Economics widens the gap as wealthy urban hospital systems easily outbid the struggling rural ones by offering better salaries, adds Geeta Minocha, a Stanford medical student raised in rural Florida.<\/p>\n
So any hike in the fee would make it harder to bring in new clinicians from abroad, putting additional financial pressure on rural hospitals that are already stretched thin, experts say.<\/p>\n
And it’s not just remote towns. The country’s capital Washington and several states, including Michigan, New Jersey, Florida, New York and California, rely heavily on immigrant physicians, external<\/a>, who comprise more than 30% of the doctors there.<\/p>\n In his book, Immigrant Doctors: Chasing the Big American Dream, Dr Kathula tells several stories of Indian medical graduates in the US who did their work at the cost of their own welfare.<\/p>\n “They have died serving our country during the HIV crisis of the 1980s-1990s when laboratory staff were reluctant to even draw blood, and during the recent Covid-19 pandemic,” he says. “I know doctors who were treating patients here but could not travel to attend their own parents’ funeral in India during the pandemic.”<\/p>\n Many of these professionals started arriving in the 1960s when the US opened its doors to fulfil surging demand, attracting thousands of highly trained doctors from developing nations such as India.<\/p>\n Most of them enter the US on J-1 visas for clinical residency training.<\/p>\n After completing their medical residency, they either switch to H-1B visas if a willing hospital sponsors them or must return to their home country as per the terms of the J-1 visa (which requires them to go back for at least two years before applying again).<\/p>\n In 1990, to fix acute doctor shortages, the US government created an exception. It waived the two-year return requirement for doctors willing to work in Health Professional Shortage Areas (HPSA) – regions where there are not enough doctors to meet the population’s healthcare needs. This waiver – the Conrad waiver – gives foreign doctors the opportunity to continue working in the US on H-1B visas tied to serving in HPSA areas once their clinical training on J-1 visa ends.<\/p>\n One such HPSA is deep inside south Alabama, where Dr Rakesh Kanipakam, a doctor trained in the southern Indian state of Andhra Pradesh, travels hundreds of miles every week to treat patients with failing kidneys.<\/p>\n “We serve clinics in three cities, five countryside clinics and dialysis centres in a 100-mile radius,” he says. “The entire place had just one nephrologist but now even he is retiring.”<\/p>\n Foreign medical workers also contribute millions of dollars to the US economy.<\/p>\n Back in Batesville, Dr Anantha’s colleagues credit him for transforming their hospital into a centre of excellence.<\/p>\n In a letter written in support of Dr Anantha’s green card application, the hospital CEO said the doctor had bolstered the facility’s financial stability by over $40m annually and has also brought them many awards in the field of healthcare.<\/p>\n For now, the AMA says it is feeling “encouraged by the administration’s openness to an exemption”.<\/p>\n But Dr Mukkamala warns that action on this needs to happen quickly “because international medical graduates are determining their next steps now and the possibility of this fee hike could deter highly qualified physicians from working in the US”.<\/p>\n Follow BBC News India on Instagram, external<\/a>, YouTube,, external<\/a> X, external<\/a> and Facebook, external<\/a>.<\/p>\n