Health Equity

Conrad 30 reauthorization bill earns bipartisan support


A bipartisan health measure before Congress would continue a program that provides access to care in underserved communities. While reauthorized without controversy in years past, the progress of the proposed Conrad State 30 and Physician Access Reauthorization Act is more contentious this year against a backdrop of controversies on immigration.

The AMA voiced its support of the measure in a letter to co-sponsors of the bill. “With communities across the country facing physician shortages, the Conrad 30 program ensures that physicians who are often educated and trained in the U.S. can continue to provide care for patients,” wrote AMA Executive Vice President and CEO James L. Madara, MD, pointing out that the program helps patients in both rural areas and low-income city neighborhoods. Joining with the AMA in support of Conrad 30 are the American Hospital Association and the Association of American Medical Colleges.

The original version of the Conrad 30 bill dates back to 1994. Through subsequent reauthorizations, the program has resulted in bringing more than 15,000 physicians to underserved areas. It does so by providing an essential waiver to physicians who come to this country on J-1 work-study visas for residency training. Otherwise, those physicians would be forced to return home for two years before applying for a new visa or green card. In exchange, the physicians give a three-year commitment to practice in an underserved community.

The current bill has bipartisan sponsorship in the Senate and House versions (S. 898 and H.R. 2141) and, if passed, would remain in effect until 2021. The introduction of the bills marks a positive moment in an otherwise worrisome year for many physicians holding or needing J-1 visas. Earlier, they and their training programs were jolted by two immigration and travel executive orders, first revised and now put on hold by federal judges.

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This latest iteration of Conrad 30 includes needed protections for physicians who are at risk of exploitation—for example, concerning on-call hours—in the limited choice of placements available to them. “Provisions in this bill that would make improvements to the program by requiring more transparency in employment contract terms, creating additional waivers per states, and protecting spouses and children of physicians in the program” all have the AMA’s support, Dr. Madara’s letter states.

The last authorization expired on April 28, but in practical terms lawmakers may take some time to vote without disrupting patient care. If not enacted, eventually the waiver process—initiated by states on behalf of doctors—will break down. The “30” in the Conrad program is shorthand for the per-state limit on waivers. At current levels, about 1,500 physician placements could be affected in the immediate wake of an end to new applications.

With a J-1 waiver in hand, the next step is the transition to an HB-1 visa that allows for six years of employment. On April 3 came the disappointing news that an expedited HB-1 approval program is on hold for up to six months. The “premium processing” program can secure a HB-1 decision within 15 days, instead of the months it could take otherwise. That speed is critically important. All this plays out in the last year of residency and the HB-1 processes can’t even start until the state obtains the waiver. Once no longer covered by a J-1 visa, there is only limited time for HB-1 approval so those physicians can begin their new jobs on schedule or even stay in the country.

U.S. Citizenship and Immigration Services says the suspension allows it time to clear out its HB-1 backlog. That has happened before, but six months is an unusually long period. The situation concerning Conrad 30 physicians is too close for comfort for patients in underserved communities, the physicians who serve them and states seeking to keep Conrad 30 running smoothly. All of them have benefited from a successful, well-focused program, designed to place critically needed doctors in settings where others are not rushing in to practice.