April 21, 2017—(BRONX, NY)—A research letter authored by fourth-year Einstein medical student Peter Kahn, M.P.H., Th.M., investigates which U.S. hospitals hire physicians using the H-1B visa program, which allows employers to temporarily hire highly-skilled foreign workers. The authors found that hospitals in just a handful of states accounted for most of the H-1B applications. The letter was published in the Journal of the American Medical Association (JAMA) on Monday, April 16.

Peter Kahn, M.P.H., Th.M.Mr. Kahn and co-author Tova Gardin, M.P.P., at Harvard Medical School, analyzed 2016 data from the U.S. Department of Labor’s Office of Foreign Labor Certification. In that year, a total of 2,156 sponsoring employers submitted 10,491 physician H-1B applications. (The authors lacked visa approval data but note that approximately 80 percent of H-1B applications are ultimately approved.)

Although individual employers—in this case, hospitals and physician groups—must submit the applications, certain states rely on the H-1B program far more than others to staff their physician workforce. Just five states accounted for more than 40 percent of total applications. New York State led with 1,467 applications, or 14 percent of the total. Next came Michigan with 945 applications (nine percent of the total), Illinois (826, eight percent), Ohio (606, six percent), and Pennsylvania (602, six percent).

To roughly gauge the proportion of foreign physicians working on H-1B visas relative to all U.S. physicians, the authors compared the number of H-1B applications to the number of physicians actively practicing nationwide and by state. Nationally, physician H-1B applicants represented 1.4 percent of the active physician work force. By state, North Dakota’s 1,602 H-1B applications accounted for about five percent of its active physician workforce. Rounding out the top five were: Rhode Island (82 applications, accounting for four percent), Michigan (945 applicants, four percent), Delaware (82, four percent), and Arkansas (156, three percent).

The top five hospitals and medical centers filing H-1B applications were William Beaumont Hospital in Michigan (470 applications), Bronx-Lebanon Hospital Center in New York (213), Cleveland Clinic Foundation in Ohio (180), and the Illinois hospitals Presence Saint Francis Hospital and Presence Saint Joseph Hospital, Chicago, both with 150 applications.

The authors conclude that eliminating or restricting the H-1B program for physicians could affect those hospitals and states that rely heavily on those physicians for healthcare.