A new federal law acknowledges persistent spot shortages of healthcare professionals by partially restoring the ability of hospitals to recruit foreign nurses and doctors to underserved areas.
The measure, called the Nursing Relief for Disadvantaged Areas Act of 1999, received little notice amid other pressing healthcare policy issues such as relief from the Medicare payment limits of the Balanced Budget Act of 1997. It was signed into law by President Clinton this month.
The legislation lets hospitals hire foreign registered nurses for the first time since 1997 but ties numerous conditions to the privilege, including attestations designed to protect U.S. nurses (See chart).
In addition, a last-minute amendment reinstated the right of hospitals in medically underserved areas to employ foreign physicians under national interest waivers, an avenue that was nixed in an August 1998 immigration ruling.
Hospitals' ability to hire foreign nurses was effectively eliminated when the 1989 Immigration Nursing Relief Act expired two years ago (Nov. 10, 1997, p. 56).
The American Hospital Association supported the legislation, with Richard Wade, senior adviser for communications, calling it "pretty narrow in terms of its impact. There are lots of requirements."
Two hospitals, 327-bed Mercy Health Center in Laredo, Texas, and 194-bed St. Bernard Hospital and Health Care Center in Chicago, sent officials to testify in favor of the nursing relief provision last year.
Ronald Campbell, vice president of patient-care services at St. Bernard, said the hospital has difficulty hiring nurses because of neighborhood crime, which includes a string of unsolved rapes. He said the hospital has about 145 registered nurses on staff and 36 vacancies.
"We're trying to keep up with our staffing needs without having to use outside nurse registries. We're a small community hospital, and we can't afford the cost (of staffing firms)," Campbell said.
Only a handful of hospitals is expected to benefit, however.
Cheryl Peterson, senior policy fellow at the American Nurses Association, said the previous visa program, which allowed an unlimited number of foreign nurses, led to wage abuses. The ANA insisted on measures in the new visa program to prevent hospitals from paying foreign nurses less than Americans. The new plan also limits the total number of foreign nurses to 500 per year.
"We wanted to make sure the use of visas was specific to hospitals that really need it," Peterson said. "The whole world is suffering from a severe shortage of nurses. If we use (immigration) as a tool, we'll just be taking a valuable human resource from somebody else."
Likewise, hospitals have been stymied in their efforts to recruit foreign physicians since national interest waivers were abandoned last year. The waivers eliminated the requirement that employers first advertise jobs to Americans and that foreign physicians obtain certification through state and federal labor departments-a process that can take several years.
The new legislation allows national interest waivers for doctors provided they work in an underserved area or veterans' facility for five years before applying for permanent residency. Under previous rules, foreign physicians could apply for a green card after three years.
Los Angeles immigration lawyer Carl Shusterman said the advertising and certification requirements were unnecessary burdens, since American physicians didn't want the jobs.
He said about 500 physicians per year have been obtaining the waivers.
"We do about 100 of these (foreign) physicians a year, and we run ads in the (U.S.) medical magazines for every one. We've never got a single American to respond to one of these ads," he said. "For the most part, Americans are totally uninterested in going out to some little backwater."
The American Medical Association objected to the legislation, saying employers of physicians should fulfill the same requirements as other employers seeking immigrant visa petitions.
In a letter to Sen. Judd Gregg (R-N.H.), chairman of a Senate appropriations subcommittee, the AMA warned of hospitals' "forcing physicians to remain in their employ, with the threat of revoking their visa sponsorship, requiring extraordinarily long hours with extremely low compensation."