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Chris Musillo on Nurse and Allied Health Immigration


  1. What Sen. Grassley Should Not Do on the H-1B Visa

    by , 10-03-2009 at 09:37 AM (Chris Musillo on Nurse and Allied Health Immigration)

    by Chris Musillo

    Last week Sen. Grassley continued his passionate cry against the H-1B program with a public letter to brand-new USCIS Director Mayorkas. Rather than furthering the discussion, his comments were loose with facts and didn't survive serious analysis. His authority for the "substantial fraud" (his words) is weak.

    Almost exactly one year ago, the USCIS produced the "H-1B Benefit Fraud & Compliance Report." According to Sen. Grassley, the Report alleges that 20.7% of all visa cases reviewed were identified as having "outright fraud or other program violations associated with them." The Senator's use of the statistical ".7%" is unfortunate. This precision gives the Report the degree of credibility and meticulousness that it does not deserve. Even the Report itself rounded off to 21% in its conclusion. Similarly, the Senator's use of the phrase "outright fraud" is exaggerated. "Fraud" is fraud; there is no such thing as "outright fraud". His aim seems to be to incite.

    The Senator's letter seems to purposefully attempt to confuse issues. In the above citation, note that the Senator says "...or other violations associated with them." The Report purposefully mixed technical violations and fraud findings. This is akin to mixing drunken driving fatalities and parking tickets in a report on motor vehicle violations. The Senator should be above this kind of word-smithing.

    The Senator also casually dismisses one of the Reports key findings: that Staffing Companies and IT Companies are not the types of organizations that are committing the fraud. Specifically, the Report's fourth finding was that the fraud was the violations were more likely in fields such as "accounting, human resources, business analysts, sales and advertising." Since this finding doesn't fit Sen. Grassley's theme, he ignores it.

    The Report itself was so poorly researched as to be virtually worthless. The sample used in the Report was 51 cases, which is a statistically insignificant number in a world where at least one hundred thousand H-1Bs are filed in any given year.

    In the year since the publication of the Report, none of the fraud implied in the Report has been acted upon. No arrests have been made. And no convictions have occurred. All of the investigations, including the much heralded Vision Systems indictments, were independent of the Report. It is also worth noting that the government recently amended their indictment in that case, lowering the damages sought. This reduction in allegation received far less press than the initial story.
    As I have argued in the past, H-1B fraud likely is overblown. As I said in April,

    In prior years we have seen more than twice as many H-1B cases accepted as slots were available. These numbers provide compelling evidence against the argument that internationally-trained workers are being used to displace American workers and lower US workers salaries. That argument just doesn't jibe with what is actually happening.

    If H-1B visa labor was being used primarily to lower US workers salaries, the H-1B filing numbers wouldn't be impacted to any meaningful degree. Why? Because the incentive to reduce workers' salaries is likely greater in a recessed economy, not less. This logic is straightforward and convincing.

    The H-1B program surely has problems that legislation could cure. As an experienced Senator, Mr. Grassley surely knows that reasonable fixes to the H-1B program are attainable. Instead it appears as if the Senator is more interested in inciting a base level interest voter. The Senator's aims would be better served by seeking out those organizations that are engaging in fraud, instead of broadly condemning the entire H-1B program. A good start would be to recognize the weak analysis in the H-1B Benefit Fraud & Compliance Report". When the Senator relies on the Report and plays politics with his language, his argument falls flat.
  2. Legislative Update for MDs

    by , 09-29-2009 at 07:00 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo
    Last week the House of Representatives passed a continuing resolution that if passed will extend the doctor's Conrad 30 program, which provides a common path for doctor immigration. The Conrad 30 program provides each U.S. state with 30 waivers for J-1 physicians each fiscal year.

    The legislation also includes extensions of the EB-5. E-Verify, and Religious Worker programs. These extensions, which are embedded in the annual government funding legislation is now headed to the Senate where it is expected to be considered today. The legislation is expected to pass before October 1, 2009, or else the government's funding will dry up.

    The legislation does not contain any "new" legislation, such as H.R.2536 - Emergency Nursing Supply Relief Act. Nursing and allied healthcare occupational visa reform is more likely to happen in early 2010.
  3. New USCIS Site

    by , 09-24-2009 at 06:36 AM (Chris Musillo on Nurse and Allied Health Immigration)

    by Chris Musillo
    On Tuesday I was asked to participate in a call with USCIS Director Alejandro Mayorkas. The Director reached out to several prominent bloggers. The purpose of the call was to get feedback on the new USCIS website. To the Director's credit, he participated directly on the call. He answered questions directly from the bloggers and had several USCIS officials there to help him with some of the details that the director of a huge agency could not possibly know.

    The new site has some very nice features. The most immediate improvement is that the site is clean and user-friendly. The updates to the Case Status section are commendable. Looking ahead, the Director explained that in May 2010 the site will alllow for interactive email service queries.

    The site is still buggy. Many of the new links are not operable at this time; USCIS expects to fix the bugs in the next few days/months. Curiously the webpage URL's are still unusually long. In the future, USCIS expects simplified URLs (e.g. instead of This URL is not a joke!).

    The Director showed a self-deprecating sense of humor. After acknowledging that the link to the Leadership Biography page was not yet fully operable, he coyly remarked that the reason for the delay was because his biography was lengthy and he had not yet finished it.

    But the best message that I heard is that the USCIS took the time to reach out to the community. In the past, USCIS announcements often come with a simple Press Release. This "new" USCIS approach to community outreach is laudable. The Director and his team deserves kudos.
  4. Fewer International Nurses Interested in the US

    by , 09-22-2009 at 07:28 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo
    During most of the 2000s, internationally trained nurses made up about 10-15% of all new RNs that came on-line in the US. These numbers disappeared with the onset of retrogression in January 2008. In spite of the retrogression, internationally-trained and educated nurses remained faithful to the US, as evidenced by the fact that internationally-trained RNs continued to take the NCLEX in great numbers.

    In 2006, about 20,907 internationally educated RNs passed the NCLEX exam. In 2007, the volume jumped; 22,827 internationally educated nurses passed the NCLEX exam. With the onset of retrogression, 2008 saw a slight decline; 18,905 internationally educated RNs passed the exam.

    But the latest numbers point to a massive drop in the numbers of internationally educated nurses passing NCLEX. Through June 30, 2009, only 7,236 have passed the exam, which annualizes to 14,472.

    While the US nursing shortage certainly has eased in recent months, economists and government officials all agree that this is a temporary condition. By the end of the next decade the US could be short 250,000 to 1 million nurses, depending on whose estimates you read.

    It is obvious that reasonable visa opportunities for international nurses must happen or else the US is going to find that it has a massive nursing shortage and international nurses are no longer there to fill the gap.

    All statistics in this posting are from the NLCEX Fact Sheets, which are published on NCSBN's webpage.
  5. The Most Optimistic Scenario

    by , 09-14-2009 at 07:09 AM (Chris Musillo on Nurse and Allied Health Immigration)
    by Chris Musillo
    I was recently asked by a client to offer my opinion on the most optimistic scenario of when we might see healthcare visa reform in the US.

    Sen. Schumer (D-NY) is one of the Senate's leading members and has long made immigration reform a legislative priority. With Sen. Kennedy's passing, the Democratic leadership informally has tapped Sen. Schumer to draft the Comprehensive Immigration Reform (CIR) bill. Earlier this summer, he listed his principles for comprehensive immigration.

    Sen. Schumer has long been a proponent of sensible immigration reform, including liberalized visa numbers in occupations that have been in short supply. In 2005 he helped pass the EX visa, which offered 50,000 visas for applicants holding Schedule A occupations and their immediate family members. Schedule A occupations are those occupations that have been certified in short supply by the Department of Labor (DOL). The DOL takes its role seriously and looks long-term before it lists and delists occupations from Schedule A. Schedule A presently includes Physical Therapists and Registered Nurses.

    Democratic leadership already has decided that CIR will not be on the agenda until 2010. Whether that happens largely is dependent on President Obama and the Democratic leadership's popularity ratings at the end of 2009. Both ratings have slipped in recent months.

    If the Democrats and Pres. Obama can stabilize or improve their popularity, then it seems likely that they will be able to pass CIR in early 2010. US mid-term elections will take place in November 2010, and so any CIR bill must be done by the spring. No politician will want a CIR bill to drag into the summer of 2010.

    Given that Sen. Schumer's historical position on employment based immigration, it seems more likely than not that the CIR bill will include nurse visa reform. But there still are many hurdles to clear before we get to spring 2010.
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