Visa Restrictions Affect International Radiology Talent
Immigration policy changes intersect with growing demand for imaging professionals
As radiology departments across the U.S. grapple with workforce shortages, new federal restrictions on green cards and employment authorization documents are creating uncertainty for international physicians, researchers and trainees who help fill critical roles.
At Johns Hopkins University School of Medicine in Baltimore, David Yousem, MD, MBA, a professor in the Department of Radiology, has watched colleagues and mentees see career plans delayed, altered or placed in limbo as federal immigration policy creates new challenges for an already strained imaging workforce.
The effects became apparent after the Trump Administration moved in January to pause green card applications for individuals seeking to enter the country from 75 countries, including Brazil, Egypt, Iran, Pakistan and Russia.
While this immigration policy change was not specifically focused on the healthcare workforce, Dr. Yousem has seen the repercussions firsthand within his department where faculty, researchers and trainees have encountered delays and uncertainty surrounding visas and employment authorization documents.
His neuroradiology division reflects the international nature of many U.S. radiology departments. The unit includes individuals from a range of national and cultural backgrounds. “It’s a great melting pot,” said Dr. Yousem, adding, “Diversity of culture, religion and ethnicity is a positive trait in the healthcare setting.”
He points to several examples that illustrate how visa and employment authorization delays can disrupt training and career pathways.
Individuals who have been conducting research at Johns Hopkins for years are now running into problems after applying for employment authorization documents (EADs) that would expand their options as they consider entering the residency match system.
An EAD allows applicants to pursue opportunities beyond radiology programs that offer only J-1 clinical or H-1B visas. However, as visa processing delays mount, some researchers are finding those options increasingly limited.
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One of Dr. Yousem’s own mentees was scheduled to begin an internship year before starting residency when her EAD application was put on hold.
“All of a sudden she had to flip everything and try to apply for a J-1 clinical visa,” he said. “The problem with that is that if you have an application for an employment authorization document and a green card, and then you convert it into a J-1 clinical visa, all your effort in trying to secure citizenship is eliminated, because you can’t do both.”
The uncertainty extends beyond trainees. Dr. Yousem described the trouble faced by a faculty member who trained on a J-1 clinical visa and was in the midst of a waiver period that would allow the holder to remain in the U.S. while working in areas with underserved medical populations before seeking permanent residency. “Because the faculty member in question is from one of the 75 countries affected by the pause, her future is now in limbo,” he said.
For Dr. Yousem, the challenges go further than delayed applications and disrupted career trajectories. “Even individuals who already possess EADs face uncertainty when traveling abroad,” he said. “For these people, there is an emotional toll in leaving the U.S. to visit family back home or take a vacation, not knowing what challenges might await them upon attempted re-entry.”
Finding Pathways Forward
Despite the uncertainty, Dr. Yousem sees reason for optimism. He referred to research by Ajay Malholtra, MD, and colleagues at Yale University School of Medicine, indicating that international medical graduates (IMGs) account for nearly 25% of diagnostic radiologists in the U.S. and are robustly represented in rural and underserved areas.
According to Dr. Yousem, physicians who complete waiver requirements in those locations sometimes choose to stay permanently. “Some of them go to underserved areas to do the waiver, love where they end up and remain there,” Dr. Yousem noted.
International physicians who have already completed radiology training in their home countries face a different set of circumstances, but they also have a pathway into the U.S. workforce. Through the American Board of Radiology’s IMG Alternate Pathway, participants commit to four years of training and/or faculty service before becoming eligible to sit for the board exam.
Dr. Yousem strongly encourages the pathway because it eliminates the need to repeat internship and residency training. Instead of spending six years retracing the traditional education and training route, participants can advance more quickly while being compensated as fellows and faculty members rather than interns and residents.
Despite the current uncertainty, Dr. Yousem is confident the disruptions related to visas and EADs will eventually ease. “The political situation is cyclical, and we have to be adaptable to the situations that we are in. I think that America's technology, innovation and open-hearted spirit will be preserved over the course of time,” he said. “There will be better times ahead. There might be harder times ahead, too, but that's the resilience you must have in the medical community and the country as a whole.”
For More Information
Read previous RSNA News stories on radiology workforce challenges:
ABR Alternate Certification Pathway
RSNA News reported on the American Board of Radiology’s Alternate Certification Pathway. Read the story to learn about the program’s promise and practical barriers and why some experts believe it can provide an effective mechanism for integrating experienced physicians into U.S. practice.