Carl Shusterman, Managing Partner, Law Offices of Carl Shusterman
One of the many challenges facing the U.S. health care system is a growing shortage of physicians. Projections released by the Association of American Medical Colleges (AAMC) and other organizations forecast a deficit of as many as 200,000 physicians by 2025.
Physicians today are in short supply not only in traditionally underserved rural areas, but in a wide range of suburban and urban areas. The national physician recruiting firm Merritt Hawkins reported last year that 44% of its physician recruiting assignments took place in communities of 100,000 people or more, underlining the fact that it is not just small communities that need assistance with physician recruiting.
While experts agree that physician shortages are most pronounced in primary care, many medical specialty areas also are facing shortages. Over 20 medical specialty societies have projected shortages in a range of specialties, including geriatrics, oncology, psychiatry, general surgery, orthopedic surgery, emergency medicine, neurosurgery and others. In a recent report, the AAMC projected a deficit of 91,500 physicians by 2020, including 46,000 medical specialists.
Given this trend, recent developments in Canada may be of particular interest to physician recruiters. Canada’s Royal College of Physicians and Surgeons has catalogued a list of high-unemployment specialties in which newly trained physicians have been experiencing problems finding jobs. The list includes orthopedic surgery, neurosurgery, and other specialties which are in short supply here. Due to this lack of opportunity in Canada, more Canada physicians may be open to seeking jobs in the U.S.
Recruiters seeking Canadian physicians should keep several things in mind. The first is that graduates of Canadian medical schools who have completed residency training in Canada are not considered international medical graduates (IMGs). Unlike physicians from any other country, they can obtain medical licenses in almost every U.S. state based on their Canadian education, training, and exams. They do not have to complete a U.S. based residency program to provide patient care in private practices, medical groups, hospitals, academic centers or other settings, as do physicians from virtually every other country in the world.
Moreover, in the great majority of states, Canadian trained physicians can obtain permanent U.S. residence (green cards) without having to take a U.S. medical qualifying exam such as the USMLE. A U.S. employer such as a medical group or a hospital can sponsor a Canadian physician for a green card based entirely on the physician’s Canadian-based education and training. This makes Canadian physicians, as a rule, easier to recruit in terms of immigration considerations than IMGs. However, the turnaround time to obtain a green card for a Canadian physician can be protracted, usually 12 months or more.
A faster route is to sponsor Canadian physicians for temporary, H-1B visas. Interestingly, while Canadian physicians do not need a U.S. exam to qualify for a green card, they do need such an exam to quality for an H-1B visa. Assuming they don’t have the required USMLE certification, they may be able to take advantage of a regulation which grants physicians of national or international renown in the field of medicine an exemption from the requirements of Federation Licensing Examination (or an equivalent examination as determined by the Secretary of Health and Human Services).
However, as physicians in Canada continue to be challenged in finding jobs, it can be anticipated that a growing number will take the USMLE in order to enhance their employment prospects in the U.S. Canadian physicians with a U.S. exam are excellent candidates, because they can obtain H-1B visas and be working in the U.S. within a matter of a few months.
While Canadian specialists certainly are not the long-term answer to the physician shortage in the U.S., they are a supplementary resource that physician recruiters may wish to consider.
Carl Shusterman served as a trial attorney with the U.S. Immigration and Naturalization Service and is principal of The Law Offices of Carl Shusterman. He can be reached at carl@shusterman.com. Follow Carl Shusterman on Twitter @immigrationasap.
