Background: Physician shortage and healthcare access is a serious issue in rural America with reports estimating a shortage of more than 45,000 physicians by 2025. The rural and the underserved communities are predominantly served by International Medical Graduates (IMGs). Majority of the IMG physicians work are on a J1 waiver, National Interest Waiver (NIW) program or H-1B program that provides visas for highly skilled foreigners in specialty occupations for three years after which they become eligible to apply for a permanent residency. However, the current immigration laws allow 7% of people from each country to become permanent residents every year. At this rate, physicians from certain countries will have to wait 150 years for a permanent residency. This long wait time is forcing a lot of physicians to consider leaving their practices and even the United States causing further shortage in rural communities. Our study intends to research the distribution of immigrant physicians across various specialties as well as what their perception is regarding immigration issues.

Methods: A survey was created using the data collection platform “Survey Monkey.” The survey was sent to international medical graduate physicians practicing on a VISA in USA. Social media-Facebook, WhatsApp were predominantly used to circulate the survey.

Results: A total of 1050 physicians responded to the survey. Attending physicians were 80.3%, the remaining are physicians in training. 36.5% of them were on a J1 waiver job and 32.1% of them were pursuing a NIW. On average, they have been living in the USA for 8.5 years but felt that they should only wait for 3.5 years to become a permanent resident.
An average of 11.5% of the physicians have children that are dependents who will lose their VISA status by the age of 18. About 96.1% of them felt that they were not able to advance in their career because of their current immigration status and 98.2% of them felt that they could serve their community better with a permanent residency status. 94.6% of them feel that current immigration policies are contributing to the health care shortage in the US. Physicians (79.4 %) are considering leaving United States for their home countries or a different countries because of the immigration backlog.

The most effected specialties if these physicians leave their practices are Internal Medicine (29.4%), Hospital Medicine (12.2%) and subspecialties of Medicine (27%). Rural communities will be significantly affected as 69.9% of these physicians work in underserved areas.

Conclusions: Healthcare in America needs more physicians. Uncertainty regarding immigration among International medical graduate physicians (IMG’s) deepens the burden to health care access – mostly rural and underserved population. Having a separate and quick physician immigration pathway will ease burden on health care access in United states of America.