Congress renews visa waiver program for IMGs

The U.S. House and Senate have approved bills that will extend by two years a program used to attract physicians to medically underserved rural and urban areas.

The J-1 visa waiver program exempts international medical graduates who have completed medical residencies in the United States from having to leave the country for two years once they have completed their studies, as required by their student visas. Instead, these physicians are allowed to apply for a work visa in exchange for committing to practice in a medically underserved area for at least three years.

The bill also exempts sponsoring organizations and their applicants from a cap on H-1B work visas, which were used by the vast majority of IMGs seeking to work in the United States. The Appalachian Regional Commission, the Delta Regional Authority, the Dept. of Health and Human Services and the Veterans Health Administration all have been subject to the H-1B visa cap that limited the number of visas to 65,000. All those visas were snatched up on the first day of the fiscal year in October, preventing these programs from sponsoring physicians for the next 11 months.

The Senate version of the bill also allows for all sponsors to support either primary care physicians or specialists. In the past, only the state-run Conrad 30 programs were permitted to place both.

Connie Berry, manager of the Texas Dept. of Health Primary Care Office, which oversees the state's Conrad 30 program, said the amended legislation would take the kinks out of a program widely used throughout the country.

The Conrad 30 allows states to sponsor waivers for 30 physicians to stay in the United States. Texas began accepting applications Sept. 1. Thirty-six hospitals and clinics applied for waivers for physicians they were prepared to hire. All the applicants qualified under the state's criteria, she said, which means there will be six underserved communities in Texas that won't be getting physicians this year.

"I wish we didn't have to turn any away," Berry said, "They'll probably look at other states that still have slots available."

One of the physicians also qualified for a waiver through a federal agency. If the physician had used the federal program, it would have freed up one of Texas' 30 slots for someone else, Berry said. However, because federal sponsors were still subject to the visa cap at the time waiver applications were being taken, the doctor didn't want to risk going through a federal sponsor for fear of getting a waiver but not a work visa. Next year, this won't be an issue, she said, making it possible to place more physicians in underserved areas.

"This will take a little pressure off the state 30 programs," she said.

There's another alteration to the program that will be particularly helpful to rural states, according to Berry. State or federal sponsors will be able to recommend up to five physicians to serve patients in shortage areas without requiring these physicians to be located in the actual underserved area. This will make it possible to provide more subspecialty care, Berry said, with the physician based at a clinic that draws from adjacent underserved communities.

The American Medical Association actively supported passage of this legislation as a means to place physicians in areas lacking access to health care.

In a letter from Michael Maves, MD, AMA executive vice president, to U.S. House Speaker Dennis Hastert (R, Ill.) Dr. Maves said, "We stand ready to work with Congress and HHS to monitor and place physicians in the appropriate underserved areas through the J-1 visa waiver program."