More U.S. jobs for IMGs as J-1 visa waivers increase

The new Conrad 30 program lets states sponsor up to 30 international medical graduates who agree to serve in underserved areas.

By Myrle Croasdale, AMNews staff. Dec. 2, 2002. Additional information

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Finding a doctor close by may get a little bit easier for patients in rural areas, now that President Bush has signed into law an expansion of a federal program that allows international medical graduates to practice in underserved areas after they've finished their U.S. residencies.

States that weren't able to recruit physicians to help offset rural shortages after the U.S. Dept. of Agriculture stopped sponsoring J-1 visa waivers earlier this year could bring in 10 additional doctors each through the program.

"In our little world, it's a big deal that states' have a 50% increase," said Carl Shusterman, a Los Angeles immigration attorney who helped draft the bill.

In theory, the expanded program would mean that 1,500 IMGs could stay in the United States each year to practice in underserved areas.

Once titled the Conrad 20 program, because states could sponsor 20 applicants for J-1 visa waivers yearly, it's now called the Conrad 30, with states allowed to seek up to 30 waivers.

In reality, it's more likely that 1,000 waivers will be sponsored through the newly expanded program, since not all states will use their 30 slots. Even so, Shusterman said this would be a sizable jump compared with the 500 to 600 waivers states were seeking in past years.

While the federal government has raised the cap on the Conrad program, some states have their own restrictions.

Texas, for example, allows J-1 visa waivers only for faculty members of the Regional Academic Health Center in the Rio Grande Valley. This has kept visa waivers in the single digits for Texas.

Oklahoma, which has a state program that places state medical graduates in rural areas, doesn't plan to use its Conrad option, since it has a steady stream of homegrown physicians to place.

But other states are eager to fill their quotas. California used its additional allotment in a single day, and Michigan is also expected to snap up the 10 new slots.

Several states that had ignored the Conrad program in the past, relying solely on USDA sponsorship, have had to open Conrad programs since the USDA bowed out. With Idaho's recent decision to avail itself of the program, all 50 states are now on board.

"A lot of states like California, Texas, Kansas and Oregon never bothered to have a state program before the agriculture department got out," Shusterman said. "Then they realized they'd have big problems in rural counties unless they jumped in."

Besides the Conrad program, international physicians can apply for J-1 visa waivers through the Appalachian Regional Commission (which sponsored 65 doctors in 2001 for primary care), the U.S. Dept. of Veterans Affairs (which requested 183 waivers in 2001 for physicians in a variety of specialties) and the U.S. Dept. of Health and Human Services (which sponsors 175 to 200 waivers each year for research jobs).

A spokesman for the state department, which oversees J-1 visa waivers, said it had issued 1,000 of the waivers this past year, including those sponsored through the VA, ARC and HHS. Before the USDA stepped out of the business of sponsoring J-1 visa waivers on Sept. 26, 2001, it had placed 3,098 doctors in rural areas in 48 states since the mid-1990s.

But Shusterman said USDA's pace of sponsorship had slowed dramatically before Sept. 11, 2001. It sponsored only 85 physicians in its last year of operation.

According to data compiled by the National Health Service Corps. and the Texas Primary Care Office, approximately 2,400 IMGs are in residency programs in the United States under a J-1 visa each year, and 1,400 of these graduates will receive a visa waiver to remain in the country upon completion of their residencies.

About 925 of these waivers are recommended for underserved areas, while 475 are used by VA and HHS.

 

 

News Release FOR IMMEDIATE RELEASE Tuesday, Dec. 17, 2002 Contact: HRSA Press Office (301) 443-3376 HHS TO EXPAND ACCESS TO CARE IN RURAL AND OTHER COMMUNITIES BY REVIEWING WAIVER REQUESTS INVOLVING FOREIGN DOCTORS HHS Secretary Tommy G. Thompson today announced new regulations to help rural and other communities suffering from a shortage of health care providers by allowing HHS to request waivers of a return-home requirement for foreign physicians who trained in the United States. Under the new regulations, HHS will expand its efforts to ensure that qualified physicians are available to improve access to care in health professional shortage areas and medically underserved areas. "People who live in these underserved communities deserve the same access to primary care as other Americans, and we will do all that we can to help these communities recruit qualified foreign physicians when necessary," Secretary Thompson said. "We want to make sure that this critical source of talented physicians continues to be available to the communities that desperately need more doctors." The new rules will allow HHS to review applications from community health centers, rural hospitals and other health care providers to waive return-home requirements for foreign physicians who come to America for medical training so that they can remain in the country to practice in underserved areas. HHS would make recommendations on these requests to the State Department. The U.S. Immigration and Naturalization Service (INS) has the authority to grant waivers. Normally under the State Department's J-1 visa program, foreigners who come to the United States for graduate medical education must return to their home countries for two years after they complete their training. However, the State Department may recommend to the INS that it grant waivers of that requirement when an interested government agency requests them to fulfill a legitimate public purpose. In the past, the U.S. Department of Agriculture (USDA) served as the interested federal government agency that reviewed waiver applications to allow foreign doctors to serve in rural, underserved communities outside Appalachia, while the Appalachian Regional Commission played that role for Appalachian communities. With the new regulations, HHS now will take over the role formerly played by the USDA in handling applications for these J-1 waivers. HHS will review the applications and verify the physicians' credentials through a federal credentialing process before making recommendations to the State Department. HHS also will coordinate its review process with state health departments. HHS already reviews waiver requests involving foreign physicians working in high-level biomedical research projects of interest to the department. "By helping review these waiver requests, we can help increase the supply of qualified physicians available to provide needed care in community health centers and other locations in rural communities and other underserved areas," Secretary Thompson said. "Their contribution is critical to the success of our broader efforts to expand Americans' access to care." President Bush and HHS have launched a five-year initiative to add or expand health centers in 1,200 communities by 2006 and to increase the number of patients served annually to more than 16 million -- up from 10 million in 2001. In fiscal year 2002, the first full year of the President's initiative, HHS funded 171 new health center sites and awarded 131 grants to existing centers to help them build capacity and expand services. To support the growth of the health centers, HHS is also expanding its National Health Service Corps, which offers scholarships and loan repayment plans to students and fully trained clinicians who agree to serve in health centers and other underserved communities. The J-1 waiver program complements those efforts. In 2001, Secretary Thompson launched a broad Initiative on Rural America to improve access to health care and social services in rural communities. In July, the department's Rural Task Force issued a report highlighting new approaches to improve access to services; strengthen rural families; support rural economic development; improve coordination among state, local and tribal governments; and conduct more and better research on the needs of rural communities. HHS will publish the new regulations related to processing waiver requests in the Dec. 19 Federal Register as an interim final rule with a 45-day public comment period. Public comments would be considered to make appropriate changes to the regulations. ### Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news. Last Revised: December 17, 2002