House Holds Hearings on Conrad 30 Extension Bill

The Physicians Underserved Areas Act (HR 4997) was introduced in the House of Representatives in March 2006 by Representative Jerry Moran (R-KS).  If passed, this bill would permanently authorize the Conrad 30 J-1 Visa Waiver Program.  Currently, the program has to be reauthorized every several years.

On May 12, 2006, the bill was referred to the House Subcommittee on Immigration, Border Security, and Claims.  The House then began holding subcommittee hearing on May 18, 2006.

In his testimony during the subcommittee hearing, Representative Moran stated that the Conrad 30 Waiver Program has greatly benefited Kansas.  “Kansas has been able to recruit 66 physicians to work in underserved areas and with underserved populations since 2002.  Each year, the interest has grown and more and more physicians and hospitals are finding that this match is benefiting not only themselves, but the communities which they serve.”

Representative Sheila Jackson Lee (D-TX) provided the opening statement for the hearing.  In her remarks, she stated: “The J-1 visa waiver program has been in effect now for more than a decade.  In addition to being a good source of additional physicians, it ensures that the additional physicians will go where they are most needed, health professional shortage areas in both rural and urban settings.”

Representative Moran detailed how the waiver program has helped several areas in Kansas, whose health care providers are now dependent on J-1 waiver physicians.  He ended his remarks by stating: “People deserve quality health care regardless of their location.  The J-1 Visa Waiver program is helping many hospitals in my district find qualified physicians for their communities and this increases the quality of healthcare overall in Kansas.  This is a well regarded, well run program that is worthy of permanent reauthorization.  The Physicians for Underserved Areas Act is the way to make this happen.”

In addition to the statements by Congressional representatives, the Government Accounting Office (GAO), represented by Leslie G. Aronovitz, prepared a study of the Conrad 30 program and presented the findings at the hearing.  The GAO found that “the use of J waivers remains a major means of placing physicians in underserved areas in the United States...In contrast to a decade ago, states are now the primary source of waiver requests for physicians to practice in underserved areas, accounting for more than 90 percent of such waiver requests in fiscal year 2005.” 

The GAO study further found that 11 states did not find the 30-waiver limit to be adequate for their physician staffing needs.  These states include Arizona, California, Louisiana, Massachusetts, New York and Texas.  Also, 25 states that did not always use all 30 of its waiver slots stated they would be willing to have their unused slots redistributed to those states that need additional waivers.

Edward Salsberg, Director of the Center for Workforce Studies at the Association of American Medical Colleges (AAMC) also testified for the subcommittee about the shortage of physicians in the U.S.  “The expected future shortage of physicians is driven by likely changes in both the supply and the demand for physicians. On the demand side, key factors include: (1) the growing U.S. population; (2) the rapid growth in people over the age of 65 (those that consume the greatest resources); and (3) the rising expectations of Americans along with increasing wealth that will motivate and enable them to use more services. On the supply side, key factors include: (1) the aging of the physician workforce (1 of 3 active physicians over the age 55 and they are likely to retire by 2020); and (2) a new generation of physicians who may not be willing to work the long hours that prior generations of physicians have worked.”

The National Health Care Access Coalition also presented testimony for the hearing, which outlined that there will be serious shortage of physicians within the next fifteen years.  The coalition also pointed out that the U.S. is not the country with the most international medical graduates.  “According to the World Health Organization, the leader in recruiting IMGs is New Zealand with 34% of its doctors being educated elsewhere and the United Kingdom closely following at 33%. Australia’s IMG population is 21% and Canada is at 23%. The US falls in the middle of this pack.” 

The statement continues: “[W]hile the U.S. may feel guilty about recruiting physicians trained in developing countries and possibly exacerbating a brain drain in some markets, the fact is a doctor will often choose to go to another developing country if they are not permitted to remain in the U.S.  Several countries, Australia being a prime example, have recently instituted “red carpet” visa programs to make it easy for physicians trained in the U.S. to move there.  The question then becomes not whether we should force doctors to leave so they can go home but whether we should be subsidizing the training of doctors for wealthy competitor countries…The only true way to address a brain drain is to address the push factors that cause a doctor to immigrate – poor working conditions, civil unrest, crime, corruption, etc.  Until living conditions and career opportunities improve in a country, a physician will rationally make the choice to emigrate.  And if a physician is going to emigrate, the question then becomes how to make the US the destination to help address our own country’s shortage.”

In addition to permanently reauthorizing the Conrad 30 Waiver Program, the coalition also recommends increasing the number of waivers a state can grant to 40, allowing states who do not use all of their waivers to redistribute them to states who need additional them, expanding the Conrad program by ten waivers reserved for U.S. research hospitals, exempting physicians from the EB-2 green card cap and exempting from the H-1B cap those physicians on H-1B visas who work in underserved areas.

The witnesses’ statements from the hearing, the preliminary GAO findings and a video recording of the hearing can be found at http://judiciary.house.gov/Hearings.aspx?ID=142.

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