Immigration is a topic that many people in America have strong opinions about, but which very few truly understand. I am one of those people, and ironically, I am a first-generation immigrant myself. When my family moved to the United States from India in the late 1980s, I was a rambunctious four-year-old girl. I presumably entered on a dependent visa tied to my parents, but in short order we received green cards, giving us permanent resident status in the United States. I became a naturalized citizen in my preteen years, when my adolescent mind was busy with the trials of surviving middle school and entering puberty.
I have been thinking about the topic more lately. My institution is built on immigrants. We have immigrants in every level of our medical center, including in many leadership positions. But very few people understand the process involved in living and succeeding in America. While a deep dive into U.S. immigration policies is beyond my scope, I can provide a brief intro into the salad of letters and numbers that make up immigration visas for medical practitioners and scientists.
The F1 visa is for students enrolled full time in a college or university. The recipients are only allowed to stay for 60 days beyond completion of the program, unless they apply for something called OPT (Optional Practical Training). This allows for 12 months of employment before or after completing your program, and it must be related to your field of study. What if you were a political science major, like I was, and wanted to do a medical research job, as I did prior to entering medical school? Not allowed.
The J1 visa is an exchange-visitor non-immigrant visa. It allows an individual to undergo specialized training, which includes graduate medical education (residency/fellowship). Again, there are significant restrictions. Your visa only lasts for the prescribed length of your training program. If you have to extend for any reason (including ill health), you will likely lose the visa before you complete your program. In addition, you must leave the U.S. and return to your home country for at least two years after completing the program. This can be “waived” if you decide to work full-time for at least three years in an underserved community in the US.
Finally, the H1B visa is a skilled non-immigrant visa, given out through a lottery. It allows people to remain in the U.S. for a longer period working in, say, medicine or the technology industry. Currently, the USCIS (Citizenship and Immigration Service) has a cap of 85,000 visas: 65,000 for those with a bachelor degree, and 20,000 for those with a master’s degree or higher. In the first week alone of the most recent fiscal year, there were over 200,000 applications for H1 visas. (They are given out via a lottery system.)
Once again, as with the other visas, there are significant restrictions on what you can do with an H1. You must continue to do the job you were hired to do. For example, a hospitalist (a hospital-based physician) on an H1B visa must do nothing but hospitalist work. She cannot cut down her hours after having a child, or going through a family crisis, or any number of reasons. She cannot move into another field completely within the line of job duties, even it’s something related, such as medical administration.
How do you get off this hamster wheel? If you want to stay in the United States, you need a green card, to be a permanent resident. Then, you have nearly all of the rights of a U.S. citizen (except the right to vote). You may pursue employment outside your field of study, work part-time, work in a community that is best for you and your family—rights the rest of us take for granted.
The challenge: the USCIS has a per-country limit on green cards, where no more than 7 percent can be issued to people from any one nation. For countries like India and China, which send by far the highest number of skilled-employment–based immigrants to the United States, this can create an extremely long backlog. For Indian nationals, that wait time to even be eligible for a green card is currently on the order of 15 years. (Another twist: there is a separate “parent” green card, for non-employed, often elderly, dependents, that can be obtained much faster—within a year, compared to employment-based green cards.)
Therefore, for many of my immigrant colleagues, their rights to pursue their “American dream” are significantly curtailed by immigration laws. The eclectic and fulfilling education I had, in political science/public policy and later in medicine literally would have been impossible had I been here on a visa. It also has made it difficult for immigrant physicians and scientists to take time for their own health or for their families.
Immigrants are a tough group. But as they become a target for completely unwarranted national rage by irresponsible politicians, and without having time in their required full-time work or study schedules to process the effect of these daily media storms, they may also crack under the pressure. As we hear more about depression and suicides amongst medical and doctorate students and practitioners, be willing to lend a hand to the hardworking newer (but still 100 percent American) people in your work and life.