Petitioning Representative Jack Kingston and 7 others

Do not outsource American jobs when Americans qualify for them

1. Create similar to Senate Bill 716 MO for every state without limitation on graduation date and time since passing USMLE exams. Increase the number of GME Residency Slots for US Citizen & Resident IMGs (International Medical Graduates). http://www.senate.mo.gov/14info/pdf-bill/tat/SB716.pdf


2. Implement a version of the Canadian model (Manitoba) for individual assessment of the clinical, diagnostic and management skills of physicians that have already trained in residency programs or practiced outside of the USA, and if adequate, prepare IMGs to work under supervision or directly in underserved areas (under sponsors). These physicians could be granted 1 year limited restricted license (sponsored by an institution or practicing physician). That license could be extended on an annual basis as needed. After 5 years practicing under such circumstances the physician in question should be evaluated for eligibility to apply for a full unrestricted state license for the scope of practice that he has been engaged in, considering he has fully satisfied his examination requirements of passing USMLE Step 1, 2 and 3 http://umanitoba.ca/faculties/medicine/education/imgp/index.html, https://www.cpsnl.ca/default.asp?com=Pages&id=117&m=319 http://www.health.gov.on.ca/english/providers/project/img/img_mn.html, http://www.cehpea.ca/

3. Place a moratorium on all J1 visas for residency training for 3 years (or use a mandatory tier system: I. US medical students II. US and permanent residents who are international medical graduates (IMGs) II. IMGs, non-us citizens, unless governments of their countries of origin are sponsoring their visas and paying for their tuition and living expenses during residency. Studying the international experience of countries like Spain, Canada, Great Britain in the matter of preferentially matching candidates who are citizens of the country in question http://www.curso-mir.com/Informacion-para-medicos-extranjeros/movimientos-migratorios.html; http://www.carms.ca/en/residency/r-1/eligibility-criteria/ , http://www.foundationprogramme.nhs.uk/pages/home/how-to-apply/FP2015-Eligibility-Information.

4. Provide targeted training for IMGs who have graduated their respective schools outside USA but have not entered or completed residency training, following the example of  California Business code 855: http://law.onecle.com/california/business/855.html These pilot programs could provide adequate training to prepare these doctors to serve as primary care physicians under the supervision of a fully licensed doctor in underserved areas.

As it stands now: The State Department regulations 22 CFR 62.22(f)(2)(v) require that approved J-1 trainee or intern visa sponsors do not “displace” US workers or “fill a labor need.” Sponsoring training hospitals routinely issue a Form DS-2019 to the alien physician.

62.22(b)(1)(ii) Exchange Visitor Program training and internship programs must not be used as substitutes for ordinary employment or work purposes; nor may they be used under any circumstances to displace American workers. The requirements in these regulations for trainees are designed to distinguish between bona fide training, which is permitted, and merely gaining additional work experience, which is not permitted. The requirements in these regulations for interns are designed to distinguish between a period of work-based learning in the intern's academic field, which is permitted (and which requires a substantial academic framework in the participant's field), and unskilled labor, which is not.

I am a US Citizen myself and a fully trained physician from Bulgaria. I myself and the members of my organization, Residency Ready Physicians are ECFMG certified and completed all required licensing exams, but cannot practice in the US because we cannot complete a required residency. There are thousands of us, International Medical Graduates (IMG’s), living in the great country, who want to help people and alleviate the physician shortage, but two things keep us out of the system: not enough residencies and thousands of visiting residents on J1 and H1B visas taking these taxpayer funded positions. No matter how much education we have, we cannot practice without this last step. These Medicare funded position are given to thousands of doctors from abroad who have not paid taxes in the US or have any commitment to this country, while thousands of US citizens and permanent residents are left wasting their education and talents.

In 2014, 3613 of the 26,678 available residency positions went to NON US International Medical graduates while 975 American graduates (each with approximately 200,000 dollars in student loans) and 4882 International Medical Graduates who are US Citizens and permanent residents who have passed the required licensing exams and who applied, were unable to find a position. Additionally 611 DO (Doctor of Osteopathy) US citizens did not match. Total of 6,339 IMGs non-US citizens matched. This is a significant number that represents 24.7 percent of all NRMP matches and 22.9 percent of all NRMP and AOA year matches combined and well above the percent of foreign-educated individuals in most other health professions, like nursing and pharmacy, which runs generally in the 5 to 10 percent range.

The above numbers by the way only count the IMGs that applied to the match. It costs an IMG about $1500 or more to apply so most only try two or three times before giving up. That is after taking the required exams, which cost about $800 for each step (there are 3 steps). We do not get student loans for these expenses.

The cost of physician shortage is a major problem. Not enough doctors means that hospitals and practices must compete for those available, offering higher pay and benefits. My organization, Residency Ready Physicians, has several recommendations for using the estimated 6000 International Medical Graduates who are currently underemployed. IMGs mainly from India and Pakistan make the major numbers of J1 visa applicants for medical residency. While they are supposed to go back to their home countries after their training, they actually never do and find ways to immigrate to USA because of the better pay compared to their countries of origin. Therefore is also unethical to admit doctors on J1 visas and “close our eyes” knowing that majority of them will never go back and drain the medical taskforce of their countries of origin. In addition (see papers attached) the numbers of J1 visas issued closely approximates the numbers of US IMGs applying for residency but being unmatched.

I would like to make it clear that even the Indian government has recently acknowledged the “brain drain” of its doctors who come for residency training on J1 visa, but actually never go back to India. According to recent publication Indian government pays estimated $60,000 per year/per medical student for Medical School and supplies, while all those doctors never return any revenue or services to their home country.
So far I have been personally lucky not to have to go into too much debt, taking student loans for my medical education. However we have many members who are Caribbean or American Medical graduates with an average of $200,000 in student loans. Unfortunately, as they are denied residency positions and subsequently medical license several of our members after years of applying to the residency Match and not being matched have defaulted on their student loans and went into bankruptcy and their families are currently living on “food stamps”.

We do not want special treatment, but just the opportunity to join the system and help those most in need. I would willingly serve in the poorest Appalachian town, the inner-city, or wherever my talents are needed. I trained all my life to serve as a doctor, to heal. All I am asking; all our group is asking for, is for the opportunity to serve. Please consider our requests.


Neviana Dimova

Letter to
Representative Jack Kingston
Senator Tom Harkin
U.S. House of Representatives
and 5 others
U.S. Senate
AMA president Robert M Wah, MD
VETERANS AFFAIRS ACTING SECRETARY Robert McDonald
HHS Sylvia M. Burwell
MN State
I just signed the following petition addressed to: Congress.

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Do not outsource American jobs when Americans qualify for them

Create similar to SB 716 MO for every state without limitation on graduation date and time since passing USMLE exams. Increase the number of GME Residency Slots for US Citizen & Resident IMGs (International Medical Graduates).
1.Require Residencies to give positions to qualified US citizens and Permanent Resident IMGs, before bringing in visiting physicians on J1 and H1B visas
2. Use federal money set aside for worker training to fund additional residencies that are earmarked for IMG’s who are US citizens or PR.I would like to bring to your attention documented discrimination in applying, interviewing and ranking of many US Citizens/Permanent Residents Physicians.

I am a US Citizen myself and a fully trained physician from Bulgaria. I myself and the members of my organization, Residency Ready Physicians are ECFMG certified and completed all required licensing exams, but cannot practice in the US because we cannot complete a required residency. There are thousands of us, International Medical Graduates (IMG’s), living in the great country, who want to help people and alleviate the physician shortage, but two things keep us out of the system: not enough residencies and thousands of visiting residents on J1 and H1B visas taking these taxpayer funded positions. No matter how much education we have, we cannot practice without this last step. These Medicare funded position are given to thousands of doctors from abroad who have not paid taxes in the US or have any commitment to this country, while thousands of US citizens and permanent residents are left wasting their education and talents.
In 2014, 3639 of the 26,678 available residency positions went to NON US International Medical graduates while 975 American graduates (each with approximately 200,000 dollars in student loans) and 4882 International Medical Graduates who are US Citizens and permanent residents
who have passed the required licensing exams and who applied, were unable to find a position. Additionally 2729 US citizens and permanent residents withdrew from the match. And since all medical residencies are paid for by taxpayers, is congress going to do anything to ensure that
these new, and existing, positions go first to taxpaying US citizens and permanent residents?

The above numbers by the way only count the IMGs that applied to the match. It costs an IMG about $1500 or more to apply so most only try two or three times before giving up. That is after taking the required exams, which cost about $800 for each step (there are 3 steps). We do not get student loans for these expenses.

The cost of physician shortage is a major problem. Not enough doctors means that hospitals and practices must compete for those available, offering higher pay and benefits. My organization, Residency Ready Physicians, has several recommendations for using the estimated 6000 International Medical Graduates who are currently underemployed. IMGs mainly from India and Pakistan make the major numbers of J1 visa applicants for medical residency. While they are supposed to go back to their home countries after their training, they actually never do and find ways to immigrate to USA because of the better pay compared to their countries of origin. Therefor is also unethical to admit doctors on J1 visas and “close our eyes” knowing that majority of them will never go back and drain the medical taskforce of their countries of origin. In addition (see papers attached) the numbers of J1 visas issued closely approximates the numbers of US IMGs applying for residency but being unmatched.

I would like to make it clear that even the Indian government has recently acknowledged the “brain drain” of its doctors who come for residency training on J1 visa, but actually never go back to India. According to recent publication Indian government pays estimated $60,000 per year/per medical student for Medical School and supplies, while all those doctors never return any revenue or services to their home country.
So far I have been personally lucky not to have to go into too much debt, taking student loans for my medical education. However we have many members who are Caribbean or American Medical graduates with an average of $200,000 in student loans. Unfortunately, as they are denied residency positions and subsequently medical license several of our members after years of applying to the residency Match and not being matched have defaulted on their student loans and went into bankrupsy and their families are currently living on “food stamps”.

We do not want special treatment, but just the opportunity to join the system and help those most in need. I would willingly serve in the poorest Appalachian town, the inner-city, or wherever my talents are needed. I trained all my life to serve as a doctor, to heal. All I am asking; all our group is asking for, is for the opportunity to serve. Please consider our requests.
Neviana Dimova
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Sincerely,