Bipartisan Proposals Address Physician Shortage in the U.S.

By Roy Maurer May 3, 2017

Lawmakers have introduced bipartisan legislation in both houses of Congress that would extend and expand a little-known program that places foreign doctors in underserved areas of the United States.

Democrats and Republicans in the U.S. House and Senate put forward bills that would help alleviate physician shortages by allowing more foreign medical students on J-1 visas to stay in the United States if they practice in a community in need for three years.

The Conrad 30 Waiver Program allows foreign physicians who have gone through the J-1 exchange visitor program to apply for a waiver for the two-year home residence requirement and instead remain in the U.S. with an H-1B visa.

[SHRM members-only toolkit: Obtaining U.S. Employment Visas] 

The program was created in 1994 to counter the shortage of physicians in the country and currently offers individual states the opportunity to exempt up to 30 foreign doctors per year.

"It has been reported that there is currently a deficit of 8,200 primary care physicians, which will balloon to 94,700 by 2025 as the population ages," said Forrest G. Read IV, an attorney in the Washington, D.C., area office of Jackson Lewis. 

The American Medical Association estimates that the U.S. will be short of between 60,000 and almost 95,000 physicians by 2025—a deficit expected to be felt most in rural and low-income communities.

"Rural communities in Minnesota and across the country are short on doctors, and they rely on the Conrad 30 program to fill the gaps," said Sen. Amy Klobuchar, D-Minn., a leading sponsor of the Senate bill. "Over the last 15 years, the Conrad 30 program has brought more than 15,000 physicians to underserved areas." Klobuchar was joined in introducing the legislation by Sen. Susan Collins, R-Maine, and Sen. Heidi Heitkamp, D-N.D.

Their proposal would:

  • Extend the program to 2021. It has been periodically reauthorized since its introduction, but often is not reauthorized until right before its expiration date, leading to much uncertainty. The program was originally slated to expire on April 28, but is hanging in limbo, tied to the federal government's omnibus spending bill for fiscal year 2017. When that budget deal is signed, the Conrad 30 program would be renewed until Sept. 30.
  • Allow for more than 30 doctors per state.
  • Provide work authorization for spouses of physicians in the programs.
  • Provide contractual protections to the physicians by prohibiting noncompete agreements, specifying the number of on-call hours a doctor must work and clarifying when a doctor may change jobs.

Reps. Darrell Issa, R-Calif., and Brad Schneider, D-Ill., introduced companion legislation in the House.
"The American medical education system attracts top international talent and produces the best-trained graduates in the world," Schneider said. "It makes no sense to force these highly-skilled new doctors out of the country at a time when many of our communities struggle to attract medical professionals."

President Donald Trump's travel ban from certain countries—currently blocked by a federal court—is another issue affecting foreign medical students. "For many years, many foreign physicians from Muslim-majority countries have been helping to fill the shortage of primary care physicians in the U.S.," Read said. "Those individuals may now be rethinking their plans due to fears of anti-immigrant sentiments and possible long delays in obtaining visas. The suspension of premium processing for H-1B visa petitions is complicating the problem because it is delaying the start dates for physicians to begin serving patients and communities in these underserved areas." 

The proposals have been endorsed by the American Medical Association, the California Medical Association, the American Hospital Association (AHA), and the Association of American Medical Colleges.

"Our nation's rural and inner city hospitals struggle to recruit and retain physicians, and the supply of primary care providers in such areas is steadily declining," said AHA Executive Vice President Tom Nickels. "In many areas of the country, a Conrad 30 physician is the only source of primary health care."

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