Health and Human Services (HHS) Secretary Tommy G. Thompson on Dec. 13 announced new regulations to help rural and other communities suffering from a shortage of health care professionals by allowing HHS to request waivers of a return-home requirement for foreign physicians who are trained in the United States. This would affect Indian physicians who constitute a significant proportion of foreign physicians operating in this country.
Indian-American physicians, meanwhile, are actively pursuing the American Medical Association (AMA) to re-evaluate its policy on physician workforce based on the Federal Government’s recent identification several regions as MUAs (medically underserved areas) or HPSAs (health practitioner shortage areas). Under a request from the International Medical Graduates section, the AMA is currently re-evaluating its policy on physician workforce and push for expansion of the J1 Visa Waiver program.
Under the new regulations, HHS will expand its efforts to ensure that qualified physicians are available to improve access to care in health professional shortage areas and medically underserved areas. Following Sept. 11 attacks, security concerns prompted the U.S. Department of Agriculture (USDA) to stop sponsoring J1 visa waivers providing physicians to remote areas such as in Nevada, West Virginia, and many parts of California.
Under new regulations, HHS will expand its efforts to ensure that qualified physicians are available to improve access to care in health professional shortage areas and medically underserved areas.
“People who live in these underserved communities deserve the same access to primary care as other Americans, and we will do all that we can to help these communities recruit qualified foreign physicians when necessary,” Thompson said. “We want to make sure that this critical source of talented physicians continues to be available to the communities that desperately need more doctors.”
The new rules will allow HHS to review applications from community health centers, rural hospitals and other health care providers to waive return-home requirements for foreign physicians who come to America for medical training so that they can remain in the country to practice in underserved areas. HHS would make recommendations on these requests to the State Department. The U.S. Immigration and Naturalization Service (INS) has the authority to grant waivers.
Normally, under the State Department’s J-1 visa program, foreigners who come to the U.S. for graduate medical education must return to their home countries for two years after they complete their training. However, the State Department may recommend to the INS that it grant waivers of that requirement when an interested government agency requests them to fulfill a legitimate public purpose.
In the past, the USDA served as the interested federal government agency that reviewed waiver applications to allow foreign doctors to serve in rural, underserved communities outside Appalachia, while the Appalachian Regional Commission played that role for Appalachian communities. With the new regulations, HHS now will take over the role formerly played by the USDA in handling applications for these J-1 waivers.
According to estimates, of the nearly 2,400 physicians receiving J1 visas yearly, it is expected that 1,400 will remain in the U.S. through J1 waiver. Of those, 500 to 600 would be physicians of Indian origin, said Dr. S. ‘Jay’ Jayasankar, vice chair of the AMA’s International Medical Graduates (IMG) Section. The waivers allowed IMG doctors on finishing training to stay in the U.S. and serve in the shortage areas without having to go back to the country of origin for two years, making it the major source of health care for underserved areas.
The State Department may recommend to the INS that it grant waivers of that requirement when an interested government agency requests them to fulfill a legitimate public purpose.
HHS will review the applications and verify the physicians’ credentials through a federal credentialing process before making recommendations to the State Department. HHS will also co-ordinate its review process with state health departments. HHS already reviews waiver requests involving foreign physicians working in high-level biomedical research projects of interest to the department.
President Bush and HHS have launched a five-year initiative to add/expand health centers in 1,200 communities by 2006 and to increase the number of patients served annually to more than 16 million ---- up from 10 million in 2001. In 2002 fiscal year, the first full year of the initiative, HHS funded 171 new health center sites and awarded 131 grants to existing centers to help them build capacity and expand services.
To support the growth of the health centers, HHS is also expanding its National Health Service Corps, which offers scholarships and loan repayment plans to students and fully trained clinicians who agree to serve in health centers and other underserved communities. The J-1 waiver program complements those efforts.
HHS will publish the new regulations related to processing waiver requests in the Dec. 19 Federal Register as an interim final rule with a 45-day public comment period. Public comments would be considered to make appropriate changes to the regulations.
