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Senator Heidi Heitkamp at Cirrus Aircrafts' celebration Tuesday, December 20 in Grand Forks, N.D. (Jesse Trelstad/Grand Forks Herald)

Heitkamp, Klobuchar say change in visa processing could hurt rural healthcare

GRAND FORKS — Sens. Heidi Heitkamp and Amy Klobuchar are speaking out against a coming change to how foreigners' work visas are processed—something they say could cause physician shortages in rural areas worse.

Heitkamp, D-N.D., and Klobuchar, D-Minn., sent a joint letter Friday, March 10, to the head of U.S. Citizenship and Immigration Services asking the administration to maintain "premium processing" for the kind of temporary work visas that help place doctors in underserved communities. Sen. Susan Collins, R-Maine, joined both of her colleagues in signing and sending the letter.

At stake is immigration officials' fast-track policy for H-1B visas, which are considered an important pipeline for bringing skilled workplace talent to the U.S., from the tech sector to medicine. The suspended "premium" program allows for the purchase of 15-day processing, which can otherwise take six months or longer.

The administration's suspension of the program, announced earlier this month and effective April 3, could last up to six months. The suspension has been chalked up to backlogs in applications, immigration authorities have said, and should "help us to reduce overall H-1B processing times" in the long-term. In the meantime, immigration officials still are expected to expedite applications on a narrow range of case-by-case criteria.

The coming pause on faster processing has some worried. The senators' concerns are centered on the "Conrad 30" program, named for former Sen. Kent Conrad of North Dakota. It allows for foreign doctors finishing their residency on a certain visa —30 in each state every year—to skip requirements that they leave the U.S. for two years afterward and instead help underserved populations.

The senators' letter asks that premium processing be kept for doctors seeking to work under the Conrad 30 program—who all still need an H-1B to keep working in the U.S.

"The Conrad 30 program has helped address chronic physician shortages in rural America and other underserved areas for over two decades," the senators wrote in their letter. "We understand USCIS is facing a backlog, but USCIS has addressed this problem in the past without suspending premium processing for Conrad 30 doctors. We have every faith that USCIS can address its administrative needs without sacrificing support to this successful, time-tested program."

The suspension stands to cause problems, said Geoff Leibl, an immigration attorney who works for Altru and foreign physicians in North Dakota and Minnesota. If an applicant for Conrad 30 has to wait out a slower process, the window between when they start and when a post-residency job would begin might be too short for them to get their an H-1B visa on time. In some cases, it could mean delays in starting a new job.

In others, it could mean having to leave the country. And Leibl said if the doctor is from one of the countries affected by President Donald Trump's revised travel ban, they might not be able to easily return.

Mary Amundson is an assistant professor in the University of North Dakota's Department of Family and Community Medicine who helps coordinate the Conrad 30 program in North Dakota. She said the state's 30 annual slots for physicians can be thought of in two groups: there are 10 spots with more flexibility that can be positioned in more populated area like Grand Forks, while the other 20 must be among underserved populations. Nowadays, the 10 slots fill relatively quickly, often with two or three additional slots filled every year.

Gary Hart, director of the Center for Rural Health at UND, said that although the Conrad 30 program provides a relatively small amount of doctors for the U.S. population, sometimes it's that one doctor who can make a difference for someone who might otherwise not have had care.

Hart said a broader context of the discussion of foreign medical work is important, though. While underserved populations are a pressing issue in the U.S., the areas where foreign-born doctors come from have extraordinary medical needs of their own, too.

But for Heitkamp, Klobuchar and Collins, the issue is clear-cut.

"Health care facilities rely on premium processing to avoid delays in placing doctors in health care facilities where their services are desperately needed," the senators wrote. "The suspension of premium processing will delay when these doctors can begin to serve patients in underserved areas across the country."

Sam Easter

Sam Easter is a City Government reporter for the Grand Forks Herald. You can reach him with story tips, comments and ideas at 701-330-3441.

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