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COMMENTARY: DON'T LET THE USDA PHYSICIAN WAIVER PROGRAM DIE
By Greg Siskind  
Most people in the United States take having readily available health care for granted. After all, the country is home to a sizeable portion of the world’s best doctors and hospitals. Much of the leading medical research in the world takes place at American institutions. Huge hospitals are springing up in suburbs all over the country and are the home to many of the 15,000+ doctors who graduate from medical schools in the US every year. 
Yet for the 51 million Americans who reside in rural areas in this country, the availability of even a single local doctor cannot be taken for granted. Nearly 40% of these Americans live in areas that have a shortage of primary care doctors available to meet the most basic medical needs. The Department of Health and Human Services has identified nearly 1200 rural areas, often entire counties, which are Health Professional Shortage Areas (HPSAs).  For millions of Americans in this country, the lack of access to a doctor can be a life or death dilemma. And the problem only seems to get worse from year to year. Several new studies indicate that there will be a nationwide shortage of physicians in the near future. 
 Why the gap between urban and suburban areas and rural areas? Despite claims by some that there is a surplus of physicians in this country, American physicians generally do not want to locate in rural areas. This is despite the fact that generous programs have been designed to attract physicians to these areas. Loan repayment plans (like the one television audiences may remember attracted Dr. Joel Fleishman to Cicely, Alaska on Northern Exposure) have had only modest success. And rural communities’ offers to pay much higher salaries usually go unheeded. 
 For thousands of communities across the US, the answer has been to hire foreign medical school graduates after they have come to the US and completed their residency programs here. Most of these physicians enter the US on J-1 visas, which are coupled with the requirement that the physician leave the US for two years when the residency program is over. To get around this requirement and stay in the US, a physician will need to find a US government agency or a state health agency that will sponsor the physician for a waiver. 
 One of the most successful waiver programs over the years has been run by the US Department of Agriculture. The USDA sponsors physicians interested in providing primary medical care to rural communities across the country. Since the USDA created its program in 1994, more than 3,000 doctors have been sponsored by that agency to serve 11 million elderly and poor rural Americans. Many of these doctors have gone to work in clinics and hospitals in remote areas of Appalachia and the Deep South. The USDA has sent a number of others to work in Texas and California. These two states, as well as Oregon, South Dakota, Kansas and Oklahoma, rely exclusively on the USDA program for the sponsorship of physicians working in rural communities. 
Unfortunately, the future of the USDA waiver program is in grave danger right now. All waivers have been on hold since September 11th, and the USDA is reviewing the program and is considering ending it all together. Some have cited security issues as a reason to kill the program, though it is hard to believe that this is an issue that cannot be addressed. There are few terrorism experts who would point to physicians working in rural areas as a real threat to the country. Except for the fact that some of these doctors may be from countries from the Middle East, there seems to be no resemblance to the September 11th hijackers. 
 Some are claiming that physicians are cheating and are not providing the promised three years of service to their communities. But there are several important safeguards built into the system to minimize such problems. Physicians cannot get their green cards until they have worked three to five years on a temporary visa. And physicians cannot legally change employers without the permission of the Immigration and Naturalization Service, and the INS cannot legally approve the employer change unless the physician can show that he or she was not at fault in needing to change jobs (for example, the facility closed). If the physician ceases to work in the pre-approved area, the waiver is automatically revoked by operation of law. All of the evidence available seems to point to the conclusion that any abuses in the program are far and few between. 
 What may be behind the efforts to kill the USDA waiver program is something far more mundane. One very able USDA employee has run the waiver program virtually on her own for the past eight years. She is reportedly interested in retiring and the USDA is reluctant to train a replacement (or replacements). The program does not produce revenue for the USDA, and bureaucrats are reluctant to take on extra work. Most communities badly needing a physician would gladly chip in for the costs of keeping this program going. How sad it would be if such a vital program as this one were to die for such a small amount of money and effort. 
 We know that many of our readers are familiar with the benefits of the USDA program through first hand knowledge. You may be a physician, an immigration lawyer, an administrator or just a resident of a town that has benefited from this program. Your stories need to be heard by both the USDA as well as members of Congress. If you would like to join in the effort to save the USDA physician J-1 waiver program, please let us know by emailing me at USDA@visalaw.com. 
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