Public Policy

SHM expresses support for Fairness for High-Skilled Immigrants Act

Without immigrant hospitalists, health care accessibility would decrease tremendously.

The Society of Hospital Medicine recently expressed its support for the Fairness for High-Skilled Immigrants Act (H.R. 392). This legislation will ensure that highly-skilled medical professionals and their families will not be turned away from working in the United States based on per-country limitations.

Dr. Amit Vashist, system chair, Hospitalist Division, Mountain State Health Alliance, Virginia/Tennessee

Dr. Amit Vashist

The Hospitalist recently spoke with Amit Vashist, MD, MBA, system chair, hospitalist division, and Clinical Council chairman at Ballad Health, a 21-hospital health system in southwest Virginia and northeast Tennessee. Dr. Vashist is a member of SHM’s Public Policy Committee (PPC), which was instrumental in providing guidance for SHM’s letter of support, and he was the recipient – as project leader – of SHM’s Award of Excellence for Teamwork in Quality Improvement in 2017.

What inspired the PPC – and more broadly, SHM – to express support for this bill?

SHM and the PPC have always taken pride in assuming a leadership role when it comes to policy issues affecting hospitalists and the patients they serve, ranging from observation status to addressing the opiate epidemic and now, immigration reform. We are one of the first medical societies to support this bill.

What inspired us to take action is that there are country-specific caps when applying for a green card for those immigrants currently in the United States on an H1B visa. In the current green card pool, no country can occupy more than 7% of applications. For more populated countries like India and China, two significant countries of origin for hospitalists practicing in the U.S., this creates a significant backlog. At the moment, the projected wait time for applicants from countries in this situation to receive their green cards could easily exceed 25 years.

What impact would this have on hospital medicine providers and patients?

The number of hospitalists trained in the U.S. who have come on visas from other countries is astounding. By virtue of what we do as hospital medicine providers, we are leaders in health care. We own major QI initiatives across the hospital and oversee health care outcomes that many other providers never become involved with. By stifling the ability of people to enter the country and stay here long-term, it would have a devastating impact on our communities. A large chunk of hospitalist staffing companies employ providers who are international medical graduates who completed their residencies in the U.S. Without them, health care accessibility would decrease tremendously – especially in rural areas like those in which I work.

This is more than just an issue of citizenship – these caps have a major impact on quality of life and morale for those affected by them. The high level of uncertainty surrounding the current process affects large-scale decision-making. For example, people who are waiting to be approved for their green cards often ask questions like, “Should I buy a house?” and “Can I visit my family abroad and still be able to get back into the U.S. without any unwarranted delays or hassles?” This demoralizes quality providers personally, and if they feel this way, I can’t see how it wouldn’t affect their performance professionally as hospital medicine providers.

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