The COVID-19 pandemic has placed an extreme physical and mental burden on health care professionals around the world. Scholars have
found that in the United States health care professionals,
particularly people of color, have suffered increased levels of anxiety,
stress, and burnout as a result of the pandemic.
International medical graduates (IMGs) in particular have
faced heightened challenges during the pandemic related to their immigration
status, argued Greenwall Making a
Difference grant research team member Elizabeth Fenton,
PhD, Lecturer at the University of Otago,
at the 2021 American Society of
Bioethics and Humanities Annual Conference.
Prof. Fenton defined IMGs as health care professionals who
have received their basic medical degrees or qualifications from institutions
outside of the United States or Canada. IMGs include foreign-born individuals
in the United States on non-immigrant visas, immigrants who hold a medical
license, and U.S. born or naturalized citizens who received their basic medical
In a country that faces growing shortages
of physicians, Prof. Fenton reported that IMGs are ready and willing to help
meet the demand. Currently, IMGs make up 25
percent of all practicing physicians in the United States, and they have shouldered
a disproportionately heavy burden during the pandemic. For example, Prof. Fenton
reported that, according to one study, IMGs account for nearly half of all
COVID-related physician deaths.
Prof. Fenton explained that IMGs have been particularly vulnerable
to pandemic-related burdens because they are overrepresented in specialties
with higher risks of exposure to COVID-19 and they are more likely to work in
under-resourced or rural areas.
To better understand the challenges and needs unique to IMGs,
the study team conducted a series of interviews with IMGs practicing in West
Virginia, healthcare administrators and leaders in West Virginia, and
representatives of national and regional professional organizations.
Prof. Fenton reported that immigration-related issues were a
source of significant stress for IMGs during the pandemic. For example, IMGs
were concerned about contracting COVID-19 not only because of the potential
health risks to themselves and their families, but also because an inability to
work could impact their immigration status and that of their dependents.
Also, IMGs explained that certain visa restrictions impeded
their ability to relocate and help patients in pandemic hot spots. IMGs living
in the United States on work visas may only work in the hospital that employs
them, which in some cases meant that they were unable to practice in the
hospitals that needed them the most.
These immigration-related restrictions and stressors place
an unfair burden on IMGs during the pandemic and are potentially harmful to the
communities that IMGs serve, Prof. Fenton claimed. She argued that the U.S.
government and society as a whole owe reciprocity to IMGs for their
contribution to public health and particularly communities with high levels of
health need. Prof. Fenton explained that under the principle of reciprocity,
society must take steps to minimize burdens and give support to those who face
a disproportionate burden while serving the public good and the welfare of the
Prof. Fenton concluded her discussion with several
recommendations to increase support for IMGs. At the federal level, she
advocates for friendlier immigration policies such as offering protection against
deportation, extension of visa status, work flexibility, and streamlined
credentialing processes. At the institutional level, she suggests developing
tailored support for IMGs, explicit and public valuing of IMGs’ contributions
to their institutions and communities, and advocating for supportive
immigration policies. At the community level, she recommends fostering support
for IMGs and immigrant communities more generally.