Governors in several of the hardest-hit states put out calls on Monday for health care workers from other states to help treat patients suffering from Covid-19, the disease caused by the novel coronavirus.
In perhaps the most striking example, Michigan Gov. Gretchen Whitmer posted a video to Twitter on Monday, saying, “If you’re a health professional anywhere in America, Michigan needs you. We’re calling on doctors, and nurses, and respiratory therapists, and other health professionals to sign up and help us fight Covid-19 and save lives,” she said, while announcing that the state had relaxed interstate medical licensing requirements to make it easier for personnel from other states to assist with Michigan’s burgeoning outbreak.
Joining Whitmer was New York Gov. Andrew Cuomo, who implored out-of-state doctors and nurses to come help treat patients with Covid-19, especially those in New York City, which has become the nationwide epicenter of the pandemic. “Help New York. We are the ones who are hit now,” Cuomo said Monday at a press conference at the Jacob K. Javits Center, which has been converted into a temporary hospital.
As of March 30, over 7,700 people in New York City alone have been hospitalized with Covid-19. A temporary field hospital has been constructed in Central Park as area hospitals are overrun with coronavirus patients.
While New York and Michigan have been among the hardest hit, confirmed cases of Covid-19 have now been found in all 50 states. That — plus the fact that the US was already facing a shortage of health care professionals before the crisis started — could limit the number of personnel available to assist in areas with high infection rates.
The health care personnel shortage, briefly explained
There are a couple of reasons the US health care system is running short on professionals to treat Covid-19, the influx of patients being most obvious.
Compounding that is a shortage of personal protective equipment (PPE). Doctors and nurses in areas dealing with widespread infections are in near-constant contact with the virus; without appropriate PPE, they’re at increased risk for contracting it. In Spain, about 14 percent of those infected were doctors or nurses; in Italy, nearly one in every 10 people infected were medical professionals.
This puts a strain on hospital staffing in areas like New York City. Most states have put orders in place to stop non-essential surgeries and are encouraging telemedicine for as many non-Covid-19 afflictions as possible in order to preserve PPE and free up personnel to treat coronavirus patients.
But as Vox’s Dylan Scott, Umair Irfan, and Jen Kirby explained, the US was already facing a critical shortage of medical personnel before the coronavirus pandemic hit its shores. The pandemic has only deepened the staffing crisis:
Overall, US hospitals employ as many people or more per capita as our economic peers. But staffing is disproportionately tilted toward administrative work in the United States.
If you focus on health care professionals specifically, US hospitals trail behind most European countries and Canada. Our hospitals employ almost as many administrative staff as medical staff, according to estimates from the Peterson-Kaiser Health System Tracker.
And US hospitals were already at risk of being overrun if the number of Covid-19 cases explodes before fears about staffing shortages fully set in.
America has about 924,000 hospital beds, about 98,000 of which can be used for people who need intensive care, according to the American Hospital Association. The number of Covid-19 cases that will require ICU care could expand far beyond what the US is currently capable of providing.
As officials in New York and Michigan scramble to fill personnel gaps, there is another potential solution besides borrowing doctors from other states that might need them.
There are other possible solutions for the medical staffing shortage
While much of the federal response has focused on managing the country’s PPE shortfall, the government has also taken steps toward easing the personnel shortages in the hardest-hit areas. On March 18, Vice President Mike Pence announced a new Department of Health and Human Services regulation allowing doctors to practice medicine across state lines.
In response to the recent critical shortage, Cuomo also put out a call for retired health workers to return and care for Covid-19 patients. About 40,000 responded as of March 25, according to Wall Street Journal reporter Jimmy Vielkind. The state also allowed medical and nursing students to jump directly into the workforce to assist with pandemic care, provided they can get the proper certifications.
Other countries have turned to foreign health workers to find enough medical staff to manage the pandemic.
In the United Kingdom, the government recently announced it would automatically extend visas for foreign health workers already working in the country, a significant decision as the country finalizes Brexit to further limit immigration.
Additionally, Chinese, Russian, and Cuban doctors have flown to Italy to help handle the country’s coronavirus emergency. But the US is unlikely to see a similar rush of foreign health workers without significant changes to current immigration law.
Foreign doctors and nurses face a nearly impossible maze of immigration hurdles to practice in the US, as Vox’s Nicole Narea explained:
Every year, roughly 4,000 foreign doctors come to the US on J-1 visas for residencies at teaching hospitals, which rely on Medicare funding to pay their salaries. While most of those doctors would like to stay in the country after they complete their training, only about 1,500 of them are ultimately able to do so, [Greg Siskind, an immigration attorney who represents doctors] said.
That’s because they are required to return to their home countries for at least two years upon completing their training in order to be eligible for an H-1B skilled worker visa or a green card, unless they can obtain one of a few sought-after waivers.
The Conrad 30 program, for example, offers waivers to 30 doctors in every state who agree to practice where the government has designated a health care worker shortage, mostly in rural areas. Doctors can also obtain waivers through the Department of Health and Human Services by conducting medical research in [a] field that is of interest to the agency or by practicing in underserved areas designated by the agency.
But even for those who are able to obtain waivers, the process of applying for a green card can involve long waits, particularly for immigrants from India, which produces about a third of all foreign doctors training in the US. That’s because there are per-country caps on the number of green cards issued annually, and India gets the same number of green cards as any other country despite being among the most populous nations in the world. (A bill that would have eliminated these country caps recently failed in the Senate.)
“Indian doctors are looking at a 20-year wait for a green card,” Siskind said. “When these Indian doctors are finishing up their training in the US, they’re seeing that they can get a green card in Australia, Canada, and UK immediately and a fast-track to citizenship. It’s a mess.”
Not only does the current system make it exceedingly difficult for doctors to stay in the US long-term, but it also severely restricts where in the US they can go. Under the terms of both J-1 and H-1B visas, doctors can’t just change jobs. They usually can’t even moonlight at another hospital and take on extra hours. At a time when doctors need flexibility to go to areas of the country that are hard-hit by coronavirus, that’s a huge obstacle.
Most nurses come to the US on green cards, but they, too, face long wait times due to the same backlogs that are hurting Indian doctors. Many of them also come from India, as well as the Philippines, where they get the … same kind of training that they would in the US.