Foreign medical graduates lose one way to stay in U.S.

Experts worry rural health care will suffer if these physician applicants are not granted visa waivers.

By Damon Adams, amednews staff. April 22/29, 2002. Correction

Rural health leaders and members of Congress are fighting to keep from losing foreign doctors who are willing to work in underserved areas of the United States.

They are lobbying the U.S. Dept. of Agriculture to reverse its February decision to quit participating in a program that allows foreign medical residents to stay here after completing their training.

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Since 1994, the USDA had provided recommendation letters to the U.S. Dept. of State on behalf of foreign medical residents seeking exemption from an immigration law requiring them to return home for two years at the end of their medical residencies. Th e government can waive the two-year condition and let doctors remain here for an additional three years if they agree to practice in rural areas.

But the Sept. 11, 2001, terrorist attacks prompted reviews of the J-1 visa waiver program, and the USDA said security concerns were raised about physician applicants because the agency said it did not have the authority to conduct adequate background c hecks. The USDA sent seven random pending applications to the Dept. of Justice for screening, and three applicants were considered to be security risks.

Meanwhile, investigations into fraud and other criminal conduct revealed an apparent scheme of false applications for about 160 physicians already in the United States, the agency said. The security concerns and investigations were enough for the USDA to end its role in the program and stop processing more than 80 pending applications.

"There continue to be some investigations concerning fraud," said USDA spokeswoman Alisa Harrison.

About 30% of rural counties have a physician shortage.

Now health and congressional leaders are meeting with governmental agencies in hopes of changing the USDA's mind or getting another agency to step in.

On April 5, a coalition of 12 rural and health care organizations sent a letter to the USDA and other governmental agencies, urging completion of the current waiver applications and seeking a coordinated effort to find solutions to the USDA's security concerns. In many areas, foreign doctors are the only access to primary care, said the coalition, which includes the American Academy of Family Physicians and American Hospital Assn.

"We currently have a severe shortage of physicians in many rural areas, and this [loss] would exacerbate the problem," said Stephen Wilhide, MPH, executive director of the National Rural Health Assn., a coalition member.

About 30% of all rural counties are underserved, Wilhide said. About 3,000 foreign doctors have benefited from the visa waivers and helped provide care in rural areas.

U.S. Rep. Jerry Moran (R, Kan.) is pressing the USDA to continue sponsoring foreign doctors. "The J-1 visa program has been successful in saving countless lives by bringing doctors to rural America," he said in a statement. "Now, in a bureaucratic fash ion, the USDA has shut down the program without warning and sent back pending applications, without setting up any alternatives."

Sponsorship by the USDA is not the only way foreign medical residents can remain in the United States. Foreign medical residents can also get waivers through state programs that sponsor 20 doctors each year for communities in need. Those waivers are av ailable in 44 states.

In addition, the Appalachian Regional Commission, a federally funded economic development organization, requests about 60 to 70 waivers a year for West Virginia and parts of 12 other states, from New York to Mississippi. The commission's program will n ot be hindered by the USDA's decision, an official said.

Still, congressmen said rural health care will suffer unless more foreign doctors receive visa waivers.

"There are a number of areas in my state that would have no convenient access to primary care were it not for a physician with a J-1 visa waiver," U.S. Sen. Sam Brownback (R, Kan.) said in a statement.

ADDITIONAL INFORMATION:

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Fact sheet on USDA participation in J-1 visa waiver program (http://www.usda.gov/news/releases/2002/03/fsj1visa.htm)

Appalachian Regional Commission J-1 visa waiver program (http://www.arc.gov/programs/j1visa/visapgrm.htm)

Correction

Throughout this story, American Medical News uses the term "foreign" in reference to doctors and residents. However, it is standard AMNews style to use the term "international" instead, as in "international medical graduates." AMNews regrets the error.