Joint IMGT - AILA Letter to State Dept re Health Care workers

1. VIA EMAIL
April 2, 2020
Chief Thomas Parillo
Waiver Review Division
U.S. State Department
RE: Proposed Actions to take in consideration of the Coronavirus pandemic
Dear Chief Parillo,
The International Medical Graduate Taskforce (IMGT) comprises professionals in law who are
dedicated to helping Americans in rural and other physician-shortage areas obtain the basic
medical services they so desperately need and deserve. We work on behalf of universities, teaching
hospitals, medical centers, and clinics of all sizes, and on behalf of physicians (“international
medical graduates” or “IMGs”) in their immigration processing. Ultimately, we share a deep desire
to ensure that Americans in underserved areas and underserved populations of the United States
receive adequate health care services and IMGs play a critical role in addressing the country’s
persistent and increasingly dire physician shortage.
Established in 1946, the American Immigration Lawyers Association (AILA) is a voluntary bar
association of more than 15,000 attorneys and law professors practicing, researching, and teaching
in the field of immigration and nationality law. Our mission includes the advancement of the law
pertaining to immigration and naturalization and the facilitation of justice in the field. AILA
members regularly advise and represent businesses, U.S. citizens, U.S. lawful permanent residents,
and foreign nationals regarding the application and interpretation of U.S. immigration laws.
The International Medical Graduate Taskforce Liaison Committee and the American Immigration
Lawyers Association are extremely concerned about the ability of healthcare institutions to provide
adequate levels of care considering the current Coronavirus pandemic. Even before the current
pandemic, a number of healthcare facilities were reporting staffing problems; and, the current
outbreak of Coronavirus is only exacerbating the situation, as increasing numbers of Americans
are infected, and as healthcare providers themselves begin to get sick. There have already been
reports of healthcare workers nationwide being infected by the virus. International healthcare
workers, including International Medical Graduates, stand ready to assist during these difficult
times, but many of them are unable to provide their much-needed services due to unduly narrow
and burdensome requirements placed on them by their visa status and/or limitations on their access
to immigration benefits imposed by the Coronavirus situation.
We believe that current law is flexible enough to allow for the expansion of the services that these
international healthcare workers can provide in these difficult times. In that regard, we have the
following suggestions for the Department of State (DOS):
AILA Doc. No. 20040334. (Posted 4/3/20)

2. 1. Expedited Processing of J1 Waiver Applications for Health Care Workers
Healthcare facilities rely on IMGs to be able to assign workers in areas of critical need without
delay. However, IMGs are unable to apply for an H-1B petition without an approved J-1 waiver.
We request that DOS expedite all J-1 waiver applications. With the USCIS announcing a
temporary suspension of premium processing for nonimmigrant and immigrant visa petitions, it is
more important than ever that DOS process all waiver requests for healthcare workers on an
expedited basis.
2. Telemedicine
We request that DOS recommend J-1 waivers under INA §214(l) on behalf of physicians who will
be treating patients remotely via telemedicine. DOS has previously responded that such an
arrangement may not be permitted under federal regulation, but that DOS would confer with the
Department of Health and Human Services (HHS) to determine whether the law might be
interpreted to permit such an arrangement. We believe that this arrangement is permissible under
existing law as a “flex waiver.” An increasing number of physicians, prospective employers, and
state-level department of health administrators are interested in pursuing J-1 waiver applications
on behalf of physicians who will spend some portion of their time working in a physical location
that is not in an underserved area but treating patients via telemedicine who reside in underserved
areas. Relaxing these restrictions will allow healthcare providers to be more nimble and to adjust
their physicians’ “worksites” to where they are needed when they are needed.
3. Waive Requirements Related to Evidence of Unsuccessful Recruitment Efforts
We request that DOS waive the requirement of demonstrating unsuccessful recruitment efforts for
Interested Government Agency (IGA) Waiver applications on behalf of physicians. This would
primarily affect HHS waivers, as well as other federal waiver programs such as those run by the
Delta Regional Authority and Appalachian Regional Commission. This requirement is expensive,
slows down the waiver process, and should not be needed during an emergency.
4. Have Department of State Waiver Review Division (DOS WRD) Sponsor IGA
Waivers if a State has Maxed Out its Conrad Waiver Allotment
The Conrad 30 Waiver program has been an instrumental piece in efforts to address the health care
needs of underserved communities throughout the United States. The State Conrad 30 waiver
program allows the departments of public health in each state to request 30 waivers per year for
physicians who have signed contracts to work for three years in an underserved area. However,
30 waivers per state is not sufficient to meet the needs of our country in normal times, let
alone during a global pandemic.
The Vice President has announced a new HHS rule that would permit physicians licensed in one
state to respond to the pandemic in another state even if they are not yet licensed there, and many
states have enacted emergency orders granting medical licenses to out of state physicians who are
licensed in another state. However, these limited changes are not enough to meet the needs of the
growing crisis.
AILA Doc. No. 20040334. (Posted 4/3/20)

3. It is imperative that more waivers are granted to allow more physicians to work. In the last
few years, the majority of states have received many more than 30 waiver applications per waiver
cycle. We encourage DOS WRD to act as an IGA sponsor for applications that were not selected
to receive a Conrad 30 waiver due to the state having already filled its 30 spots. As of today’s date,
27 states have issued all 30 of their waivers and several others are very close to doing so.
5. Expand the List of Signatories Who Can Sign Waivers
Current DOS guidelines require the signatory of the Division of Public Health (DPH) letter to
match the individual listed in DOS records. During these chaotic times, we request that DOS
permit other appointed persons to sign these letters. Designated persons may not be able to
sign due to a variety of reasons, including remote work and sick leave, among others. Given the
March 13, 2020 Presidential Proclamation on Declaring a National Emergency Concerning the
Novel Coronavirus Disease (COVID-19) Outbreak, greater flexibility these requirements is called
for.
6. Remove Restrictions on Medical Residents and Fellows Seeking to Provide
Services Beyond Their Sponsoring Employer
There are many residents and fellows that are interested in assisting with medical efforts to treating
the Coronavirus outbreak. However, these individuals are not currently eligible to because of the
restrictions related to their residency. This issue has been raised by both IMGT and AILA and we
thank DOS for looking into it.
7. Grant Board Extensions for Physicians Who Tried to Register for a Board Exam
Within Six Months of Graduation
Many IMGs will require Board extensions in order to have sufficient time to get through the J-1
waiver/H-1B process. Granting such extension will ensure that these physicians are able to provide
badly needed medical services without interruption.
Thank you for considering our request. Please let us know if we can provide any further
assistance in your consideration. Please feel free to contact Sharvari (Shev) Dalal-Dheini at 202-
507-7621 or SDalal-Dheini@aila.org or Ian Wagreich at iwagreich@hsplegal.com with any
questions you may have.
Very truly yours,
Ian D. Wagreich, Chair, IMGT Liaison Committee
Sharvari (Shev) Dalal-Dheini, Director of Government Relations, AILA
cc: Ms. Karen S. Hawkins, Director, Office of Private Sector Exchange Designation (ECA/EC/D)
Senator Amy Klobuchar
AILA Doc. No. 20040334. (Posted 4/3/20)