A Call for Rational Immigration Reforms to Address Critical Healthcare Shortages

We owe a tremendous debt to the healthcare worker battalion, who fought, and continues to fight, to save lives globally during this pandemic.  It is important to consider that while the COVID-19 pandemic has underscored the severe healthcare worker shortages globally, we are now facing an increasing percentage of burnout departures in the industry.  For example, a survey conducted by the International Council of Nurses (ICN) found that, “20 percent of national nurse associations reported an increased rate of nurses leaving the profession in 2020.” The ICN estimated that 13 million nurses could be needed to fill global shortages and replace nurses who leave the profession in the next few years.  In a May 11, 2021 article published regarding the global shortage of nurses, the Clinton Health Access Initiative noted that while investing in training capacity is critical for a stronger global workforce, government planning for health emergencies must support and protect health workers while also increasing capacity and strategic placement.

So what failed during the pandemic in the facilitation of entry, visa issuance, and/or work authorization of critical foreign healthcare workers?  Below is a list of examples for consideration:

  1. For those healthcare workers outside of the U.S. requiring visas, there was no dedicated team of consular officers and support staff to serve as a task force for healthcare related visa facilitation to cut through the normal bureaucracy and lengthy process.
  2. There was no option to use standard video conferences for consular interviews, even as Zoom conferences became the norm for businesses, courts, and families.
  3. During the ongoing consular delays for visa appointments due to global United States consular closures, there was no designation of certain consular posts for healthcare visa emergency processing.
  4. There was no option for visa revalidation in the U.S. by the Bureau of Consular Affairs. Yes, there was the extension of visa renewal options without interview for visas that had expired in the last 48 months, but due to the paucity of visa appointments and geographic health-based travel restrictions, the impact of the extension was not significant enough.
  5. Customs and Border Protection (CBP) task forces were not set up to address potential documentary waivers of visas to allow a shift of the burden for visa processing for critical healthcare workers. This option could have been facilitated for pre-registered healthcare systems and prospective employees.
  6. U.S. Citizenship and Immigration Services (USCIS) did not implement a critical care expedited processing protocol for all healthcare related petitions filed for critical care areas or providers.
  7. All Schedule A cases for nurses and physical therapists attempting to immigrate to the U.S. in these designated shortage occupations could have been expedited via Executive Order, for example, but again no specific action was taken.
  8. There was no separate funding or staffing for expedited processing for Visa Screen Certificates for affected healthcare workers.

What could we be doing? 

We have plenty of brilliant healthcare workers with data regarding what has and has not worked to date to address healthcare shortages. Perhaps the answer is a federal Pandemic Healthcare Task Force on Immigration, or a legislative package as a proposed cure regarding how we can weaponize our immigration policies into a state of the art life support system for our nation.   Why not consider:

  1. The creation of a critical health worker registry for pre-approved healthcare positions. This registry could be accessed by all relevant agencies such as the Department of Homeland Security, the Department of State, and the Department of Labor to verify facts versus reverifying the same sponsor based on the same information redundantly.  The information could be updated in real time depending on the robust nature of the shared data system.
  2. The creation of exemptions from in person consular interviews, which are replaced by video conferences.
  3. The creation of a healthcare worker EVUS/ESTA type pre-registration to minimize biometric intake and security secondary checks, unless further security review is required based on the initial pre-registration. This process could include a voluntary biometric intake with countries agreeing to data sharing with the U.S., which is already in existence for many countries.
  4. The creation of follow-up audits regarding registered healthcare providers to reduce fraud or compliance concerns and provide oversight.
  5. The creation of healthcare worker hotlines for submitting reports to government agencies as to alleged compliance violations.
  6. The creation of more Schedule A healthcare worker occupations for critical positions along with streamlined processing.
  7. The enhancement of options for foreign nationals to be approved for expedited immigrant visa allocations for those filling critical research and healthcare positions.
  8. The funding of expedited processing and reduced costs for necessary Visa Screen Certificates for affected foreign national healthcare workers.
  9. The expedited processing of employment authorization documents by USCIS for any healthcare worker, or for that matter, a waiver of the employment authorization document for any healthcare worker with a pending adjustment of status application.
  10. A waiver of visa/petition filing fees (or a reduction) for critical healthcare workers during any designated national healthcare crisis.
  11. The creation of a program along the lines of “healthcare workers without borders” to be activated during a global healthcare crisis to allow pre-registration and tracking globally with participating nations to reduce and streamline visa application and admission requirements.
  12. Resurrect and improve nonimmigrant visa options for healthcare workers. We have had H-1A and H-1C visa categories in the past for nurses, which have been allowed to lapse. Why not create a strategic healthcare based nonimmigrant category to address a variety of identified healthcare shortage needs and include mental health as well?  For that matter, expand it to address our veterinary shortages as well.
  13. The reduction of processing times for any healthcare worker for visa related benefits, who serves a critical care function during the pandemic. Perhaps, we could call it an immigration thank you to our healthcare heroes.

We would all benefit from the creation of a cutting edge solution for our future by connecting the dots between our immigration laws and policies, our national educational system, and our critical healthcare shortages.  We certainly do not want to waste this lesson from the pandemic by failing to implement and create immigration solutions for our healthcare industry.

This article was originally published in Healthcare Michigan, July 2021.

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About the Author:

Kathleen Campbell Walker is a member of Dickinson Wright PLLC and serves as a co-chair of the Immigration Practice Group. She is a former national president and general counsel of the American Immigration Lawyers Association (AILA) and is Board Certified in Immigration and Nationality Law by the Texas Board of Legal Specialization.  She serves on the AILA Board of Governors.  In 2014, she received the AILA Founder’s Award, which is awarded from time to time to the person or entity, who has had the most substantial impact on the field of immigration law or policy in the preceding period (established 1950).  She has testified several times before Congress on matters of immigration policy and border security.