by Nicky Robertshaw, Memphis Business Journal

Congress has approved legislation that provides an important new incentive for attracting doctors to medically underserved areas, including poor areas of Memphis and rural areas in the Mid-South.

Foreign doctors who commit to work in these areas for five years can obtain their green cards, or permanent residency status, once they complete such service. In contrast, before the law took effect Nov. 12, these doctors who typically come to this country for their residencies, had to go back to their own countries for two years before they could return to the United States to work and apply for permanent residency.

"The doctors I've been speaking with are very interested in having some certainty about their status in the United States," says Greg Siskind, an attorney with Siskind, Susser, Haas & Devine. He notes that they don't like the idea of settling into life here, then later finding out they have to leave because of immigration laws.

About a quarter of all residency slots nationwide go to foreigners and many prefer to remain in the US, he says.

The problem of attracting doctors to rural areas of Tennessee, Arkansas and Mississippi is nothing new. Jim Hunt, chancellor emeritus of the University of Tennessee, Memphis in 1990 set up a program for Tennessee under which small communities would help pay for a medical student's four year education in exchange for four years of doctoring once the student finished school. 

"We signed up 200 people, and I'd say half of them graduated and relocated," Hunt says, adding that the program tries to match students with their hometowns.

The US Department of Health and Human Services maintains a list of both rural and urban areas that it considers to be underserved in terms of primary medical care. The current list includes census tract areas in Whitehaven, Millington, Frayser and northwest Memphis as well as numerous rural counties in Tennessee, Arkansas and Mississippi.

In the urban areas the problem is a shortage of local clinics to provide basic care. These typically impoverished minority areas have trouble getting doctors, Siskind says.

This law applies to areas underserved in terms of primary medical care, mental health care and dental care.

The new law gives these medically underserved areas, both rural and urban, a powerful incentive for recruiting from a different group of doctors. These are doctors from other countries who are already in this country under a J-1 visa to complete their residencies.

Technically, the law requires the government to grant a national interest waiver-based permanent residency petition, filed on behalf of any alien physician who meets certain criteria. The idea is that the physicians are entitled to the waiver because they work in the national interest.

Siskind points out that until two years ago, the Immigration and Naturalization Service did consider the doctor's work in underserved areas to be in the national interest and therefore eligible for waivers from the usual green card requirements. However, at that time INS decided that this work was in the local interest, not the national interest, and therefore the doctors were not eligible for waivers. 

"What Congress has done is to force the INS to go back and start approving national interest waivers," he says.

The criteria for receiving the waiver are:

In addition to creating national interest waiver for doctors, the law also creates a new visa category for nurses from other countries who want to work in disadvantaged areas, Siskind says. However, since it only is available to a small percentage of employers hiring nurses, he sees this provision as less significant. 

American College of International Physicians executive director Laura Baker estimates there are 300,000 physicians in the United States who received their degrees in other countries, a number that includes American citizens. She says that the degree requirements in other countries are equal to or greater than the requirements in this country.