Health providers said last week that they were cheered that a program used to recruit foreign physicians to underserved areas is likely to be extended, but advocates for the program said they would also like federal requirements for the waivers to be less stringent.
President Bush is expected to sign into law a bill that gives a two-year extension to the so-called J-1 visa waiver program, which expired on May 31 and is used to recruit foreign doctors to medically underserved areas-usually rural and inner-city communities. The bill passed the House last week by a 407-4 vote and passed the Senate in October.
"In general I am happy with the bill," said Robert Aronson, a partner at Ingber & Aronson, a law firm specializing in immigration cases.
About 7,000 people are receiving or are about to take part in medical training in the U.S. using a J-1 visa, according to the Educational Commission for Foreign Medical Graduates. Without a waiver, foreign physicians must return to their native land for two years after training in the U.S. The program waives the requirement for physicians who agree to work in a medically underserved area for three years. States are allowed to apply for 30 waivers per year, and the bill allows them to use five of those waivers for facilities that aren't in underserved communities but serve patients from those areas. In the past, waivers could be granted only to physicians who worked in facilities that were actually located in underserved areas.
This bill also says physicians practicing primary-care and specialty medicine can be granted a waiver. The program's previous language didn't specify whether a specialist could be granted a waiver.
HHS can also apply for the waivers, but the agency's requirements are more extensive than states' rules. In order to meet HHS' criteria, physicians must be working in a community that qualifies as underserved and is considered to be a "greatest shortage" area, which is determined by using a 25-point scale that factors in population, primary-care physician-to-patient ratio, poverty level, infant health index and travel distance to the nearest source for care.
David Rutstein, deputy associate administrator of health professions for HHS' Health Resources and Services Administration, said the HHS restrictions aren't keeping physicians from accessing the waivers because they can still apply through the states, which usually don't issue 30 waivers apiece throughout the year.
But officials with the National Association of Community Health Centers, a trade association with about 1,600 members, said they also would like to see the HHS restrictions relaxed. The association, which only tracks health centers, said there are at least 600 physicians working in health centers that have used the waivers, but the overall number of physicians who have used waivers is believed to be much higher.
A spokesman for Rep. Jerry Moran (R-Kan.), sponsor of the House bill, said more than 120 physicians have used the waiver in Kansas and the state's retention rate for doctors in the program is about 60% after three years of service.