The US Department of Health and Human Services this past week reopened its J-1 waiver program for physicians working in underserved areas. The program was closed several months ago without warning or explanation. When it reopened, several additional rules were announced that will significantly reduce the number of physicians that will be eligible for waivers:

• Only facilities in Health Professional Shortage Areas with a score of 14 will qualify (previously, facilities in any Health Professional Shortage Area as well as Medically Underserved Areas were eligible)
• The only qualifying facilities will be health centers qualified under the Public Health Service Act, rural facilities as defined by the Social Security Act and Native American/Alaskan Native tribal facility 

Critics of the program have questioned why HHS felt it necessary to reduce the number of eligible facilities when only a few dozen applications were received under the more liberal rules. According to HHS, only 43 applications were received in the several months the program was active even after the program received a great deal of publicity. And the timing is even more awkward given the very public reversal this week of the American Medical Association on the question of the nation’s physician shortage. Coupled with the publication of an article in JAMA – The Journal of the AMA – of a study showing medical school deans deeply worried about the future supply of doctors, the AMA confirmed that the nation is facing a severe physician shortage – particularly for specialists – and immediate action is needed. An abstract of the JAMA report can be found online at http://jama.ama-assn.org/cgi/content/abstract/290/22/2992.