The staggering insecurity of immigrant health care workers

When the pandemic unleashed its global trauma, I witnessed its damage up close. As a hospital psychiatrist, I saw a surge of patients enter our psychiatric unit and watched as severe depression upended the lives of previously functional adults. Suicide attempts spiked. I'd never received more crisis calls from my patients. It was grueling. My rural Ohio community has a major shortage of mental health practitioners. Our small team could barely handle demand even before the pandemic. But if these conditions weren't difficult enough, I worked under the knowledge of a painful truth: the career I've built here in rural Ohio could be taken from me at any time. I'm one of thousands of immigrants who work in health care and served in essential and frontline position during the pandemic whose security in this country is under threat. I'm stuck in a Green card backlog that stretches for decades. U.S. immigration policy currently limits the number of Green cards given out per country, so applicants from heavily populated nations like India or China face wait times of up to 150 years. As an Indian native, I'm one of roughly 16,000 physicians impacted by this outdated policy. Meanwhile, Green cards designated for less-populated countries often go unused. Last week, Congress introduced the bipartisan EAGLE Act, which would eliminate the country cap on employment-based Green cards. Swift passage would clear the backlog and give these health care workers the security they deserve. I've been working to shine a light on the damaging impact of this policy for three years as a member of Physicians for American Healthcare Access (PAHA), a coalition of Indian physicians. Recently, we've been advocating for the Healthcare Workforce Resilience Act, which would redistribute unused green cards to foreign-born physicians and nurses. Sen. Dick Durbin reintroduced the bill this year, and its passage would be a win for everyone. Immigrant physicians would have the security their families deserve. They'd also be able to open their own practices, creating new jobs and expanded health care access for Americans. Research shows that a practice adds about three to five staff positions per physician, treats thousands of patients per year and the higher income actually increases a physician's ability to care for people from underserved populations. The health care industry remains terribly understaffed. Even before the pandemic, in 2018 Ohio had 32.5 open health care practitioner jobs for every one unemployed health care practitioner, according to NAE. Rural communities bear the brunt of these shortages, and their health care needs are greater due to their older populations and higher rates of disability. Meanwhile, Ohio's rapidly aging population is driving up demand for health care support. All this is happening against a backdrop of a staffing shortage crisis at nursing homes, among personal health aides and across health care positions. I've seen these shortages up close and cannot emphasize enough how scary they are; we cannot afford to lose a single worker, regardless of their immigration status. When I moved to the U.S. with my wife, a physician of internal medicine, we marveled at this country's diverse and robust education and medical establishments. I loved my residency at St. Elizabeth's Hospital in our nation's capital, my post-residency work in community psychiatry at George Washington University and my time studying advanced treatments for depression at Harvard Medical School. Today I'm based in Sandusky, and my department serves almost seven counties. Since I began working here in 2013, I've seen high turnover, as many psychiatrists prefer urban centers to our rural environment. The burden on rural psychiatrists like me is significant; I'm constantly filling in at far-flung clinics, rushing to the hospital at all hours to help patients in need and fielding their crisis calls. That's in addition to my regular patient appointments. The wait time for a new patient today can be anywhere from three to six months and many people drive hours to see me. It's not just our region. About 80% of rural communities lack a single psychiatrist, according to New American Economy. I'm committed to staying part of this community for the next 30 years. It's critical that doctors and nurses —and especially psychiatrists — build trusting relationships with their patients. I frequently hear from one mother whose young adult son struggled with schizophrenia for eight years. Over time, I helped him reduce his medications and stay out of the hospital. Today he is mentally stable and employed, something his mother never thought she'd see. I've also heard countless stories from immigrant physicians and nurses who sat by patients' bedsides when family and friends were prohibited from visiting them during the pandemic. Their work is sacred, and their security in this country should be too. None of us can continue helping families in this underserved region if we cannot stay here permanently. If my wife or I get hurt, can't work or lose our jobs, we could lose our visas. If we leave the country and face a travel delay, we could lose our visas. Six years ago, fear of visa complications prevented me from visiting my grandfather before he died or attending his funeral. Yet this was the man who inspired me to become a doctor. He'd been a physician in India, and I grew up watching him work, awed by his ability to heal bodies and minds. It's not surprising that many Indian doctors have left the U.S. for countries with more welcoming policies. That's a particularly jarring loss for U.S. rural communities, as immigrant doctors are significantly more likely to move to underserved areas than U.S.-born doctors. Congress must move swiftly to pass the EAGLE Act and the Healthcare Workforce Resilience Act. The health of our nation depends on it. Anupam Jha is the medical director of psychiatry at Firelands Regional Medical Center in Sandusky.