International medical school graduates need an easier path to practice in the US

Here’s a frightening fact: In just one week at the Alabama hospital where I work, 117 patients were admitted for COVID-19. Of those, 15 lost all kidney function and had to go on dialysis. At least six others are being monitored for possible acute kidney failure.

I’m a nephrologist: Improving kidney health is my life’s work. What we’re seeing locally is unprecedented and mimics what we’re seeing nationwide. Early reports show up to 40 percent of patients hospitalized with COVID-19 experience kidney damage and require dialysis. Worse, data from New York City show that among kidney transplant recipients treated for COVID-19, up to 30 percent died. 

As COVID-19 numbers skyrocket nationally, we will need more doctors who understand the complex and life-threatening effects of kidney damage. Before the pandemic hit, 37 million Americans struggled with kidney diseases. More than 750,000  Americans experience kidney failure. To live, they require a kidney transplant or lifelong dialysis. 

This is a public health crisis. Those 37 million Americans need access to physicians who specialize in this area. So do the increasing numbers of people suffering severe COVID-19 symptoms. The United States has 10,796 practicing nephrologists — just one kidney physician for every 3,427 people struggling with kidney diseases.  

The physician workforce in America has experienced challenges for decades. This country has a reputation for excellent health care, in part because of contributions from International Medical Graduates (IMGs). One in four physicians in this country is an IMG. Nephrology especially benefits from the contributions and expertise of IMGs; 49 percent of practicing nephrologists are IMGs. Countless Americans depend on our expertise and dedication. Which is why we have to make it easier for IMGs to practice here.

The Healthcare Workforce Resilience Act – introduced by Sens. Durbin (D-Ill.), Perdue (R-Ga.), Young (R-Ind.) and Coons (D-Del.) – will provide some of that help. It will strengthen the health care workforce by eliminating barriers that prevent immigrant doctors and nurses from securing the stable immigration status necessary to help our nation fight COVID-19. 

Without such a policy, foreign-born doctors have few options. Right now the Conrad 30 Waiver is the only federal program that offers a pathway for foreign-born doctors who complete a medical residency in the United States to practice medicine here. But it’s limited to just 30 doctors per state per year. Some doctors can receive exemptions from the cap on H-1B high-skilled worker visas. But it’s a temporary status and carries many restrictions, like prohibiting workers from taking shifts at a second hospital where they may be desperately needed.  

Growing up in India, I was enamored by medicine from a young age, influenced by my father, who was chair of a pathology department. I earned my medical degree from the Kasturba Medical College in Mangalore and completed an internal medicine residency at the Postgraduate Institute of Medical Education and Research in Chandigarh. I became fascinated by the specialty of nephrology, seeing first-hand the amazing effects of kidney transplants in patients who then no longer needed dialysis.  

In 1989, I was selected for a fellowship in nephrology at the same institute and received great training in the specialty. When I decided to come to the United States in 1992, I had 12 years of medical education and training. I still had to pass the licensure exams and complete additional fellowship training in the United States before I could practice here. I was fortunate to be offered further training as a fellow at the University of Minnesota, advancing my exposure to basic and translational nephrology research.  

Today, I serve as the president of the American Society of Nephrology, as executive vice dean at the University of Alabama at Birmingham School of Medicine and director of the Division of Nephrology. Nationally, IMGs account for 67.8 percent of nephrology fellows, and the majority of our fellows are also IMGs. Their passion inspires me and my colleagues to do everything we can to improve the health of those we care for.  

With no end to the pandemic in sight, America’s nephrologists continue to struggle to treat all the patients in need. Eventually, we’ll have a vaccine. But America’s health care crisis won’t end there unless we make it easier for IMGs to practice here. Immigrants already comprise a significant portion of the country’s health care professionals, including 28.7 percent of physicians, according to New American Economy. But it’s not enough. Currently, 135 U.S. counties lack a single physician. By 2023, we’ll be short nearly 122,000 physicians nationwide, according to the Association of American Medical Colleges. 

A growing number of COVID-19 patients will need treatment even after they leave the hospital. The Healthcare Workforce Resilience Act will help ensure that we as a nation are ready to care for them. We must act before it’s too late.  

Anupam Agarwal, MD, FASN, is the executive vice dean at the University of Alabama at Birmingham School of Medicine, director of the Division of Nephrology and president of the American Society of Nephrology.