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Time Sensitive Appeal DocuSign Envelope ID: 564E320D86C691E4-C40A2C15--496B47CF--BCBA967F--5DD3EFD5F3FF3530236955B9 TIME SENSITIVE APPEAL APPEAL TO SUPPORT LEGISLATIONS S.3599 / H.R.6788 and S.948 / H.R.2895 (FROM INTERNATIONAL PHYSICIANS PRACTICING IN THE STATE OF MISSOURI) To To The Senate Majority Leader The House Majority Leader The Senate Minority Leader The House Minority Leader The Honorable Senator Josh Hawley Blaine Luetkemeyer (MO-3) United States Senate Emanuel Cleaver (MO-5) Washington, DC Sam Graves (MO-6) Billy Long (MO-7) Jason Smith (MO-8) We trust you and your families are staying safe and healthy in these unprecedented times. We are reaching out to your office to solicit your support and co-sponsorship for critical legislations that benefit the patient population of the state of Missouri and US trained Licensed International doctors practicing in Missouri (enclosed are the physicians’ signatures and biographies of several physicians from MO). BACKGROUND: The COVID-19 public health emergency has imperiled our healthcare workforce in an unprecedented manner. Based on recent CDC data, more than 77,186 doctors, nurses, and other health care providers on the front lines in the US were infected, and at least 412 have died, but based on their report this is a significant underestimate. [As per CDC, data were collected from 1,785,007 people, but healthcare personnel status was only available for 379,858 (21.3%) people. For the 77,186 cases of COVID-19 among healthcare personnel, death status was only available for 48,748 (63.2%)]1. According to ‘Lost on the Frontline’, a project launched by The Guardian and Kaiser Health News, 635 front-line health care workers appear to have died of COVID-192. Enlisted below are some key facts regarding how US trained Licensed International doctors working legally on temporary visas (under H1B, J1 waiver, O1 visa programs) are remaking American health care and how they have changed the face of American medicine. Based on statistics collected by American Medical Association (AMA)3, US trained International physicians: a) Account for 22.7% of licensed U.S. doctors. b) 98% of them speak two or more languages fluently, helping patients overcome linguistic and cultural barriers that can impede care. c) 62% are primary care physicians and remaining in the other specialty practices. This about double the 31% of all U.S. physicians who work in a primary care specialty, helping to meet a critical workforce need. 58% of US trained International doctors were born outside the U.S. d) 33% of US-trained international doctors work in a hospital setting. This is the most popular setting for these doctors. Group practice follows at 31%, solo- or two-doctor practice is next at 20%, while the rest work in managed care, academic or unclassified settings. PROBLEM: Unfortunately, nearly 15,000 of these doctors are still on temporary visas despite working for several years in the US. The COVID- 19 crisis has made a significant negative impact on everyone and overstretched our healthcare workforce. The burden on the existing healthcare systems has intensified, and the brunt of the aftermath of this pandemic is yet to come. In many states, hospitals are already short of physicians with resurge of patients (with both COVID-19 and non-COVID-19 issues). In a situation like this, if a physician gets quarantined or falls sick, physician access to these communities is jeopardized. Sadly, thousands of US-trained, international physicians are not eligible for disability benefits, even if afflicted by COVID-19 while treating their patients. If they lose their job due to disability from illness, their legal status in the US can be endangered, and they can be deported from the US, resulting in worsening of the physician shortage. If a physician on a visa succumbs, their ultimate sacrifice is rewarded with the deportation of their dependents. References: 1. CDC report: Cases & Deaths among Healthcare Personnel https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in- us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-in-us.html 2. Almost 600 US Healthcare Workers Have Died From COVID-19. https://www.medscape.com/viewarticle/932028 3. How IMGs have changed the face of American medicine? https://www.ama-assn.org/education/international-medical-education/how-imgs-have-changed-face-american-medicine DocuSign Envelope ID: 564E320D86C691E4-C40A2C15--496B47CF--BCBA967F--5DD3EFD5F3FF3530236955B9 SOLUTIONS: To overcome these above challenges, six senators [3 Republican and 3 Democratic: Perdue R-GA), Durbin (D-IL), Leahy (D-VT), Cornyn (R-TX), Todd Young (R-IN), Coons (D-DE)] and four Congressmen [2 Democratic and 2 Republican: Brad Schneider (D- IL), Tom Cole (R-OK), Abby Finkenauer (D-IA), and Don Bacon (R-NE)] came up with an outstanding solution and introduced “Healthcare Workforce Resilience Act” S. 3599 / HR 6788. The medical organizations nationwide and the Congress have worried about physician shortage for a while, that also resulted in the introduction of S.948 /H.R.2895 (Conrad 30 Program and Physician Reauthorization Act). While 5 of 8 Missouri house representatives (Lacy Clay, Ann Wagner, Vicky Hartzler, Emanuel Cleaver, and Billy Long) have supported and cosponsored HR 2895, we hope the other three representatives are convinced to support it with this letter. The following is a snapshot of the proposed bill S. 3599 / HR 6788 in the Senate/House: a) Will retrospectively recapture unused green cards from 2004 to 2020 and allocate some of them to 15,000 physicians and 25,000 nurses working in the United States on temporary visas b) Will help in preparing by increasing the geographical radius of service by these healthcare professionals to cross cover across states helping/handling more patients during current or any future pandemics and their long-termafter-effects. c) Will not increase the number of overseas physicians coming to the United States prospectively. d) Will not incur any expenses for the taxpayers. e) Will bring an average of 13 to 14 new healthcare-related jobs and develop an average revenue of 1.3 million USDevery year per physician in the country. f) Will increase the revenue for USCIS in the short term with the adjustment of status of these legal immigrants. We sincerely request your support towards these selfless physicians/ healthcare workforces. We kindly ask our respected Senate and House members to prevent this grave injustice to our healthcare heroes, who are placing themselves and their families at risk, for the love of the people they serve in the country. As of now, nearly 1/3 of Senate members have already sponsored /cosponsored /officially agreed to cosponsor S. 3599. Of note, the State of Missouri has been utilizing all the 30 J1 waiver slots through Conrad- 30 program every year. As per the MO state Office of rural Health, the state is unable to recruit International physicians that were trained in US although significant shortages are prevalent in the state. We need more Bipartisan support and cosponsors from Senate and House for Conrad 30 program and Physician Reauthorization act (S.948/H.R.2895) which in the long-term helps to increase the J1 waiver positions from 30 to at least 35, help with the decentralization of physician’s availability to rural / medically underserved areas, increase patients’ access to doctors, and improve retention of doctors. These legislations are projected to be included in the upcoming COVID-19 relief phase. Both legislations are in the nation's best interest to help our patients, and to strengthen our healthcare workforce. These legislations will help to fight the current pandemic, and its after-effects by mobilizing healthcare workforce to be available in the required areas, and to overcome potential future healthcare workforce challenges. Notably, these legislations will not replace an American healthcare professional, but will assist in improving healthcare access. We request you to kindly view and support these healthcare legislations. As US-trained, international physicians with multiple years of US-based experience on temporary visas, we can be a novel solution to the existing and projected shortage of physicians. There are several hundred such physicians in the state of Missouri. We are a large and diverse group of physicians practicing in all settings all across the state (especially in areas with unmet need), with robust experience in our specialties. We are including some of our stories below give you an insight into our anxieties with temporary visas and our contributions to our communities. To be clear, we do not claim to represent the views of our employers, but we are solely advocating for our patients, health of your constituents and for ourselves. We convey our heartfelt thanks if you have already supported any one of these legislations by the time of this appeal. Of note, along with the US Chamber of Commerce, Bipartisan Policy Center, National Immigration Forum, American Immigration Lawyers Association, Americans for Prosperity, and Physicians for American Health Care Access-these bills have been endorsed by multiple reputed medical organizations as attached to this letter. We look forward to your response and support. Please do not hesitate to reach us back by email with any questions/concerns. Sincerely, Aayushman Misra, MD Meelie Bordoloi, MD Chair, Internal Medicine and Hospital Medicine Physician, Psychiatry Resident Physician, University of Missouri Mercy Hospital Jefferson Columbia, Crystal City, MO Columbia, MO Email: [email protected] Email: [email protected] DocuSign Envelope ID: 564E320D86C691E4-C40A2C15--496B47CF--BCBA967F--5DD3EFD5F3FF3530236955B9 Abhishek Bhandiwad, MD Monika Thangada, MD Hospital Medicine Physician, Poplar Bluff Regional Medical Psychiatrist, Harry S Truman VA Hospital, Center, Columbia, MO Poplar Bluff, MO Email: [email protected] Email: [email protected] Naganathan Mani, MD Associate Professor of Radiology and Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO Email: [email protected] Amar Jadhav, MD Critical Care Physician/Intensivist, SSM St.
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