Dr. Amir Qureshi has hardly had a minute to himself since the COVID-19 pandemic set off a worldwide medical scramble last year. Most days, he works a 12-hour shift, consulting on patients with the virus or other infections like pneumonia. “I’m sometimes exhausted, sometimes frustrated,” Qureshi said. “And there is a human side to it, too.” He’s missed out on time with his wife and three school-aged children, and he finds it difficult not knowing when the crisis will be over.
Qureshi works just down the street from Caesars Palace on the famed Las Vegas Strip — the only infectious disease specialist at the 293-bed Desert Springs Hospital Medical Center in Las Vegas, Nevada. His services have always been in demand, but the pandemic has brought a heightened level of urgency. Last July, during the second peak of infections, hospital staff were treating from 40 to 60 patients at a time, while ICU beds were always in short supply.
Las Vegas is lucky to have him. Nevada, like many other Western states, is facing a shortage of doctors — a problem that is only going to get worse. By 2030, New Mexico, Nevada, Montana, Idaho and Arizona will suffer some of the worst physician shortages in the country, according to recent projections by the public health journal Human Resources for Health.
Distribution is one problem: There have always been higher concentrations of doctors on the coasts. Then, a decade ago, the Affordable Care Act increased demand for medical care by insuring over 20 million people across the country. But as the U.S. population ages, its doctors do as well; in New Mexico, 37% of doctors are expected to retire in the next decade, according to the Association of American Medical Colleges.
To fill these gaps in health care, hospitals rely on medical professionals born abroad. Through a visa waiver program called the Conrad 30, states like Nevada are able to lure foreign-born physicians to work in underserved areas in exchange for the chance to stay after they’ve completed graduate school in the U.S. “They’re providing services to the whole population, but specifically, they’re here to try to plug the holes for those most in need,” said Gerald Ackerman, director of Nevada’s Office of Rural Health. As the country struggles to cope with the pandemic, they are filling a crucial role in both rural and urban areas across the West.
WHEN QURESHI CAME TO THE U.S. from Karachi, Pakistan, at the age of 24, the country was dealing with a different epidemic. It was the early 1990s, and the AIDS crisis had swept through the nation. Facing a shortage of doctors, the U.S. did what it has done before: It loosened visa restrictions. “That’s when the floodgates opened for the foreign doctors,” Qureshi said. “(It’s) another example of foreign doctors coming to the rescue.”
Qureshi estimates that nearly a quarter of his classmates — about 100 physicians from the Dow Medical College in Karachi alone — were granted visas. Qureshi started his own residency at the sprawling St. Luke’s Roosevelt Hospital in New York City.
It was an exciting time for Qureshi. From the window of his 30th floor apartment, he remembers being able to see the World Trade Center. He found the city fascinating; its culture and customs were so different from what he’d known before. “A lot of things were new to me, let’s put it that way,” he chuckled. He looked forward to advancing his medical career, even as he worried about becoming infected with HIV. “At that time, you know, obviously, the biggest worry was getting stuck by a needle,” he said. “Thank God, I never did.”
Most of the doctors he worked with also came from other countries; in Nevada today, nearly a quarter of physicians and 37% of nurses are immigrants.
After completing his residency program and fellowship training, he moved to North Las Vegas in 1998 under the Conrad 30 program to serve in a hospital with a high volume of Medicare and Medicaid patients. At the time, he says, people were flying in from all over the world to experience the gambling and glamour of that bustling desert city. Most of the doctors he worked with also came from other countries; in Nevada today, nearly a quarter of physicians and 37% of nurses are immigrants.
Three years after coming to Las Vegas, he decided to stay. Eventually, he became a U.S. citizen. Though he’s no longer required to work with underserved populations in lieu of a visa, many of his patients are lower-income, sometimes traveling miles to his hospital from rural areas like Pahrump, Nevada, or Bullhead City, Arizona.
The Conrad 30 program has had its problems. Whenever labor is seen as an exportable commodity — something you can turn on-and-off with barely a moment’s notice — exploitation tends to follow. In 2007, the Las Vegas Sun published an investigation revealing that some physicians were being taken advantage of, working long hours with less pay than they had been promised. “In some cases, the employers would threaten them and say, ‘You are here because of me. If you don’t do what I say, I’ll get you deported,’ ” Qureshi said. But Nevada passed legislation to address the issue, and Qureshi, who now serves in an advisory role for the program, says it doesn’t happen anymore.
HAVING YOUR VISA TIED TO YOUR JOB is difficult for other reasons, especially now that tighter immigration restrictions and a backlog of applicants have made obtaining citizenship much more difficult. In 2017, under the Conrad 30 program, Dr. Kamalika Roy moved to rural Oregon to work as a psychiatrist after completing her residency and fellowship in Michigan. Originally from Kolkata, India, Roy now works for the Oregon State Hospital in Salem, as well as for a rural hospital a 100-mile drive from her home. As part of her contract, she also teaches at a university and spends hours on the phone with adults who need psychiatric help. The COVID-19 pandemic has impacted her patients greatly. Now that nursing homes are in lockdown, residents’ dementia symptoms are getting worse. “The group treatment totally was shattered due to COVID-19,” she said. And without family visitation and with staff in quarantine, “there is no daily structured routine for psychiatric patients anymore.”
“It’s stressful in the sense that you cannot focus on anything. We don’t buy good houses here, because we don’t know how long we’ll stay here.”
Despite the important work she does, Roy’s ability to live in the U.S. remains in constant limbo. Many hospitals have been forced to lay off staff, owing to the financial strains caused by the pandemic. Roy is not a permanent resident, so if she were to be laid off, she would have just one month to find a new job, or else return to India. Under the Trump administration, the visa renewal process became even more complicated; renewals were previously good for three years, but now sometimes they are only effective for one year. Meanwhile, the application alone takes 6 to 8 months to complete. “It’s stressful in the sense that you cannot focus on anything,” she said. “We don’t buy good houses here, because we don’t know how long we’ll stay here.”
Doctors like Roy also face a huge backlog for green cards — up to a 50-year wait made longer by the growing number of Indian nationals seeking Silicon Valley jobs in IT and technology, according to The Washington Post. Many of Roy’s colleagues have moved to Canada instead, where they are immediately granted permanent residency. Roy thinks it’s illogical for the U.S. to make everything so difficult; after all, taxpayer money funded part of her education. If she leaves the U.S., it will be Canada or Australia’s gain. “It doesn’t help anybody,” she said. “It doesn’t help me at all. But it also does not help America as a country.”
In some ways, Qureshi was luckier: He was able to hit the supply-and-demand pulse of visas and citizenship when he moved here 30 years ago. He’s happy in Las Vegas but remains grateful to Pakistan for subsidizing his medical education. And, in some ways, he thinks the U.S. should be grateful too.
“I say this without mincing my words,” he said. “The city of Las Vegas would not have survived without foreign doctors.”
Jessica Kutz is an assistant editor for High Country News. Email her at jessicak@hcn.org or submit a letter to the editor. Follow @jkutzie
This article appeared in the print edition of the magazine with the headline A good bet on health care.
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