Student Union
- By Hitender Rao
Doctors from India Frustrated by Visa Issues
NOTE TO READERS: This story is Part 1 of a two-part series.
Bijender Kumar, the son of a farmer in India's northern state of Haryana, came to the U.S. on an H-1B visa in 2007 after graduating from medical school in India.
He landed a residency in Toledo, Ohio, and then earned a master's in business administration in medical business from Kelley School of Business at Indiana University-Purdue University Indianapolis in 2016.
Now, Kumar is the medical director at Hancock Regional Hospital in Greenfield, Indiana.
"It's a matter of pleasure to look back and see as to how a person who came from a modest background was able to make it to this level," he told VOA. "The fact that a person who came from what I came from can go to Kelley and sit in class with distinguished physicians is amazing."
India exports more foreign medical graduates than any other developing nation, according to the World Health Organization (WHO).
In 2016, of more than 210,000 actively licensed foreign medical graduates (FMGs) or international medical graduates (IMGs) in the U.S., nearly 50,000, or 23%, graduated from schools in India. The next-largest group of international doctors — 35,971, or 17% — are from the Caribbean, according to 2016 research by the Federation of State Medical Boards.
An IMG is a U.S. citizen or green card holder who obtained their degree outside the U.S., while an FMG describes a foreigner who completes a degree in their country of origin.
But the number of doctors who graduated in India and sought a "certificate of good standing" — required in India for working abroad — declined from 2,984 in 2015 to 1,497 in 2017, according to India's Ministry of Health and Family Welfare data cited in news reports.
Jaivir Singh Rathore, who worked as a resident in adult neurology from 2013 to 2017 at the University of Illinois at Chicago, said most foreign medical graduates struggle to get their foot in the door of the U.S. medical field. He now serves as director of the epilepsy division at the Watson Clinic in Lakeland, Florida, after working as a medical fellow at the Cleveland Clinic in Ohio and the Johns Hopkins Hospital in Baltimore.
Rathore said he came to the U.S. on a J-1 student exchange visa in 2010 and eventually received a green card that afforded him more stability. He later became a U.S. citizen through family-based immigration.
Immigration experts have indicated it could become more difficult for foreign nationals to get H-1B visas or find other immigration pathways to work in the U.S.
"Tougher green card control will force doctors to explore other options (to work in the U.S.)," said Ranvir Singh Rathore, a doctor of internal medicine in Toledo, Ohio, and Jaivir Rathore's brother.
"It's a big hassle to live and practice on H-1B or J-1 visa because of the uncertainties that loom," Jaivir Rathore said.
Visa hurdles
A foreign worker with an H-1B visa can stay in the United States for a maximum of six years; with a J-1 visa, up to five years.
"Despite the fact that there is significant physician shortage — especially regarding specialists in many parts of America — it doesn't seem like the [Trump] administration is making any significant changes to help with these immigration issues for physicians of foreign origin," Jaivir Rathore said.
The Association of American Medical Colleges (AAMC) wrote in April 2019, "The United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply."
Exploiting doctors
"Many physicians from India and other foreign countries … consider and explore options in other countries like Canada or Australia," Jaivir Rathore said.
Some U.S. licensed physicians return to India because they are highly valued for having education, training and experience in the U.S., especially in the private health care sector, said Anupam B. Jena, an Indian American and associate professor of health care policy at Harvard Medical School.
"Some physicians that I know, including myself, think about it sometimes … to probably do part-time consultancy in India's leading private sector hospitals and with charity organizations," Jaivir Rathore said.
"As telemedicine is becoming vogue, the idea of making American dollars while living in India is becoming a reality and many Indian doctors, especially in the field of diagnostic radiology, are already doing that," he said.
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Economics, tensions blamed for Chinese students shifting from US to Australia, Britain
U.S. universities are welcoming international students as the academic year begins. But while the total number of foreign students is steadily growing, the top sending country, China, is showing signs of leveling out or shrinking.
Industry analysts say the negative trend is mainly due to higher costs amid China’s struggling economy, with a growing number of students going to less expensive countries like Australia and Britain, and tense ties between Washington and Beijing.
The number of foreign students studying in the U.S. in 2022-23 passed 1 million for the first time since the COVID pandemic, said Open Doors, an information resource on international students and scholars.
While the U.S. saw a nearly 12% total increase year-on-year for that period, the number of international students from China, its top source, fell by 0.2% to 289,526.
That’s 600 fewer students than the 2021-22 academic year, when their numbers dropped by nearly 9%. The COVID pandemic saw Chinese student numbers drop in 2020-21 by nearly 15%, in line with the world total drop.
While it’s not yet clear if the drop is a leveling out or a fluctuating decline, analysts say China’s struggling economy and the high cost of studying in the U.S. are the main reasons for the fall in student numbers.
Vincent Chen, a Chinese study abroad consultant based in Shanghai, said although most of his clients are still interested in studying in the U.S., there is a clear downward trend, while applicants for Anglophone universities in Australia and Britain have been increasing.
"If you just want to go abroad, a one-year master's degree in the U.K. is much cheaper,” Chen said. “Many people can't afford to study in the U.S., so they have to settle for the next best thing."
Data from the nonprofit U.S. group College Board Research shows that in the 2023-24 academic year, the average tuition and fees for a U.S. private college four-year education increased 4% to $41,540 compared with the previous academic year.
The British Council said three to four years of undergraduate tuition in Britain starts as low as $15,000.
The number of Chinese students in Britain was 154,260 in 2022-23, according to the U.K. Higher Education Statistics Agency, HESA, up from 121,145 in the 2018/19 academic year.
Australia’s Home Affairs office said in the 2023-24 program year, China was the top source foreign country for new student visa grants at 43,389, up slightly (1.5%) from the previous year.
Chen said Chinese state media's negative portrayal of the United States and concerns about discrimination have also contributed to the shift.
Bruce Zhang, a Chinese citizen who received his master's degree in Europe after studying in China, told VOA Mandarin he had such an incident occur to him after he was admitted to a U.S. university’s Ph.D. program.
When he entered Boston's Logan International Airport last year, Zhang said customs officers questioned him for more than an hour about his research, and if it had any links to the military, and took his computer and mobile phone for examination.
"Fortunately, I had heard that U.S. customs might be stringent in inspecting Chinese students, so I had relatively few study-related data and documents on my personal computer," he said.
Zhang was allowed to enter the U.S. for his studies in materials science, but the questioning left him so rattled that he has encouraged other Chinese to study elsewhere.
Cui Kai, a study abroad consultant in Massachusetts told VOA Mandarin that experiences like Zhang’s or worse happen for a reason.
"Students who were questioned or their visas were revoked at the customs are usually those who completed their undergraduate studies in China and come to the U.S. for a master's or doctoral degree in a sensitive major," said Cui.
Former President Donald Trump signed Proclamation 10043 in June 2020, prohibiting visas for any Chinese student who “has been employed by, studied at, or conducted research at or on behalf of, an entity in the PRC that implements or supports the PRC's “military-civil fusion strategy.”
The U.S. says China has been using students and scholars to gain access to key technology and, under Proclamation 10043, revoked more than 1,000 visas issued to Chinese nationals and has denied thousands more.
Critics say the policy is costly to the U.S. and is encouraging Chinese students to look to European and other universities.
Adrianna Zhang contributed to this report.
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