This week, the ATS sent a letter to U.S. Immigration and Customs Enforcement (ICE) urging the agency to withdraw a controversial proposal that would eliminate duration of status for international students on J-1 and other visas, including international medical graduates (IMG) in training, which would impact physician training and the nation’s health workforce. If implemented, the proposed rule would disrupt the training of an estimated 12,000 J-1 medical trainees that provide care at over 750 teaching hospitals across the U.S. at a time when there are already national physician shortages, including across pulmonary, critical care and sleep medicine.

Currently, IMGs remain in the U.S. in medical training programs through a process called duration of status, administered by the Educational Commission for Foreign Medical Graduates (ECFMG). The ICE proposal would replace "duration of status" as an authorized period of stay and replace it with a fixed end date annually, requiring J-1 physicians to apply to the U.S. government for a duration of status extension every year. The current average processing time for a stay extension application ranges from 5 to 19 months. With the majority of residency/fellowship contracts issued only three to five months in advance of the July 1 start of each new academic year, the proposed change would create an impossible timeline, and do so on a recurring, annual basis, resulting in disruptions in IMG training. Furthermore, the change may potentially result in few IMGs choosing to train in the U.S., reducing an already strained U.S. physician workforce during the COVID-19 pandemic.

The ATS letter points out that IMGs make up a substantial part of our nation’s pulmonary, critical care, and sleep physician workforce. The letter states, “IMG pulmonary and critical care specialists and trainees are on the frontlines of the COVID-19 pandemic providing life-saving care and conducting vital scientific research to improve our understanding of COVID-19 and develop diagnostics, treatments, and prevention interventions for this respiratory disease. IMGs are also a critical pipeline of health care in underserved communities around the country, including in small rural hospitals and communities of color disproportionately impacted by COVID-19.” The ATS urges ICE to withdraw the rule due to its discrimination against international students. If the proposal is not withdrawn, the ATS urges ICE to carve physicians out of the proposal to prevent more shortages in the physician workforce that will limit access to care.