would appreciate it. >> yes, sir, thank you, and thank you for the question. >> we have an entire family advocacy division who works with the parents, with the family, of the missing child and in working to ensure that the environment, the child returns home to, hopefully safely, hopefully quickly, is appropriate and the family is set up for reunification, especially in the time of long-term. some of our cases that our family advocacy division are working to support at times long-term and missing children where there's been a period of time between the last time the family has scene the child and today. so they work with the family to ensure that the family has the right things to say and the right support services to carry on. >> another area that we have is our team, which is a group of

volunteers, parents, who suffered either formally or currently missing or exploited child, and they engage with the family as well because they can speak on the same level. they know the emotions, they know the strength that the family is going through, and they can help the family work through the emotions. and once again, they're together because the family is going to be the most important second to the child, to make sure that the child returns to a good environment and the family stays together. >> thank you very much. madam chair, i'm just sitting here kind of frustrated, having served in this body for 10 years and then leaving for 24, and coming back, and seeing that so many of the issues that plagues this congress and this country are still with us and unresolved. so again, i want to commend chairman raskin and all the members of this subcommittee who are absolutely devote today

trying to find a way to make sure that that sort of thing is not replicated, duplicated 10, 15, 20 years down the road by pushing this congress to do everything in our power, after hearing this testimony to make real changes. i yield back. >> thank you mr. imfume and thank you for that historical perspective as well. the final -- finally, i want to recognize mr. raskin to close out this hearing. five minutes of questions. >> thank you very much, congresswoman norton and congressman imfume, thank you for the moving and stirring words that you just gave us both on the historical perspective as ms. norton says, but also what it means to fathers and mothers and families. mr. wilkinson's testimony is absolutely searing, as is

ms. foster's and it's an excruciating thing to contemplate from the standpoint of mothers and fathers, and brothers, sisters and other family members. mr. imfume reminds us that, you know, this is not like a peripheral issue. it's so often treated as kind of a marginal thing. it's like a detail. and this is why we have organized political society, you know, if you read the social contract philosophers being like hobbs and lock and rustaro, we enter into this, because our bodies, our properties, our families will be safer and more secure than we would be just out in the

state of nature. and yet, the social contract is not working if we're losing hundreds of thousands of women and girls every year. and if that has a disproportionate effect on minority communities, then is it that much more of rupture of the basic social contract. mr. wilkinson, does he see grounds for optimism in terms of society, those of us in government addressing this problem meaningfully? >> i do, however, my concern is that it's not happening fast enough. that the resources needed are not provided fast enough. that the people on this panel

are not seeing the results fast enough that are black, indigenous people or women of color are being violated faster than the resolution can be presented to it. so, yes, but no, in the same statement. >> all right. well, we'll take that with some cautious optimism that things are moving in the right direction, but far too slowly and we all need to redouble our efforts, both to galvanize national attention to the problem and then to make these legislative changes we have been talking about told. i thank you, ms. norton, madam chair, for filling in there and i thank all of our witnesses today for participating in a really important hearing. i yield back. >> well, thank you, chairman raskin, all of us are hoping for you. you're looking good. so, i think that's a good sign.

at least from here. in closing, i want to thank our panelists for their very important remarks. neve been very -- they have been very helpful to the committee. i want to commend my colleagues for their important participation and their important questions in this conversation. without that -- with that, and without objection, all members will have five legislative days within which to submit additional written questions for the witnesses to the chair. which will be forwarded to the witness is for their response. i ask our witnesses to please respond as quickly as possible. this hearing is adjourned. [inaudible conversations]

materials that members might want to offer as part of our hearing today. if members would like to submit materials, please send them to the email address that has been previously distributed to your office and we will circulate the materials to members and staff as quickly as we possibly can. i also ask all members to please mute your microphones when you are not speaking. this will help prevent feedback and other technical issues and you can unmute yourself anytime you seek recognition. this hearing will explore the essential role of immigrant physicians in the provision of general and specialized healthcare in the united states.

access to high quality healthcare has long been an issue of great importance throughout the united states and unfortunately, for many, access to healthcare has been a lacking due to a scarcity of physicians in their area. our immigration system has long contemplated a need for physicians. throughout the pandemic, immigrants in healthcare fields served on the front lines and been a driving force behind the research that led to the development of vaccines and cutting-edge covid-19 treatments. unfortunately, our antiquated immigration system discourages these needed physicians from coming to and remaining in the united states which exacerbates a serious level of physician shortages. this hearing will allow the subcommittee to hear from witnesses who will discuss the current and future demands for physicians, the current process for physicians to complete medical residencies and remain

permanently in the united states, as well as the need for reforms to our immigration laws as they pertain to physician immigration. now, i've chaired the immigration subcommittee in this congress and in prior years. one of the things i'm committed to doing is making sure that less senior members of the committee also have an opportunity to sit in the chair, have the opportunities to shape a hearing and have the experience of presiding. with that in mind and without objection, my colleague, representative mary gace gamon will preside over the hearing, give her public statement and recognize our esteemed ranking member mr. mcclintock, i now recognize ms. gallin for her opening statement. >> thank you, i thank you

virtually as i take the virtual chair. to recognize the importance of immigrant physicians in our healthcare system, the united states is facing a shortage of physicians, according to department of health and human services more than 86 people , 86% of people live in areas with insufficient primary care physicians. under extreme strain, causing some of them to leave their jobs, sadly, some of our most dedicated front-line physicians lost their lives in the front of this pandemics, immigrant physicians have been on the fore front of this, putting their life in harms way, even when it could leave family members without status and at risk for deportation. foreign nationals make up about 25% of the population of those obtaining graduate medical education in the united states. educational commission for foreign graduates, philadelphia

organization that sponsors foreign physicians who undergo medical training in the united states reports that over 70% of the physicians they sponsor for training are pursuing graduate medical education in a primary care specialty, we cannot continue to attract foreign physicians to this country with an immigration system that doesn't take their dedication into consideration. now, our current immigration system makes it difficult for immigrant physicians to work in the united states, for example, while immigration laws seek to encourage immigrant physicians to work in rural and medically under-served areas, the pathways to legal status and work authorization in such areas are insufficient. the conrad 30 program which helps place immigrant physicians in under-served areas only allocated a maximum of 30 slots in each state. my home state in pennsylvania with fourth highest number of immigrant physician exchange visitor trainees in the united states in part because we have

such a robust medical training system in the region nearly always has more than 30 applicants for conrad slots. additionally, the pathway to green cards for immigrant physicians contain decades long back logs from countries such as india and china. these long waits discourage physicians from remaining in our country when they know they can go elsewhere and obtain residency in a matter of months. lack of physicians is exacerbated by the fact our population is ageing, as more and more people in our country reach retirement age, we need additional doctors to meet the nation's healthcare needs. presently, 34% of demand for physicians is ages 65 and up and expected to increase. meanwhile, only two of every five physicians in the united states will be 65 or older within the next ten years so those retirements are also

creating additional pressure. it's imperative that we work to fix this problem now to ensure that americans have access to the medical care they need. immigrants play an important role in alleviating the physician's shortage. it's especially important that we address the problems immigrant physicians face as they disproportionately fill jobs in general message and geriatry in areas that need care. i look forward to discussing the complex issue of immigrant physicians to our healthcares system and approvals that better utilize their talents. this is a bipartisan problem that requires bipartisan solutions and i look forward to working with colleagues to find those solutions. i'm looking forward to hearing your perspectives.

so it is now my pleasure to recognize ranking member of the subcommittee, gentlemen from california, mr. clintock for his opening statement. >> thank you, madam chairman for your kind words. you know, in the time the democrats controlled the executive branch, roughly 2 million illegal immigrants apprehended by customs and border protection and of these, roughly a million have been admitted into our country. and that doesn't include the hundreds of thousands of got-aways who evaded apprehension while border patrol's been inundated by migrants responding to the unmistakable open borders this administration intended on day one. i quote, we have fundamentally changed immigration enforcement in the interior, for the first time ever, our policy explicitly

states a noncitizen's unlawful presence in the united states will not by itself be a basis for the enforcement. let me repeat that so it sinks in, quote, a noncitizen's unlawful presence in the united states will not by itself be a basis for enforcement action. fellow americans, if our immigration laws are not going to be enforced, we have no immigration laws and if we have no immigration laws we effectively have no border. if we have no border, in very short order will we have no country, just this vast international territory between canada and mexico. no civilization has ever survived a max migration on this scale the democrats have been actively encouraging, aiding and beting since they took power. history warns us that countries that cannot or will not secure their borders simply aren't around very long. now, in this deliberately created border chaos,

individuals on the terror watch list are entering our country, previously deported aliens committing murderer and other crimes unit continue to enter our country. this is the immigration subcommittee, republicans have begged the majority to address this crisis since they created it. instead, the subcommittee have five hearings, including this one, in four of the five, democrats focused on bringing additional foreign nationals into the united states. they have yet to explain how american workers are helped by flooding the market with cheap foreign labor or how our schools are made better flooding classrooms with nonenglish speaking students or streets are safer by refusing to report criminal illegal aliens, and have yet to explain how our hospitals are made accessible by packing emergency rooms with illegal aliens demanding care. instead, their solution is deport more foreign doctors to

exploit the foreign population. enough. as we will hear, there are thousands of u.s. citizens who have earned their medical degrees at enormous cost some carrying over $100,000 in debt to do so but cannot be placed in residency programs that make it possible for them to practice medicine. further more, foreign nationals are already admitted to practice medicine in in country through a large number of visa programs, 353,000 j-visas in 2019, how many physicians include you had, we don't know, they qualify for hb 1 visas, 183,000 issues in 2019, how many physicians, unknown. they fall fight for o-visas, 18,000 in 2019, how many physicians, again, don't know. yet, as we hear, the physician

shortage in the united states is largely of our making. we have the doctors, we just don't match them with the residency programs they need to enter practice. now, don't you think that just maybe, we ought to put american physicians first? don't you think just maybe, we should take control of our borders before we encourage more foreign nationals to cross it? don't you think, just maybe, we ought to enforce our immigration laws before our jails, our schools, our prisons and hospitals are completely overwhelmed? american people are awakening to the damage that's being done by the left's open border policies. proceedings today are another attempt by the left toward meaningless borders. american people know what that means to their families, their prosperity, their communities, their safety, their schools, and their healthcare. now, when we put americans first, we enjoy the lowest

unemployment rate in 50 years, lowest poverty rate in 60 years and fastest wage growth in 30 years, i believe people are going to want those days back very soon, including securing our borders and will have the chance to set things right very soon in about 266 days, i believe. i yield back. >> thank you for that mr. mcclintock, now recognize the chairman, from new york, mr. nadler for his opening statement. >> thank you, madam chair, our country has long relied on fine-educated physicians to supplement the domestic physician workforce. today's hearing invites us to explore the role that immigrant physicians play in the provision of healthcare in the united states, including essential services they provide to americans in rural and medically under-served areas. i also appreciate the opportunity to examine how our broken immigration system has made it difficult for such physicians to remain in our communities and continue to

provide critical care to those in need. today, approximately 200,000 foreign medical graduates work as physicians in the united states. immigrants account for more than 50% of physicians practicing geriatric medicine, approximately 40% of those practicing critical care and internal medicine and nearly 1/4 of those practicing general medicine. even before the covid-19 crisis, experts were projecting that our country would experience a significant shortage of physicians in the near future. due to the ageing population and other factors, american association of medical college estimated a shortage of nearly 140,000 physicians by 2023, covid-19 outbreak brought this problem into sharper focus. pandemic has taken an enormous mental and physical toll on physicians in the united states, exacerbating existing shortages and making these projections even more dire.

in response, throughout the country, including in my home state of new york, implemented emergency measures such as relaxing licensing requirements to increase the pool of available physicians yet many states still struggle to meet the demand for care. unfortunately, our outdated immigration system only adds to the problem. although foreign-educated physicians who come to the united states to complete medical training, their temporary visa options are limited. without a visa classification that is designed specifically for them, foreign physicians are forced to deal with the challenges of the flood system that was designed decades ago. after completing their training, if they want to stay here permanently and continue to treat patients in their communities, they must overcome additional obstacles, for example, the conrad 30 program intended to shorten the visa

application process only allows 30 such physicians in each state to benefit from this program. if a physician is fortunate enough to be allocated one of those visas, many must then wait for years and often decades for an immigrant visa to become available. over the years, various bills have been introduced that would improve the physician immigration system. some would exempt certain physicians from the numerical limits on immigrant visas, other ease the barriers while streamlining processing. we should explore these and other options. we have an obligation to ensure all americans have ready access to quality medical care today and in the future. to do that, must ensure immigration facilities, there are immigration assistance facilities, facilitates, rather than blocks the admission of stock from around the world. i want to thank chair loughgren for holding the hearing, i thank

today's witnesses for participating in the important discussion and i yield back the balance of my time. >> thank you, mr. nadler. it is now my pleasure to introduce our witnesses for today's hearing. david j.scorten is the president and ceo of the association for american medical colleges which is a nonprofit institution that represents the nation's medical schools, american medical schools, teaching hospitals and health systems in academic societies. prior to becoming president and ceo of the association for american medical colleges in 2019, dr. scorten served as 13th secretary of the smithsonian institution and president of two universities, cornell and university of iowa, received both his ba and md from

northwestern university. also welcome dr. kora, intereventually nephrologist at the bluff medical center following education at the armed forces medical college in puna, india, dr. kora came to the united states in 2003 to undergo graduate medical education and nephrology at pen state, center of medicine, the only nephrologist serving his community in missouri, served under the category of, quote, alien of extraordinary ability. despite the freedom of movement his green card afforded, dr. kora chosen to remain in paplor bluff in the under served area to treat his patients. we also welcome kristen harris,

principle of immigration law, ms. harris advises healthcare entities across the united states of immigration including sponsorship of physicians, researchers, allied healthcare professionals and technical professionals, as well as e-verify and i-9 compliance, additionally, ms. harris works with the american medical association, american association of medical colleges and educational commission for foreign medical graduates which is based in philadelphia on immigration physician issues. she received bachelors degree from meryl university and jd from michigan law school. also joined boy kevin lynn, co-founder of doctors without job and see professors for immigration reform, served a variety of roles in the private sector including director at ryan llc and senior manager at

earnston young, served in volunteer capacity at several organizations including respect farmland, democracy for america and 1992 ross perot campaign, was a captain in the united states army and received degree from cavner military college. we thank all our witnesses for participating in today's hearing. i'll begin by swearing in our witnesses, i ask that you make sure your audio is on and that we can see your face and raised right hand while we administer the oath. i think dr. cory, you need to unmute as well. great. thank you. do you each swear and affirm under penalty of perjury that the testimony you're about to give is true and correct to the best of your knowledge, information and belief, so help you god? >> i do.

>> thank you so much. let the record show that the witnesses answered in the affirmative. and please note that each of your written statements will be entered into the record in its entirety and ask everyone, witnesses and congresses to keep mute button on when not speaking so that we can try to minimize chaos. and witnesses, i'd ask that you summarize your testimony in five minutes then to help you keep track and stay within the time, there is a timer on your screen which you'll see. so dr. scorton, if you could lead us off, i'd appreciate it. >> thank you chairman adler, ranking member mcclintock and members of the subcommittee. immigration is the bedrock of the united states, it is because of our diversity of backgrounds, cultures and ideas that we thrive, not in spite of it.

i have been fortunate to work in government, education and healthcare and seen first hand the value immigrants bring to this country across the board even in my immigrant father's family-owned shoe store, approximately 23% of physicians practicing in the u.s. identify as foreign-born, these physicians help improve access to care, particularly for patients in rural and other underserved areas but many face significant challenges to enter and remain in the u.s. physician diversity has been widely recognized as key to excellence in medicine and quality care. physicians from other countries have a unique cultural perspective which can affect patients' health and healthcare experiences. the importance of physicians from other countries was seen acutely during the pandemic but was amplified each year as the result of growing nation-wide health work shortages. projects the overall physician shortage will grow to 124,000

physicians by 2034, simply put, we need more doctors from everywhere. medicine has responded by increasing enrollment by 35% over the last two decades, including opening 30 new medical schools and 6 more have applied to be considered for accreditation however increasing medical school enrollment without increases in graduation residency physicians has no effect on the size of the work force because medical residency is required for work placement. an approach that increases the residency physicians as well as improving immigration processs for physicians and teaching hospitals. residency program directors seek the best candidates, regardless of citizenship status or national origin, through a

highly competitive selection process. and, some students may be unable to find a residency physician in the u.s. last year, 55% of non-u.s. graduates of international medical school matched to a residency program. comparatively, 93% of u.s. seniors matched to a residency program and 99% entered residency or full time practice within six years. i can confidently say physicians from other countries are not displacing graduates of u.s. medical schools. for non-u.s. physicians who are fortunate to make it through rigorous medical education, examinations, screening and obtain a residency position, the three months between the match and program start dates is a critical immigration window. wamc humbly offers to work with the subcommittee on ways to ensure the physician immigration

process is predictable, speedy, efficient and better aligned with continued education, training and state licenseship, in addition, the wamc supports the conrad 30 program that has recruited 15,000 physicians to rural and under-served community over the last 15 years by waiving the j-1 visa home country return requirement. wamc endorses the bipartisan physician access, reauthorization act which among other improvements would allow the program to expand beyond 30 slots per state if certain nation-wide thresholds are met. we are glad congress recognized the vital role of national health service core by increasing funding and believe the number of conrad 30 waivers should likewise be increased the first time in two decades, also urge congress to pass a pathway to citizenship for individuals with daca status such as the

bipartisan dream act 2021 or the house act american dream and promise act of 2021, the 34,000 current healthcare providers with daca status encompass a diverse, multiethnic population who are often bilingual and more likely to practice in underserved communities. finally, the wamc supports reducing greencard back logs and prioritizing healthcare workers through the bipartisan healthcare with resilience act. thank you, again, for the opportunity to testify regarding the critical importance of physician immigration to the united states healthcare system. >> dr. kora you're up next, you have five minutes. >> chair nadler, ranking member, mcclintock, honorable members of the committee, thank you for the

opportunity to offer my perspective on an issue i understand firsthand as an immigrant physician serving in rural and underserved areas. the united states is in the midst of a healthcare workforce crisis. we are facing an ever-growing shortage of doctors exacerbated by the covid-19 pandemic. the reality is this healthcare worker shortage existed before the pandemic and will continue to harm communities, particularly rural, and under-served communities absent congressional action i came to the united states in 2001, completed my residency in internal medicine nephrology, on j-1 visa, then had to either return to india two years before applying for a new visa or apply for a conrad 30 program which raised the two year home residency requirement if i would

practice in a designated under-served area for a minimum of three years. upon arriving in missouri, i learned of patients traveling 18 miles to see the nearest nephrologist, in fact i was the only -- 24/7 for the past 11 years, to serve the community i now call home. despite the visa restrictions serving in southeast missouri for the last 11 years has been an incredibly fulfilling mission. i supported building a new dialysis unit in 2015 which now has about 90 patients receiving dialysis every other day, along with 18 staff members. currently, i'm the director of one in-patient and preout-patient dialysis unit across southeast missouri, i'm proud to support my patients, their family, staff, and local economy in southeast missouri.

but these visa restrictions have greatly impacted many physicians like me and the communities we serve. for many physicians, the requirement to residency will take decades limiting career mobility and jeopardizing the immigrant status of our children. doctors on the temporary hbb visa may only work for visa sponsors and are not allowed to start their own practices, work outside of specific practice area or even volunteer. these are not hidden from international physicians like me but inability to impact patients with sometimes life and death consequences. covid-19 pandemic complicated these issues when highly skilled physicians could not lend support to hospitals in need due to their visa restrictions. legislation to confront this challenge is pending before congress and could help save american lives. i would like to share how these

issues personally affected me, my family and my patients. the h 1 b visa mandates every physician to apply for a a renewal every three years leaving the country for a stamp on their pass port in order to freely move across the border. in 2019 i chose to go to canada as it was closer and would allow me to quickly return to patients who must have a superviezing physician on sight for care happen unfortunately, i was delayed due to administrative processing issue even though i had been in the country 16 years and pre-proved for the green card. to find a physician to cover for me when dealing with complicated immigration process took a toll on me and my family. uncertainty was so stressful and began applying for jobs in cab dau and received offers of employment but i did not want to leave my patients so reached out for help and was able to come

back to my patients in a timely fashion, given this overwhelming need, to take a look at bipartisan for those to serve in underserved areas, the conrad 30 which strengthened for internationals to practice residencies in underserved areas maximizing the return on investment congress makes in graduate medical education. this legislation would also provide greater clarity to physicians who fulfill their visa obligations, strengthening the incentives to serve in rural and underserved areas. in 2020, after applying for ev 1, extraordinary ability visa, i was fortunate enough to get my green card, and am grateful my family no longer has to deal with the uncertainty of my h 1 b status but many like me are not so lucky. thank you, again, for the opportunity to speak with you today. i look forward to answering your

questions. >> thank you, dr. kura. ms. harris, you're now recognized for five minutes. >> thank you, good afternoon chair laughgren ranking members of the subcommittee, thank you for the opportunity to speak with you today about the need for improvements to our nation's physician immigration system, my name is kristen harris and i am a immigration opportunity who has represented several hospitals, healthcare systems and foreign national physicians for 17 years. the opinion i am expressing today der iesk from years of practice. in no time, have americans been in need of high quality, u.s.-trained international physicians, kura's dedication to his patients shows how important it is to addressing our issues. unfortunately, current system is suboptimal at best in its ability to attract and retain the most talented physicians in the world to treat americans. we have outdated laws on our

books, that create barriers. today, i bring you concrete examples of missed opportunities caused by current immigration system. in each case, we have a willing employer, a u.s. trained physician and americans in need of a doctor. one, we happened to improve and expand the conrad 30 program, under this program, doctors in j status who would otherwise have to leave the u.s. at the end of their training can stay here if they treat patients in medically under served area. each state only allowed 30 waivers per year, last raised in 2002, it has brought thousands to communities but could do more if expanded and approved, placings like texas, pennsylvania, many more regularly max out of their 30 slots early in the year, for example, our firm represented a hospital in one of the poorest cities in massachusetts, sponsored indian-born u.s. trade physician for conrad waiver,

timely filed the application, physician was fully available but state maxed out and physician was not among the lucky 30 that year, by the time it was announced, he was out of options and moved to canada with his family to practice there. this happens time and again, by expanding the number of waivers available to each state, congress can solve this problem. two, we need to improve the j-waiver options for federal agencies such as for the va and hss for important programs like treating veteran and see medically underserved, statute provides for greater opportunities than administered at present, for example, my firm represents nephrology practices including one that continues to find u.s. trained physicians ready to treat dialysis patients but for their need for a j-waiver they haven't been a able to do that. any one such nephrologist can cover 13 practice sides throughout an area including dialysis clinic and rural areas

in indiana so under served the department of labor does not have sufficient wage data for doctors, unique visits can exceed 200 patients in a month with yet cannot apply to the hss program to keep these physicians in the u.s. because they receive subspecialty training, we need to change the h1b visa after training but there is a capper limit which can serve as a barrier to immigration physicians, for example, family owned medical practices in texas, for months searched for a u.s. trained licensed primary care physician to start patient care yesterday. they found the perfect candidate, bilingual and ready to relocate from peru to texas, however, before the doctor can start working here, must participate in the random h-cap lottery held in march. statistically, odds are against her getting selected at all.

even if approved, her visa won't allow her to start treating texans until october at the earliest, this is eight months of lost care and coverage, this must change, must exempt physicians to address immediate healthcare needs. fourth and finally, the green card system must be fixed to keep u.s.-trained doctors in the country out of permanent basis. doctors born in india can wait over a decade before even allowed to file the final step green card, even when services to medically under-served deemed in the national interest by iscis, this is wrong, these physicians fill an immediate need for american and see therefore should be allowed to file greencard immediately as with immediate relatives of u.s. citizens, healthcare access is is a bipartisan constitchent wnt issue that requires bipartisan solutions, the solutions presented today are well within congressional reach and our nation will benefit from congress working together to improve healthcare access for all americans by making it easier for us to retain our

u.s.-trained physician workforce. thank you again for the opportunity to testify, and thank you for your attention to this critical issue. >> thank you very much, mr. lynn, you are now recognized for five minutes happen >> okay i am coming through now? thank you, very much. chair woman, laughgren, ranking chair mcclintock thank you for the opportunity to discuss immigrant physicians in u.s. healthcare system, we are facing a doctor shortage however it is shortage of our own making. in recent years, thousands of american medical doctors denied the right to practice medicine, this is one of the most ignored situations by medical

professionals and medical community. leadership in america, including medical schools and the various governing bodies who represent physician in 2018, started the doctors without jobs, to represent doctors graduating from medical schools not matching to residency physicians each year while foreign trained were, creating more doctors to advocate for themselves and push back against educational profiteers. it is a process managed by the national residents matching program. please understand that without a medical residency, a doctor cannot practice medicine and the residency may require three to seven years to complete depending on the specialty. each year, over 7,000 u.s. citizens and lawful permanent

resident physicians which include seniors and graduates do not match a medical residency. all of whom are qualified, ready, and willing doctors who have been sidelined and are waiting to serve their communities now. a situation we work to draw attention to at the start of the pandemic so they might be deployed. our call went unanswer. there is much more to this story that should concern the subcommittee. in 2021, over 4,000 noncitizen foreign-trained physicians received residencies in the u.s., this is enormous increase from ten years prior where 700 received residencies inspect between 2011 and 2021, more than 40,000 non-u.s. citizen foreign trained physicians given u.s. tax-payer funded residencies, each residency cost tax payers 150,000 a year so we are subsidizing foreign doctors,

many foreign-trained physicians arrive in the u.s. for residency training via the j1 visa a cultural exchange visa, many arrive to work directly in hospitals. in 2020, over 3,500 labor condition applications were filed for 4,052 workers, over 5,000 applications to extend from prior years were also approved. every country prioritizes its citizens, canada, the last hold out changed its policy to prioritize canadian citizens and permanent resident as couple years ago. failure to prioritize americans is emblematic, instead of making necessary adjustments to broaden

education and improve healthcare delivery infrastructure. this doesn't just cause problems here at home. at 2020, migration policy institution article titled global demand for medical professionals drives indians abroad despite acute domestic healthcare worker shortages describes the brain drain and harm it does to india's healthcare system. same can be said for countries in subsaharan africa where health professionals are drawn from u.s. and canada. the existential benefit to the united states, believed to be around 8 frieks million dollars. the sending countries lose about $2.1 billion from the investments made in their doctors who leave. according to survey data, in 2020, roughly 70% of doctors in the u.s. were born here, about

20% were naturalized and some seven% noncitizens. these percentages have remained consistent over the past 10-years. every area of american endeavor has been impacted by relentless importation of foreign workers. starting with lower paying work, seasonal hospitality workers and manufacturing, to technology workers and now to doctors who have spent at least eight years and hundreds of thousands of dollars to practice the healing arts of very specialized profession, only to be sidelined and saddled with debt they are unlikely to pay off if they can't practice medicine. the demand and enthusiasm to enter the medical profession is there, applications to medical schools are at all all-time high as are enrollments in the nation's nursing programs. we have thousands of physicians in line waiting for residency training, we need more residency positions, and we must prioritize u.s. citizens and

lawful permanent residents. thank you for your time. >> thank you, mr. lynn, thank you all for your testimony, we'll now proceed under the five minute rule with questions and i'll begin by recognizing myself. dr. scorton let me start with you. as you described in your testimony, the aamc has done a great deal of research on the physician shortage. according to that research, what are the main drivers of physician shortage in the united states? >> thank you chair, there is really five factors. the first one is the happy fact that our country has grown. the second is the fact that our country is aged and with age, as mechbed in opening remarks from members of the subcommittee, will come the necessity of greater need for healthcare. thirdly, the healthcare workforce is ageing, i'm an example of that and proudly in the over 65 crowd, and at a

certain point, like every other kind of worker, the medical worker in the over 65 will decide to retire and because of the big hump of humanity in the boomers, we're seeing more retirement. the fourth, as i mentioned in opening remarks and i'll reiterate very briefly, just the fact that we've increased the number of first year medical students by over 1/3 is not enough to make a difference. because of a need for graduate medical education slots and we're still not getting the job done, something about which we all, i believe, agree, and then finally, a special, more recent phenomenon and that is the stress of covid-19 on the country, of course, has been dramatic and terrible. had has also been dramatic and terrible on the hrk workforce. we have lost people to covid. we have lost people to behavioral health problems, even suicide related to the stresses of covid, as best exemplified by

dr. warner green as presbytarian allen hospital, some led to retire earlier than planned or if not retire, perhaps reduce their hours so those five factors the ones we believe are leading to this continuing shortage and let me take a quick prerogative since i have the floor to say that we need doctors in all disciplines, certainly primary care, certainly behavioral health, but also every specialty that you can imagine, we need them in urban areas, we need them in rural areas, we need them in well-served areas and under-served areas. thank you. >> thank you, dr. scorton. dr. kura, we appreciate the excellence and dedication you and your non-usa born colleagues bring with attendance at u.s. medical colleges and institutions and your treatment of folks in our communities.

you noted in your testimony that you're the only nephrologist in the area you served. has your employer attempted to recruit other nephrologists to the area and if so, why weren't the efforts successful? >> thank you, congresswoman scalin, yes, when i first came to the proper bluff in 2010, i never thought i would be staying here more than three years. once i start hearing stories from the patients, the amount of stress they have to go through, you know, that made me decide that i have to take -- restart my nearest, i said i want to build a dialysis unit for the people because they are not able to get adequate footing here so that helped me start a new dialysis unit and was done by 2015. and dialysis unit at that point had only about 15 to 20

patients. now i have 90 patients. and the volume is increasing. yes, we do need more nephrologists, we have advisement out there for the past ten years to get, to hire nephrologists and i need partners, i mean i partners. i cannot work like this the next 10 years. i was 35 when i started. i'm 46 now. there was always shortage of physicians and staff here. people do not want to come here due to geographical location. there is not a lot to offer other than health care here. and people want to fly out .. the best thing -- first thing they say is how far is st. louis from here? it's about 2.5 hours. that deters them from coming to rural areas as such. and i want to grow this place. i want to help people here. i'll establish my roots. i'll established recommendations

with my patients. they know my family. but unfortunately i'm not able to get help. we need some kind of legislative act to get more help. thank you. >> thank you, ms. harris can be, can you briefly add what would be the number one thing you think congress should do to help ease this issue? i know your extended testimony in the record. >> okay. thank you. i think one of the biggest fixes honestly would be to exempt physicians. there are a number of ways to do this from the per country limits. that would be huge. >> i see my time has expired. and i believe mr. mcclintock -- representative mcclintock, you're recognized for five minutes. >> thank you, very much. mr. lynn do you have do we have data how many american health care workers have been fired from jobs because they declined mandated vaccination sns i see a number reported as over 10,000. >> mr. ling, you're muted.

>> oh, thank you ranking member mcclintock. i have not been studying data on fired physician but i know anecdotally speaking in california where i lived for 20 years and here in pen enwhere i have relatives in new york, i have for me family members in the health care industry. and they're being literally threatened with either take the job or -- >> 10,000 prior i say prior because their own medical judgment they should not be taking the vaccine. that's a significant number. now we're told the growing population needs more doctors that makes sense as far as those. but much of the population growth has been because of unprecedented increase in foernl nationals entering the country illegal and illegally seems this is a feedback loop with more foreign doctorsen and more foreign doctorings we need to

import. this a sustainable strategy >> the strategy is unsustainable because ultimately you cannot have infinity growth on a planet with finite resources roughly 80% of all population growth in the united states is attributable to immigrants and the children of immigrants. i myself am the child of an immigrant. so we have to understand that there is a push factor as well as a pull factor in this. and, yes, a rising population is certainly a factor. we have also been seeing a move to states -- such as the carolinas, southwest, states like georgia, populations over the past three decades. and because we froze the number of residencies in 1997 we have not been able to, one, build teaching -- or respond medical education programs in these areas. and expand teaching hospitals in these areas.

>> we made it more difficult for us to produce doctors among americans, correct. >> absolutely. that is absolutely the case and the costs are so prohibitive as well. gu gu dpoot despite that there is huge demand. >> can you share with us a couple of stories of medical school graduates and doctors without jobs have been have not been able to get jobs as physicians in the u.s.? >> the the cofunder of doctors without jobs. dr. doug medina was never able to match. i know of at least several that i can tell you point blanc where some have -- we talk about suicide. well, i mean, imagine you're strled with over $400,000 in debt. and you're not -- your income is -- you're getting income from uber as well as working a job that might be paying $15 an thundershower working on a dock which is what i know is doing that. and you have over 400,000 in

student loans and the str aaccumulates. >> that's physicians searching the medical degree. it's not a question of competence. >> absolutely. all of them received a medical degree here in the united states or in a foreign degree program. >> has the rate of unmatched physicians increased or decreased these years. >> it actually increased. last year it was 1431 u.s.-trained physicians. and total it was over 7,000. we actually saw an increase in the unmatched numbers from u.s. medical schools and a small decrease in u.s. citizens lawful permanent residents who studied abroad. so. >> let's be clear on this point. if you're not matched -- if you received juror -- you are a

mcclelland doctor you can't match with a residency abram you can't practice smelled am i right. >> that's absolutely correct. >> and that is a situation that is affecting over 10,000 u.s. doctors at this moment? >> absolutely. and all of them could have been deployed during covid. there were opportunities to do that, particularly july 1st 2020 when they needed at the residency positions. >> we refused to match over 10,000 americans who have their medical -- their medical deer doctors. we fired 10,000 health care workers because in their professional compelled judgment they should not be receiving a vaccine. that's 20,000 right there. yet we're told the only answer import more foreign nationals. does that pretty much sum up this hearing so far. >> it does sum it up. there is just that bias to not

really address the infrastructure problems, the hard problems that require investment in americans and american institutions. and as always, the pan sea is to import foreign works whether. >> the gentleman's time has expired. with that i would recognize mr. nadler for five minutes. >> thank you, adam chair. dr. courten aamc has conducted a great deal of research on the provision of health care in the united states. can you discuss living in a medically underserved area impacts a person's health and does this include a decrease in the likelihood that they'll seek out seek out regular medical checkups. >> thank you, chairman nadler, it's a very, very important question. i'm glad to have a chance to answer it pl there is two big issues here. in any underserved area, whether it's in an urban area, rural area, any underserved area, people by definition will not have access. either to preventative services,

for example like cancer screening, or to therapeutic services. and non-communicable chronic diseases like the type dr. occura deals with, kidney failure, hypertension walks diabetes, heart disease, niece are things requiring ongoing medical care as well as cancer screening. and of the big concerns we have mr. chairman in terms of covid is people stepping away from segreto getting cancer screenings during covid. in addition to those things that i mentioned, behavioral health services are at a premium. and we need that very, very much in our country for a wide variety of reasons, including the epidemic of substance use disorders. that's one set of things. the other set, which is huge somebody is in addition to these health care medical-related items there are the so-called social determineants of health. and it turns out the things that the things affecting our health most strongly are the social

determineants of health, the ability to live in an area where we have clean air, clean water, safe streets and so on are very, very important. and the precursors to social determineants of health, racism and poverty have enormous effect on people in and frequently in underserved areas. there are the medical issues and then there are the social determineants of health. and both contribute to questions problem. thank you, sir. >> dr. occura since receiving a green card you and your wife can live and work anywhere in the united states. why have you chosen to remain in poplar bluff newman. >> as mentioned i have come here about 10 years ago. as time went on and i had my children and my wife is a physician too, working in about

30 miles from here in a place. i built a dialysis, seeing the need -- there are patients needing more room. there is growing population. there is aging population. i started, you know, working more. and with -- i had restrictions to do what i could being on a visa i could -- i couldn't get a lone from the bank. i built the dialysis unit, now about 18 staff members. and this unit has grown. now i'm the director. and i consider this as my home now. i have been in india for about 25 years and the united states almost 20 years. this i consider as my home. and this place called poplar bluff is where i grew. i have my roots. my patients know my children. and it's difficult for me to just pack my bags and go detach

from patients who who look upon me as family. i cannot just leave this place. i have to -- i have to proceed with what i have at this moment. >> miss harris, we heard from dr. occur about some of the challenges he faced from the difficulties he experienced of obtainings his visa to logistical challenges once in the united states and the green card backlog. would you say this is a chon experience for physicians to the united states especially from india >> yes, unfortunately i can say he actually exemplar fis the problems we see again and again. if i could take a quick moment to say in what ways. one is the way he went straight from graduate medical training to a medically underserved area and stayed there. but two the fact that even though he started there over ten years ago and even though he filed what's called a physician national interest petition, even

though working five years in an underserved area he didn't get to file the last green card step until he approved he had extraordinary ability in the ev 1 category. this is a real example of our system being broken and not showing the benefits and appreciation and incentives to somebody who might not have dr. occura altruism to stay in that area. it's a an kparm of how broken the green card system is. one other area that's sad appear often happens to physicians and patients. when they go to get a visa abroad they are planning on coming back. their patients plan on them coming back on time. with a mere week or two or several months to a consulate why might not seen huge from their perspective when it comes to their f1s and medically underserved patients it's really really significant when they get held up abroad at the consulate. >> thank you, my time is expired. i yield back.

>> thank you very much. i see that mr. buck isn't with us right now. so i recognize representative biggs for five minutes. >> thank you, chair. this is the fifth hearing that the immigration committee -- this subcommittee held this congress. none of the hearings have focused on the biden border crisis. none of them of the majorities even mentioned the border crisis which means that the context of this hearing is out of whack a little bit. based on the materials prepared appear circulated by the majority you wouldn't know there is a border crisis. perhaps there is -- you're in denial. maybe you're in defile that we're experiencing the worst border criesness our hertz. maybe you're in denial that the policies complemented by president biden and secretary may oerksz a making the crisis worth and plab you hope if you don't ac floj the crisis the american people will not realize how big a crisis we have on the southern border. if that's the plan i don't think it there work. since president biden took

office. cpb encountered morp 2hill plel aliens' border doesn't include the got aways. during that time dhs released hundreds of thousands of loels in our communities. by some estimates over 800,000. you'llo all in violation of the law. during that thyme secretary may oerkz has abused the limited authority that congress has given him to parole aliens in the country by pa roehlinging at least 70,000 into the country. that's not normal. and i expect esuspect the actually number is higher. additionally we know that cpb enter dikts only a smaum amount of the drugs crossing the berd. the estimate i was old told by cpb individuals just two weeks ago was that maybe 5% to 10%. and that includes fentanyl according to cdc data killed americans age 18 to 45 than covid in the last two years. and that -- what is the majority focused on today? not the biden border cries he is and not markus's frl.

he won't be called before this committee which has jurisdiction. once qin i call upon the committee chair to request at full hearing with senator secretary mayorkas so we could conduct oversight. dpagts are here arguing we need import more foreign doctors but have not heard one criticize the vaccine mandate which forced hospitals to fire doctors. in her opening statement, the representative scanlan mentioned many numbers and causes and many reasons why doctors ino and health care providers are leaching the field in droves. and that we don't have enough doctors. but she left out one reason. and i'll only mention one today. for more than a year doctors nurses and other health care professionals were on the forefront, the front lines of providing care during the covid outbreak. many of them -- include many

folks include some on the subcommittee praised them as heroes. while we face the shortage in the medical field highlighted by the chair and others on the subcommittee, some of these same supporters changed course and demanded that tens of thousands of these heroes who chose not to be vaxxed be terminated from jobs. that doesn't make sense to me. president bide. effectively fired all of the unvaccinated health care workers in america. so here the way to think of it. there is one article talking about more than 30,000 health care workers out of jobs in new york alone because of vax mandates. and at the same time what adds to the strangeness of all of it is that you have doctors being fired for not receiving covid-19 vaccine but hospitals allowing covid-19 positive health care workers to continue working. if we need more doctors then logical first step would be not to fire the doctors we have unless they are incompetent. mr. lynn thanks for being here

today. there's been a system at you can every by some to replace american workers with foreign workers thanks for your work you shed light on this area. >> thank you. >> is there a reason -- sfl reason that foreign born physicians are getting taxpayer positions over foreigno american doctors. >> i'm gob smacked by it. prior to 1980 there was a situation existing where weren't filling the residency available. you could see where at that point there would be some -- a mechanism to fill that with foreign-trained physicians. and we did. that is not the case today. as i testified there are thousands of doctors every year who are u.s. citizens or lawful permanent residents that are not getting residency positions. they've -- they've gone through

eight years of education. it's not like when you're an attorney you're told that well you have to pass the bar in a specific state. i mean, i don't think anyone told them that, wow, your chances of becoming a doctor after you've graduated as a doctor were 50/50, or, you know, one in 10. injury that -- i think that would be a little more fair if they would begin on informing them of the current-day risk. but no i don't see a need at this point to continue on with the number of foreign-trained physicians. we have the doctors here in the u.s. >> mr. lynn, my time is expired. adam kmar i have two articles lied tokyo like to submit to the record. one entitled termination of unvaccinated he health care back fires as biden pledges help amid covid surge. another entitled health officials let covid reflectived staff stay on the job. i'll provide those copies to the committee. >> without objection, thank you.

>> thank you. next i'm sorry. i -- i would recognize representative jayapal for five minutes. >> thank you, adam kmar. the pandemic has taken a tremendous toll on our braver health care workers as countries around the world compete for compelled talent the united states is at a distrang advantages. currently there are more than 1 million individuals stuck in the employment based visa backlog about 16,000 of the people are physicians. these backlogs make it incredibly difficult to attract qualified health care workers to work here. recent my home state of washington passed a law allowing internationally trained medical graduates the chance to obtain renewable two-year medical licenses to work as doctors. this is an important step. but congress also has to take action to allow immigrants medical professionals the chance to work in preusse chosen fields and serve our country in this difficult time.

dr. occura your story resonated strongly with me. i think i may be the only member of the judiciary immigration subcommittee to be on an h 1 b to have been on h 1 b visa. took me 17 years of alphabet soup to get my citizenship. i'm grateful for your service as a physician in our country. in your testimony you talk about the difficulties you faced, uncertainty of immigration status, the harassment when coming back flew the united states and more. you already have var nanoseconding job as the only nephrologist serve your area for many years. and ends it took you almost 20 years just to get your green card. briefly, can you tell me how receiving your green card changed life for you and your family and did it open up new opportunities for you to have that green card? >> well, the green card is new to me. after longing -- or 11 years of

hardship and nine years of residency fellowship prior to that, a total of about 20 years, i could finally get if in 2020. so it's relatively new. prior to obtaining green card i could do only so much. i tried to work in a place filed fikston, establish my myself in rural areas other than poplar bruv. i got a letter from uscis i have to hoe how many hourls who hours i would be spending at which what time i use in which area. which icu, which hospital. i cannot answer that question. no doctor is -- it's impossible for any physician to tell which er he is going to be -- which patient is going to appear in which icu, where do i have to perform -- get dialysis or generally take care of the patient. i withdrew fry application for my extension of h 1 b or it's

called a jump h 1 b. and the end point is not me. the end point is the health care getting affected because there is nobody else to take care of those patients and half those have to ship them two hours to st. louis or memphis. such is the condition of current status. after getting my green card i could establish myself. i do not have to prove to sponsors that i'm going there or to a different place to work. i can just apply for my credentials. and once i have credential i can work in the hospitals, take care of all the patients. >> and one of the first thing you did was to sta are the building an urgent care facility, right. >> correct. "i" -- in my hometown we are seeing 130 to 2:50 patients from 5:00 a.m. to 9:00 a.m. we are going to start digging next month. and this is going to cost me

quite a bit. but i'm willing to do that because this place needs it. and the only which i can do this is by the ability to have the green card. if i was on h 1 b i don't think i would be able to do this. >> dr. occura, if you could choose over again. knowing what you know now would you come to the united states or would you go somewhere else more welcoming and -- allowing of immigrant doctors? >> okay. that's a difficult question to answer, because to every person when -- at the age of 25 or 24 when he looks at the united states it's the dream place, the land of opportunity. it's the place where i can shine because i'm talented. and i closely relate myself to the i.t. professionals who have come here and now all the ceos of big companies. i'm pretty sure united states is proud of them. and likewise i'm in the medical

field. unfortunately they could get their green cards early and be where they are they are but i could not get nigh green card until about two years ago. looking back at everything if i had a crystal ball and if i could see myself today talking to you all, i would not probably have coasten the united states. now i probably would have gone to canada to prove my metal prove my worth and probably been in a better spot. however, after establishing myself putting my time and effort and energy into this place for such a long time, i cannot detach myself. i'm going to rise. i'm going to go stronger at this point. >> we are so grateful to you. and adam chair my time is expired. i want to point out it can take up to 195 years for those just entering the green card waiting line to receive permanent residency. with that i yield back. >> thank you. and with that we recognize representative buck for five minutes. >> thank you, adam chair.

dr. skorken, i wanted to visit with you you mentioned in your testimony five factors that really caused or caused in part the issues that we have with the the doctor shortage in the country. and i think that you really perhaps because of a liberal bias perhaps because of other factors you really understated some of the other issues that exist. my friend and colleague from california mr. mcclintock has pointed out the vax mandate and the serious consequences to our health care system as a result of that. and my friend from arizona mr. biggs has talked about the crisis at the border. and we not only have people coming into this country that have diseases that stress our health care system -- and frankly cause illness and injury to our border security patrol

officers, but we also have illegal drugs coming into this country across our southern border that stresses our health care system. fennel has been a scourge in this country. heroin has been a scourge in this country. neither of them are produced in this country. they are both imported illegal mostly across the southern border. and we also have an overwhelmed immigration system that can't handle the kinds of thapgs that we're talking about, much less putting on another burden, another stress with the the necessity of looking at applications from doctors overseas. so i think you really should acknowledge that the -- there are more than 5 factors that cause the problem that we're dealing with. it's not just an aging population. it's not just a growing population. it is really a -- a series of very poor policy decisions that have been made by the biden

administration, in particular that have caused additional stress to our system. but i have a question for you, dr. skorken. imwondering, what percentage of doctors that come into this country and -- or medical students that come in this country on a owe and who receive a taxpayer subsidized, not completery paid for necessarily but taxpayer subsidized education and then go to work in areas that are hard to recruit doctors for either rural areas or some the of the more dangerous urban areas? how many of those doctors stay five years, ten years and continue to practice in those areas? >> thank you very much for your question, representative buck. i don't have the answer to that. and i will get back to you very quickly for the record within a couple of days at the most so i

can answer that question. and since i've garnered the floor i just wanted to say two other things very quickly. i think that the -- the committee -- subcommittee deserves to have some reconciliation between the numbers i'm giving you and the numbers that mr. lynn is giving you. and i want to make this offer to mr. lynn. we are both children of immigrants. i would like to make the offer to work with subcommittee staff and mr. lynn so we can reconcile very different numbers that you're hearing so that we can give you something that you can hang your hat on. and the other thing i must say is that i take extreme umbrage where mr. lynn characterizing the graduate medically education system as profitering. it's a. >> mr. skoken you made 34 billion. >> look, my time. you're both wrong. i don't give up the floor so you guys can argue. you can do that on your own

time. mr. dr. skorken, another question, would you find the number 50% -- that 50% of the taxpayer subsidized students, medical students in this country get their taxpayer subsidized education and leave the country to go back to their country of origin -- in other words wsh americans are paying for doctors in other countries to get their medical education and -- and work in those other countries? would that number surprise you? >> well, i can't tell you whether it would surprise me or not i've never looked at that number. i'd have to know representative buck whether they left because they were unable to get permanent residence in the country or what the reason was. i'm very glad to look into that as i told you. and i promise you i will get back to the committee quickly for the record. >> okay. and i thank you for getting back to me on that issue. i do have to say that i am really distressed that the

committee -- it this subcommittee has not addressed some of the underlying causes and just automatically defaults to asset position of bringing in foreign nationals to deal with our medical shortages in this country. i think we've got to look at a much more encompassing and holistic pretty much. wiltzius i yield back, madam chair. >> representative correa is recognized for five moonts sfl thank you madam clair. first of all i want to thank the witnesses for joining us here today. it's a very important issue we have to address which is really the health care of our society today as we age, as we grow in population. i agree with some of my colleagues. we have to look at all options, including adding more slots to educate doctors here in america, not only doctors but nurses. we've been importing nurses from

all over the world for decades. my wife right now my spouse is a obgyn as kaiser. i can tell you right now he is going through burnout. she is working way too many hours. and when they call her in because another one of her colleagues can't come in she just will not say no. she goes in and it's tough time. but thank you, the witnesses. i have a couple of quick questions for doctor skorken, first of all. confirm, you said 23% are physicians in the united states are foreign-born. stharkt. >> yes that's right. >> did we have a dr. shortage before covid-19. >> yes we had a doctor shortage for a long time especially in primary care behavioral health but across all specialties yes. >> and behavioral health is at issue of substance abuse, fentanyl abuse, drug abuse,

mental -- that's what we're talking about, correct. >> yes, sir. including substance abuse and mental health in general. >> dr. skorken quickly with you mentioned 30,000 daca health providers are you saying we have 30,000 health providers under the daca program where they could be deported at any time should the daca program be terminated. >> i think the specifics would be that they would lose work authorization, representative. >> okay. >> but 34,000 is the number. and they sure could use that if daca were rescinded >> and they are productive members of our society, paying taxes, saving lives as my colleagues mentioned front line work he is. >> you bet. >> dr. lynn -- excuse me mr. lynn talked about residentsy mismatch that brings back nightmares when my wife and i got married at a lining "time." we were hoping he she would match somewhere in l.a. not

chicago. >> thank good she matched. stayed here and got married and the story is a happy one ever after. but dr. lynn -- i'm going to ask dr. skorken >> i want to find out what is this thing about a mismatch about sidelined educated american doctors? dr. skorken i'm give you the opportunity to that quickly. >> the own answer that i can give without checking the numbers with mr. lynn as i've offered to do is to tell you that we depend on the residency training directors to do a very careful job of is choosing the people who are most likely to benefit from residency training. and as i mentioned at the beginning, within six years of that -- of that finishing medical school, 99% are practicing or? residency slots. and we believe thats important to allow the residency directors to do what they are doing. it's also important for me to mention, representative, that we're very concerned about

students who do not match at the aamc, very concerned as are those at the medical schools. and they will work with those who didn't match to look at the reasons. perhaps they matched only against a very, very competitive specialty. perhaps they didn't apply to enough programs. braps there was something in the application that could be better. and the medical schools are devoted to trying to help them perhaps dr. occura or others know about that particular status. and sewo so we're also very, very concerned about it zbrir dr. skoerken i'd love to take you up on your offer to help us reconcile some of the numbers for this subcommittee. because this is important for us as policy makers. you mentioned increase in freshman slots at medical schools, 33%. is that correct? >> 35%. some of it because of enlarging and 30 new medical schools and six more on deck waiting for accreditation. >> and i say this to you because it's very expensive to educate a

doctor. and to hear that there is no match here that doctors are sidelined, there is something here that's wrong. love to work with you, trying to figure this one out. but at the end of the day, 35% increase in freshman, i would imagine that's still not going to address the dr. shortage moving forward. >> one thing, representative, is that we can increase the number of doctors in compelled schools even more. but if we don't open up that blockage at the graduate compelled education level, we will not have more doctors taking care of patients. and so it's been a great thrill to see the two decade-long freeze lifted just in the last year, year and a half. and we're very much hoping that congress in its wisdom will increase funding for medicare funded gme slots, not for the doctors but for the patients of america we hope that that will happen. >> madam chair i'm out of time.

i yield. thank you. >> thank you very much. representative tiffany, you're recognized for five months. >> thank very much madam chair. dr. occur aivr it was implied earlier in question that you were not welcomed to america about did the people of poplar bluff not welcome you? >> no, it's never been that way. people of poplar bluff love me and continue to love me. and i will -- i know they will love me in future also. it is the way the system works. i never implied that people do not like me. >> okay. >> i'll just expand on that a little bit. when i was trying to come into united states across a port i was questioned as to what the full form of i was questioned if i have a green card and how many years i would stay in this country. i applied for a green card but did not get it was this did not deter me from coming into the

country. >> thank you for the work you do. kevin lynn, in earlier questioning you mentioned residencies were frozen was why read a frozen? >> i wish i had an answer. they were frozen in 1997 and that demonstrates -- >> with the impact of that? >> the number of residency opportunities based on the number of graduates from medical school is not being able to pair up. that's why we are seeing sidelined physicians. i'm happy to submit for the record how i came up with my numbers. when we did a deep dive into this in 2020 i did the unmatched without interviews which is often not reported and that is how we came up with our numbers. >> i hope you share that.

i remember when i sat on the joint finance committee we saw restructurings were barriers to entry and we created more residency including in rural parts of the state and those have been filled and there are ways to deal with this. it is important as policymakers we create ways of doing it at the state level. i have to comment, what is happening with the vaccine mandates, i have seen it both ways which i represent a largely rural area in northern wisconsin and have friends who lost their primary position as a result of the vaccine mandate. when you think of the mayo clinic which is in a region they lost 700 employees, and

all doctors, as a result of vaccine mandates. when you see things like that that are happening the american public is going to be skeptical about claiming poverty that we can't get enough positions in america when we are driving them out with vaccine mandates. we heard about bringing all these people in, bringing doctors in from africa, india and places like that and we are hearing about equity. are we doing the right thing as americans, taking doctors from poor countries? i pose that is a rhetorical question, should we be doing that if we are going to just benefit the united states of america at the detriment of poorer countries, those

standing on the equity ground, how do you support that, just a rhetorical question. i would close by saying this. why is secretary mallorca's not here? the preeminent issue, one of the top 3 issues if not the most important issue facing america is a borderless southern border and yet we have not seen secretary mallorca is here. the cynic in me asked the question to you want to bring in more doctors because we have more fentanyl and methamphetamine overdoses than we have ever seen, is that why we need to import doctors? is it because of the increased crime including sanctuary cities, the democrat run cities that have been setting records for murder rates in america, is that why we have to import doctors orders at the human trafficking? when we see -- i've been to the border three, four times in the

last two years, been to panama and the number of women that are sexually assaulted are incredible. i say to the advocates for immigration that sit on this panel america has deep concerns about what is going on, some of this better get fixed otherwise you are not going to get what you're asking for because americans want the border controlled and it is not now. when -- >> the gentleman's time is expired. >> representative garcia is recognized for 5 minutes. >> thank you to all the witnesses for your patience, it is an interesting topic. adding so much more in highlight, the many contributions immigrants have made and will continue to make in the united states of

america, they have to face a shortage of health professionals in this country, at the very least unfortunate and shameful especially during this pandemic period. in my district studies indicate houston has one of the lowest rates of healthcare workers among us and metro areas. the houston metro area has 3.5 healthcare workers for every 100 residents facing houston at number 10 on the list of major metro areas with the lowest share of healthcare workers per capita including doctors, nurses, and therapists and i can attest to this shortage because i can tell you in my district alone, we have one small community hospital. we are essentially a doctor desert. but for the work of the health clinics provided by the county and the city we would not have healthcare in my district.

as members of congress we have a duty to develop a robust and comprehensive health care system to meet the needs of all americans especially are most vulnerable communities lose thousands of healthcare professionals are ready, willing and able to provide essential services across america so we need to do everything possible to keep those scores open. i want to reconcile those numbers. it doesn't seem to me that easy, maybe 10,000 doctors were fired because they didn't want to get a vaccine, that would be enough for a shortage. it is not that simple, is it? >> i think a general statement

i could make is we need more doctors, more american doctors, more doctors from overseas, more doctors in this country. as has been said by several witnesses we need more residency slots, more graduate medical education was we need to put our shoulder to the wheel and make sure this happens. the reason it is important is we need to be there for districts like yours and throughout the country. >> the residency thing has caught my ear. this match question. i am a pediatrician which i remember when she -- went on to be a residency. who decides the number of residencies and what other factors? surely they don't sit there and go here is the pile of foreign trained doctors, they don't pick and choose that way?

do they choose objective criteria? >> they sure do use objective criteria and those criteria include a panoply of things, scores on tests, how the person has done in medical school, the recommendations they get, certain specialties are extraordinarily competitive. others are less competitive. it's a wide variety. i get the tip of the hat to those who run the residency training programs, it is a difficult job to do, negative cost center. if we were making money every hospital would want to have teaching facilities but it is not the case. only a minority of hospitals do this because it is complicated, costly, and draining to the

system. it is based on a variety of criteria and although nothing is perfect i have great confidence in the overall system and yet it is important we figure out what we can do to help those who do not match to go forward. this is a high priority for the medical schools themselves. >> we are focused on immigrants in america. do you know how many of those have come to america through the southern border? >> do you mean without authorization? >> i just me coming through the southern border? immigration justice to decide if it is authorized or not. >> very briefly, nearly all foreign born physicians in the

united states, doing credit medical education are doing so through a visa, by the us government. the very minor exception would be what we call daca. some may have matched but that would be only subcategory the would not have been vetted by the us government before they arrive. >> adding to the supposed crisis at the southern border? >> not at all. >> representative jackson-lee recognized for five minutes.

representative jackson-lee, recognized for five minutes. there we go. >> thank you very much for this hearing and thank you to the witnesses. i am going to focus a lot of my questions on your testimony and thank you again for leading the nation's doctors. living as well in houston and interacting with texas medical center the public health system, portions of which are in my congressional district and spending a lot of time on the journey we took within the pandemic. i'm sure you are aware of doctor peter cortez and the work he has been doing and i've worked with him extensively throughout a number of infectious disease, ebola etc.

that doctors, researchers are crucial. there are individuals in the texas medical center that are still attempting to get citizenship, either permanent residents or have physicians status and are not at that point. it does cause of depression if you will in the level of research and amount of expertise we have which i happen to be one that believes we can answer the points the are made by a minority witness which i happen to believe we can walk and chew gum at the same time and there's no doubt medicine is international. you may actually want the expertise of international research to provide americans with the best medical care they

can but i think the brain drain of training foreign doctors and losing them is also consuming. we must find like we have 2 regularize immigration we must find a crucial way to address that so hopefully i have laid the groundwork for a number of questions. one, my empathy for individuals who have gone into social media and not gotten vaccinated in the medical arena is limited at best. i want to make sure you give your best answer how we address the question from the american medical association's perspective on dealing with foreign doctors, the exact point that you like and answer the question about homegrown doctors particularly the african american community and the low number of doctors and how we cannot be attacked by supporting the reality of the

importance of doctors of immigrants who push this idea of ensuring depressed areas without african-american doctors that we can do that as well. that's why i focus on you at this time. >> very important questions. i will try to be brief. my colleagues at the association of american medical colleges would want me to say we over present ama at the association of american medical colleges and that is medical schools teaching hospitals and academic societies. >> thank you for clarifying that >> thank you for allowing me to. our failure especially to get african-american men in medicine is one of the failures of my generation of leadership. i started my first equity position in 1979-80. until last year we didn't

change the proportion of black men in medical schools by even 0.4% so we have a lot of work to do, we are beginning to see some light at the end of the tunnel. as was mentioned, applications to medical schools are very high and last year we saw not only a great increase in applicants from the african-american and hispanic community that increases in medicaments from both of those communities. let me say however that in native american and alaskan native communities, always seen an increase in applicants, we saw a decrease in medicaments. secondly i would say there are some other good ideas especially thinking about the pathways to a medical career and i personally having been in higher education for a long time think we need to start earlier in the educational pathway, perhaps as early as middle school in helping people dream the dream of a life in

science and medicine that i wouldn't want to yield the floor without mentioning in every field of medical medicine -- >> can you quickly answer the question about what we need for the doctors who are immigrants? i ask that as well. >> there are a few things, you can get the most authoritative advice from kristin harris, lucky to have her as a witness but if we could have a pathway to citizenship through daca and the conrad 30 program to increase the number of slots in that program that would be a pretty good start. in my longer submitted testimony there are a few other areas we think would also be helpful. >> the chairwoman's time is expired. you are recognized to close us out.