Care Across Cultures Expanding Your Services

Charles-Mok-jr-DO

There’s an interesting opportunity available to physicians and occupational health programs that presents a great deal of benefits both in terms of the business side of running a medical practice and the humanitarian aspect of serving the community. Though the subject often goes overlooked, providing immigration physicals can be a great way to onboard new patients, develop a positive image for your practice, connect with other cultures from around the world, and serve as the welcoming face of the U.S. healthcare system all without leaving your office. Individuals applying for a “change of status” with regard to US residency are required to complete an application process and physical examination through the United States Citizenship and Immigration Services (USCIS).

The physical examinations are often referred to as “immigration physicals.” The examination entails screening for “communicable diseases of public health significance” (tuberculosis, syphilis, etc), updates in immunizations, history, and physical examination. The USCIS requires civil surgeons to only accept results that can be reasonably verified as belonging to the patient. Hence, most lab results and testing will need to be performed at the civil surgeon’s office. Typically, this process necessitates two separate visits (lab collection on the first visit and results review, immunizations, and physical on the second visit). The results of the evaluation are documented on USCIS form I-693.

Only “designated civil surgeons” are permitted to perform immigration medical examinations. Physicians seeking to provide these exams must apply through the USCIS1 and meet basic requirements: unrestricted licensure and a minimum of four years of professional experience. The local USCIS field office makes the final determination if there is a need for additional civil surgeons in a given geographic area.

From a business perspective, immigration physicals present a very positive situation for physicians because the patient pays for the service upon completion, reducing overhead costs such as administrative manhours, collections, and billing filings that often delay cash flow from coming into the practice. Beyond that, civil surgeons are providing an incredibly valuable service for the community. Many of the patients who seek immigration physicals are experiencing the U.S. healthcare system for the very first time, which gives doctors the opportunity to introduce them to our medical system’s structure welcome them into their practices, and establish what could be a lasting precedent.

Performing immigration physical exams can be rewarding, fiscally and professionally.

In providing a warm and inviting environment for these patients, physicians are vicariously promoting a positive message about their practice. It’s common for increased referrals and lifelong patient relationships to form as a result of these initial appointments – building not only a great rapport with a new patient but also earning the privilege to experience and treat a new culture. Professionally, it’s incredibly rewarding.

The medical examination itself must include a review of medical/psychiatric history, hospitalizations, and physical examination. The criteria to be included in the examination are defined by the Centers for Disease Control and Prevention.2 Patients presenting for immigration physicals may come from any country in the world. Some are fluent in English, while for others language barrier is an issue. This creates difficulty for staff during scheduling and for the physician-patient interaction. It is extremely helpful to have a language translator service available. In typical practices, having staff members who are fluent in languages other than English can meet most needs. This is not the case for immigration physicals. In my facility, some of the languages encountered that required translation included Macedonian, Vietnamese, Arabic, Chinese, Japanese, Korean, and Portuguese. It is unlikely any one facility can have a sufficient variety of translators to meet all needs.

Cultural differences and expectations may pose hurdles to completing the process. For some patients, this is their first experience in the US healthcare system. They are not familiar with the expectations or “etiquette” of the physician’s office. Patients may come from countries where bartering is common practice. At the time of fee collection, these individuals may attempt to barter with the receptionist. This creates confusion with staff members who are accustomed to set pricing for services rendered. In other situations, patients may be offended or refuse an exam by a physician of a different gender. Although this is common practice in US physician offices, some patients interpret this as an insult to their modesty. Such awkward situations can be avoided through cultural sensitivity training and prior explanation of immigration physical components and expectations.

Performing immigration physical exams can be rewarding, fiscally and professionally. As most services are provided on a “fee for service” basis, payment in full is received at the time of the exam. Professionally, it provides an opportunity for the physician to introduce the patient to the US healthcare system and the patient to provide a glimpse into their culture. Understanding the unique skills required for this exam can help to overcome initial challenges. Physician and staff preparation and education facilitate a smooth, stress-free process.

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