managing partner at Musillo Unkenholt Immigration Law, a Cincinnati-based firm.
“It is unfortunately expected that that line is just going to continue to get longer,” he said.
Bill Lowe, CEO of Chicago Methodist Senior Services, a skilled nursing care and rehabilitation organization based in Chicago, called the announcement "a real gut punch."
Chicago Methodist Senior Services, which developed its international recruitment program in 2005, has been employing immigrant clinicians for years, working with an agency in the Philippines to help staff its skilled nursing facility and home care program, Lowe said. It also sends foreign-trained clinicians to other facilities in need of staff.
More than 150 nurses in various stages of the visa application process are being actively recruited by Chicago Methodist, all of whom are trained and have passed the National Council Licensure Examination.
The nationwide freeze on EB-3 visas—the main category that foreign nurses are eligible for—will significantly delay the arrival of many of the nurses, Lowe said.
“It is a big disappointment,” he said. “The government is not in sync with the situation. This is affecting everyone from hospitals down through skilled nursing, any healthcare provider that needs nurses to provide services. We’re desperate for nurses.”
By as early as 2025 it is estimated that the U.S. will experience a shortage of between 200,000 and 450,000 nurses, a McKinsey report found.
In 2021, immigrant clinicians living in the U.S. accounted for more than 18% of all healthcare workers, according to a Migration Policy Institute analysis of U.S. Census Bureau data. Of the 546,000 immigrants working as registered nurses, 27% were from the Philippines, 7% were from India and Mexico and Jamaica each accounted for 5%.
In 2015, immigrant healthcare workers accounted for 17% of those in the field.
Staffing shortages and recruitment issues have meant that facilities are more dependent than ever on foreign nurses entering the workforce to provide stability and work long-term assignments, said Patty Jeffrey, president and regulatory committee chair of the American Association of International Healthcare Recruitment.
“We've never seen such a demand for this type of nurse,” Jeffrey said. “For as long as I've been doing this, it's always been somewhat of a supplement.”
One major issue contributing to the visa retrogression is that immigration quotas have remained unchanged for more than two decades, despite population and economic changes, Musillo said.
Also, no special visa category exists for healthcare workers, meaning nurses compete with other bachelor’s-level professions for the 40,000 spots available under the EB-3 pathway, he said.
“U.S. immigration rules just aren't as flexible as one might hope,” Musillo said. “There isn't an interpretation that the State Department, or Homeland Security can make, there's not an executive order that President Biden's administration can make. This is going to take congressional action.”
One solution proposed by a bipartisan group of senators in 2021 is the Healthcare Workforce Resilience Act, which calls for the government to recapture and reallocate thousands of previously issued visas that went unused to give to licensed foreign nurses. No action has been taken on the bill.
The Migration Policy Institute seeks to raise awareness about the cumbersome licensure requirements for internationally trained healthcare workers and urges health systems to engage with state-level policymakers, said Jeanne Batalova, senior policy analyst at the institute.
States could also convene a group of stakeholders, like Colorado did with its Global Talent Task Force, to examine barriers to medical practice entry for immigrant clinicians and remove unnecessary technical requirements, Batalova said. The task force made policy recommendations to the governor and General Assembly about ways to better integrate and use the skills of foreign-trained professionals.
Another challenge to hiring foreign-trained clinicians is helping those who have already immigrated to the U.S. enter the healthcare workforce,
In order to practice medicine in the U.S., international clinicians often have to go through expensive and time consuming re-licensure processes, said Dr. José Ramón Fernández-Peña, founder and executive director of the Welcome Back Initiative, a program created to assist immigrant health professionals.
Even though a physician may have 20 years of experience in another country, they still have to pass the U.S.Medical Licensing Examination once in the country, and apply for residency training, which is a process that can take years, Fernández-Peña said.
During the pandemic, the Welcome Back Initiative helped advocate for temporary licenses that allowed foreign-trained physicians to practice on a limited basis and under the supervision of practicing U.S.-licensed physicians in several states, including Illinois, he said.
“Now the temporary licenses have expired, so we're hoping there will be a way to maintain those licenses or to create pathways that with adequate supervision and support, individuals may be able to regain a license without having to go through a four- or five-year residency training program again,” Fernández-Peña said.
In the post-acute space, long-term care providers are facing unprecedented challenges in competing with hospitals for international nurses.
Many in the sector have seen foreign clinicians leave facilities to be paid up to $20 more per hour in hospital settings, said Carol Silver Elliot, president and CEO of Jewish Home Family, a nonprofit nursing home organization based in Rockleigh, New Jersey.
The organization has signed several contracts with the United Methodist Healthcare Recruitment program to receive international nurses who are integrated into the workforce and surrounding community over the course of a few weeks, Elliot said. Jewish Home Family has had a few foreign clinicians jump ship for hospitals that can pay higher wages.
“The acuity of our patients is rising,” she said. “The competition for nursing staff is rising. I won't say that it's an unfillable need, but for most of us, it's a need that has no endpoint.”
While the freeze on visa applications is in place, Chicago Methodist Senior Services plans to keep recruiting international nurses and create relationships with agencies in Ukraine and various countries in Africa to diversify its sources of nurses, Lowe said.
“It is troubling to think that we might go for a couple of years before we can deploy these nurses to enter the workforce,” he said. “The best strategy we have is to just continue to petition the nurses, and now from multiple sources.”