Foreign physicians who come to the United States for residency programs and the patients they later treat in medically underserved areas like East Tennessee are being "caught up in the anti-immigrant mood sweeping the country," a local immigration lawyer wants.

At issue is a letter recently sent by Donna Shalala, US Secretary of Health and Human Services, to the heads of other federal departments urging them to make states solely responsible for granting a limited number of "J-1 visas." The visas, which historically have been granted by federal agencies, allow international students to dodge a requirement that they return to their homelands for at least two years if they agree to practice medicine in regions with few physicians.

Each state would have a maximum of only 20 visas each year, though Shalala leaves open the possibility of "increasing flexibility with respect to the numbers of physicians that can be placed."

"This makes it much more difficult for rural areas to recruit physicians," said Greg Siskind, a Nashville attorney who discovered the Shalala letter while scanning a forum for the American Immigration Lawyers Association on Compuserve.

There are more than 100,000 doctors practicing in the United States who were foreign nationals when they entered the country. Tennessee normally places 20-25 physicians under the J-1 visa program each year, said Gary Zelizer, director of community health services for the Tennessee Department of Health.

"We will be assuming responsibility for the program within the next four to six months," Zelizer said.

Many of the "J-1" physicians already in Tennessee were granted waivers by the Appalachian Regional Commission and serve in rural areas of East Tennessee. There are other "health professional shortage areas" throughout the state eligible for foreign doctors, including downtown Nashville.

While the state might recommend expanding the 20-doctor cap, Dr. Fredia Wadley, state health commissioner, sees the department’s expanded role "as an opportunity to make sure we place up to 20 doctors in the most needed areas," Zelizer said.

In Shalala’s letter, she said HHS sees the purpose of the program not as "a mechanism to help resolve the problems of shortage areas, but as a way to make sure that the foreign physicians share their advanced medical knowledge with their home countries. Further, she said there could be a surplus of doctors in the United States by 2000 as managed care takes greater hold.

But attorney Siskind sees the proposed change in more political terms.

"It’s coming at a time when the most serious anti-immigration legislation in years is moving through Congress," Siskind said, referring to bills in the House and Senate that would reduce legal immigration levels by as much as one-third.

While Republicans have drafted the bills, rank-and-file Democrats appear more willing to support such legislation in order to satisfy traditional party supporters’ appetite for immigration reform, he said.