Lawmakers look to allow more international physician residents

Lawmakers reintroduced a plan to allow more international physician candidates attend residency in the U.S. and stay in the country after their training if they agree to work in underserved areas.

The legislation was reitroduced Thursday and would increase the number of slots in the Conrad 30 program. Sen. Amy Klobuchar (D-Minn.) first introduced the bill in 2019 with bipartisan support, but it failed to pass the Senate Judiciary Committee.

Minor changes were made to the bill to drum up a broader coalition of supporters, including reauthorizing the Conrad 30 program for three year following the bills enactment, language clarifying hospital malpractice concerns, and a mandate that directs U.S. Citizenship and Immigration Services and HHS to keep track of how the J-1 visa program is being used by states.

The American Hospital Association and American Medical Association both support the bill, but it is unclear whether the legislation’s effort to raise the number of slots for residency graduates to work in the country will effectively address workforce shortages in rural communities.

According to one study in the Journal of Primary Care and Community Health, over 40% of Delaware healthcare professionals working in a Healthcare Professional Shortage Area were recruited through the Conrad 30 waiver.

The bill comes as part of a push by lawmakers to bring more physicians to rural and underserved areas experiencing shortage. Each state implements the program differently based on the resources of individual medical facilities. But under the new bill each state will increase the 30 slot cap on the waiver to 35, if 90% of the country’s total available waivers are used. Some experts say this is unlikely to happen.

A report by the Rural Health Research Center shows from 2000 through 2010 states used, on average, 15 to 19 of their 30 allotted waivers. Half of the waivers used in 2010 went to physicians working in rural areas, but this number fluctuated throughout the decade. In earlier years, more waivers went to physicians practicing in urban, underserved communities than rural. More recent data on this distribution is not publicly available.

In 2019 only 25 states filled up all 30 of their waiver slots, the highest usage in the last 20 years. States with large urban populations like New York and Michigan used up every slot over this course of time, while states with smaller urban populations like Wyoming and Idaho struggled to fill 15%.

“The truth is that a lot of states never used all of the waivers available to them,” said Davis Patterson, director of the Rural Health Research Center. “There’s a concern that if you increase the cap [for the waiver] big states will suck up applicants and lead to greater maldistribution.”

Patterson also said the amount of oversight provided to each waiver program varies depending on state resources, making workers dependent on their employer to remain in the country vulnerable to exploitation and abuse.

The bill provides some fixes to these concerns, including a mechanism to only increase slots as the rates of utilization hit 90%, preventing better resourced states from taking applicants from smaller states, and added protections for workers to prevent mistreatment.

“By expanding access to healthcare in our rural and underserved communities, this bipartisan bill would promote healthier lives and ensure that families across the country receive the healthcare they deserve,” Sen. Susan Collins (R-Maine) said in a statement.

It’s unclear whether the bill will effectively bring more doctors to specifically rural areas.

In Thursday’s Senate Health, Education, Labor, and Pensions Committee hearing lawmakers expressed support for providing incentives to healthcare workers willing to work at rural facilities, even considering a loan repayment program for those graduating from GME Medicare slots.

A report by the AAMC shows the U.S. will have a shortage of 139,000 physicians by 2033. Rural areas are especially vulnerable. Only 11% of physicians practice in rural facilities, while 20% of the U.S. population live in rural areas. Neither of these statistics take into account the exodus of physicians from the workforce following the COVID-19 pandemic.