It took the University of Nevada School of Medicine in Las Vegas three years to fill a job opening for a pediatric gastroenterologist. This is hardly a surprise given the nationwide shortage of physicians with a pediatric subspecialty, a shortage that means families often have to wait months to get an appointment for a sick child.
But the need was even more pressing in Las Vegas, which has been so short of both general practitioners and specialists that the state finally took emergency action and allotted $10 million to expand its medical training programs beginning in 2017. The number of doctors moving to Nevada simply hasn’t kept pace with the state’s rapid growth over the past three decades.
Families that can’t wait months for an appointment often drive out of state for medical care.
By 2015, the state ranked a dismal 48th in the nation for practicing physicians per capita. Clark County, where Las Vegas is seated, had just 14.9 pediatricians per 100,000 residents, only about half the national average. The entire state of Nevada had only six pediatricians with a subspecialty in gastroenterology, a field in ever-greater demand due to a rise in chronic childhood gastrointestinal conditions.
Families that can’t wait months for an appointment often drive out of state for medical care, taking their dollars with them and hurting the local and state economy. State officials determined that Nevada would have to boost the number of medical residency slots it offered if it wanted to keep more medical students in the state after graduation. It would also need to provide meaningful educational experiences to medical students already in the state, so they’d be inspired to return here to practice. Fortunately, in 2015 the University of Nevada Las Vegas was able to fill a slot for a combination pediatric gastroenterologist and instructor when it hired Dr. Rabea Alhosh, who had just completed his subspecialty fellowship at Children’s Hospital of Los Angeles.
Alhosh, an award-winning instructor, teaches medical students, trains residents, and provides direct clinical care to children. “I’m very happy here,” Alhosh says. “This is the kind of job I was looking for from the beginning.”
Alhosh is an immigrant from Syria, and while his patients sometimes inquire about his accent and ask if his family back home is safe, it’s unlikely that any are aware of the hurdles he had to overcome to reach the exam room to treat their child. In many ways, his story is illustrative of just how complex America’s immigration system has become.
Alhosh was born and raised in Damascus, the capital of Syria and one of the oldest continuously inhabited cities in the world. During medical school at the University of Damascus, he participated in a three-month training program at Baylor University and Texas Children’s Hospital. Foreign medical graduates with experience in America improve their chances of being accepted into a U.S. residency program—“the dream of every medical student in the world,” Alhosh says.
But when Alhosh arrived at the American airport, a U.S. immigration official looked at his first hospital assignment, which was for one month, and refused to issue him a longer visa. “She was yelling, searching through my wallet,” before a supervisor finally came over and, understanding the process, “let me in for four months and saved my life,” he says.
So if you leave the country, you have to go back to the embassy, and every time you go to the embassy, it’s a matter of luck.
Alhosh was accepted to a pediatric residency program at the University of Iowa Hospitals & Clinics, graduating in 2011 with a teacher-of-the-year award. But he’d opted to apply for an H-1B visa for skilled workers as opposed to the J-1 visa, which is easier to obtain but requires doctors to return home for two years after their residency. The downside was that his H-1B visa was only good for one entry.
“So if you leave the country, you have to go back to the embassy, and every time you go to the embassy, it’s a matter of luck. You don’t know if you’re going to get approved again,” he says. “So, since 2009, I haven’t been home. The painful part of the H-1 visa is that for certain nationalities you can’t go home until you get a green card.”
Alhosh was willing to delay seeing his relatives, but he wasn’t quite prepared for the added, and perhaps unintended, strain the immigration rules imposed while he was here. The H-1 visa expired after three years, but Alhosh could renew it to accept a fellowship in pediatric gastroenterology at Children`s Hospital of Los Angeles. “You have to apply a month and a half before it expires,” he says. “But then it doesn’t arrive right away…. It was really stressful to have an expired visa and move to a new state and try to establish a life there.”
Alhosh couldn’t get a driver’s license, and no amount of explaining to the DMV helped. “They didn’t understand that part of the visa process, and they wouldn’t give me a license,” he says. He showed them his work documents and said, “‘How can I work in a hospital if I’m illegal?’ And they just couldn’t register that.” He ended up giving a student free room and board in exchange for being his driver.
I can’t go home, because now there’s a war in my country. But if I stay beyond my visa time I would be considered out of status, which isn’t legal.
When his visa extension did arrive, Alhosh looked at the paper and entered the most stressful time of his years in America: It was set to expire two weeks before the end of his fellowship. “That was the worst time for me,” he says. “I can’t go home, because now there’s a war in my country. But if I stay beyond my visa time I would be considered out of status, which isn’t legal. I can’t work. I can’t get paid… And being out of status is not a good thing for my file if I want to apply for a green card later.”
So in 2012, three years before his H-1 extension was set to expire, Alhosh applied for political asylum. When he didn’t hear back after two years, he contacted his Congressman, who sped up the process. Alhosh received asylum at the end of March 2015, just in time to graduate and take the job in Nevada.
Alhosh says he is grateful for the opportunity to live and work in the United States, and to his father, George Alhosh, for helping him pay for all those early travel and exam costs. Damascus has been the site of repeated car bombs of late, but copies of Alhosh’s medical licenses still hang in his father’s home. “It was due to him. He had to take a lot of the family money and move it to me,” says Alhosh. “But he knew it would be a good investment.”