On August 31, 1995, Secretary of Health and Human Services Director Donna Shalala sent a letter to the heads of several federal agencies asking that they review and consider terminating their programs to sponsor waivers for physicians subject to the J-1 home residency requirement. Most of those programs are limited to foreign physicians wishing to work in primary care in a Health Provider Shortage Area. Secretary Shalala has indicated that she would like to limit J-1 waivers to those issued under the new Conrad State 20 waiver program which lets individual states sponsor J-1 waivers for up to 20 physicians in each fiscal year. According to Shalala, the increasing emphasis on managed care arrangements in the US are decreasing the demand for specialists. Shalala cited the Council on Graduate Medical Education estimate that by the year 2000, the national supply of specialists will exceed demand by more than 100,000. Shalala believes that those specialists will be largely retrained as primary care physicians and the demand for foreign physicians will decrease.
The logic behind Shalala’s proposal is questionable. First, the main reason for the drop in demand for specialists is because there will be a reciprocal increase in demand for primary care physicians. With a large nationwide increase in the number of primary care positions available, why would retrained specialists choose openings in rural areas over newly opened positions in more popular large cities. Most agencies already require that the applicant work in a health provider shortage area and that the petitioning facility demonstrate that a recruitment campaign has failed to yield a qualified US applicant. If the shortage of primary care physicians in rural areas disappears as Shalala indicates, foreign physicians would not be granted a waiver under current rules. Finally, many states have not implemented their Conrad Programs because of a lack of funding and available personnel. Shalala fails to mention anything in her letter about providing state officials with the resources to carry out the programs. Furthermore, the 20 physician per year limit would clearly be inadequate for many states. One official in Texas reported that his state receives more than 10 inquiries every day from persons interested in J-1 waivers.
A copy of the Shalala letter will be included on our documents page within the next few days.
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