One of several programs that allow foreign physicians to practice in underserved areas was suspended following complaints of rule violations.
The U.S. Department of Housing and Urban Development this month indefinitely halted its approvals of J-1 visa waivers nationwide. The waivers, which HUD began issuing in 1994, allow foreign physicians who complete their clinical training in the United States to remain here if they work in urban areas that need doctors (See chart).
Several other federal agencies and some states issue waivers to meet the needs of a variety of underserved populations. About 1,550 foreign physicians received waivers in 1995, twice as many as in 1994, according to the U.S. Information Agency. HUD issued more than 200 of those waivers.
A HUD spokesman cited "certain questions" that were raised about the program by HUD staff and the General Accounting Office. He said HUD has limited staff and wants to focus on its core mission of providing affordable housing.
HUD's action followed Texas medical societies' complaints that some foreign physicians broke rules by working in areas without a physician shortage or in specialties other than primary care. Alleged violations occurred in the Mexican border communities of El Paso and McAllen, an official of the Texas Medical Association said.
Bonnie Weikel, executive director of the El Paso County Medical Society, said a single physician in El Paso hired 15 foreign physicians in order to build his practice.
Weikel said she believes foreign physicians amount to cheap labor, receiving as little as two-thirds of prevailing physician incomes.
But others said it's a case of entrenched U.S. physicians fearing competition from foreign-born doctors.
Columbia/HCA Healthcare Corp., the nation's largest hospital chain, recruited 20 foreign physicians to El Paso with HUD waivers. The Nashville, Tenn.-based company operates two acute-care and two specialty hospitals in the market. Under the company's recruitment program, the physicians sign five-year contracts with Columbia. After three years they are eligible to become U.S. residents.
Columbia's physicians are among those accused of violating rules.
Michele Diaz, a spokeswoman for Columbia's West Texas division, defended the company's recruitment strategy. She said it's difficult to attract physicians to El Paso, which ranks among the nation's poorest cities.
"Prior to the J-1 waiver, the medical community had a problem meeting the primary-care needs of the community," Diaz said. She said the waiver requires physicians and their employers to document that the wages are in line with prevailing incomes.
Immigration attorney Gregory Siskind said foreign physicians are a last resort for some hospitals, which pay hefty recruitment and relocation costs.
For physicians, he said, `it's a competition issue."
Siskind, of the Nashville.-based firm of Siskind, Susser, Haas & Chang, acknowledged there have been enforcement problems with the growing J-1 waiver program. Recently, steps have been taken to address them.
Immigration legislation signed into law in September imposed a three-year waiting period before foreign physicians may apply for permanent residency. Before, some doctors received permanent status and abandoned underserved areas before their contracts expired, Siskind said.
Siskind hopes the program will resume once enforcement issues are addressed.