[Maine-NPs] Foreign Med Grads and Rural Care

[Hannah Pressler]

I encourage everyone who reads this to respond to the AP 'info at ap.org'  This
is a physician-centric article. I included links to AANP and ACNP with
statistics, definitions and quality of care research/articles as well as
Susan Collins' introduced FECA and Home Health Legislation. I encouraged
Chris Talbot to look beyond J-1 visa applicants and medical school loan
paybacks as a way to improve care to the underserved and focus on the nurse
practitioners who provide this care.

 

Shortage of doctors affects rural U.S.

 

By CHRIS TALBOTT, Associated Press Writer

Sun Jul 22, 2:58 AM ET

 

GREENWOOD, Miss. - A national shortage of doctors is hitting poor

places the hardest, and efforts to bring in foreign physicians to fill

the gap are running into a knot of restrictions from the war on terror

and the immigration debate.

ADVERTISEMENT

Doctors recruited from places such as India, the Philippines and sub-

Saharan Africa to work in underserved areas like the Mississippi Delta

and the lonesome West already face an arduous and expensive gauntlet

of agencies, professional tests and background checks to secure work

papers and permanent residency.

Those restrictions have only tightened in the years since 9-11, and

now many believe the process will become more difficult after the

attempted terrorist bombings in Britain that have been linked to

foreign doctors.

"The consensus seems to be that if you have a first name like

Mohammed, you can forget it," Dr. Sanjay Chaube, a much-needed

internist in Hurricane Katrina-ravaged Bay St. Louis, Miss., and one

of more than 40,000 Indian doctors in the U.S. He is working in this

country under what is known as a J-1 visa waiver.

The government estimates that more than 35 million Americans live in

underserved areas, and it would take 16,000 doctors to immediately

fill that need, according to the American Medical Association. And the

gap is expected to widen dramatically over the next several years,

reaching 24,000 in 2020 by one government estimate. A 2005 study in

the journal Health Affairs said it could hit an astonishing 200,000 by

then, based on a rising population and an aging work force.

"And that will mostly be felt in rural America," said Sen. Kent

Conrad, D-N.D. He added: "We're facing a real crisis."

America's rural and inner-city poor already are suffering the most.

For example, there are 280 doctors for every 100,000 people in the

U.S. But there are only 103 for every 100,000 in the 18-county area of

the Mississippi Delta, according to the Mississippi State University

Social Science Research Center. And the Delta has some of the nation's

highest rates of infant mortality, heart disease and other serious

illnesses.

Steps are slowly being taken by individual states and universities to

enroll more students in medical school. But it takes years to educate

a doctor. And even then, many professionals are unconvinced those

steps alone will make much difference.

To help relieve the misery in the Delta, Appalachia and other parts of

the country in dire need of physicians, the government lets foreign

doctors into the country under J-1 visa waivers, dispensed through a

variety of state and federal programs.

J-1 visa waivers allow foreign doctors to work in underserved areas

for three to five years, with a shot at eventually obtaining permanent

residency.

Over each of the past three years, about 1,000 practicing physicians

have come to the U.S. on J-1 visa waivers. Many of them are from

unstable or undeveloped countries and come here in search of better

training, working conditions and pay.

Yet, since 9-11, the federal government has made it more difficult to

qualify for the special visas and to obtain permanent residency. The

tests are harder, the legal fees are higher, and the rules have been

changed by the Department of Health and Human Services in such a way

that fewer counties and clinics are designated "underserved" and thus

eligible to obtain J-1 doctors.

As a result, some foreigners are choosing to leave after their

commitment is up, or are not applying to come to the U.S. at all.

The number of physicians in training with J-1 visa waivers has fallen

by almost half over the past decade, from 11,600 in academic year

1996-97 to fewer than 6,200 in 2004-05, according to the Government

Accountability Office. And federal and state requests for J-1s for

doctors dropped from 1,374 in 1995 to 1,012 in 2005.

Medical professionals and others have put much of the blame on HHS.

Before 9-11, the Department of Agriculture operated a program that

brought more than 1,000 doctors a year to the United States, but it

was shut down after 9-11. HHS then took charge of a new program in

2003 with tighter rules, and has approved just 61 J-1 visas since.

But the HHS said the numbers dropped because of a lack of interest

among doctors.

"We just aren't getting that many applications because the pool is

smaller and the tendency is to go to the states because the rules

about what they can do are much broader," said Stephen R. Smith,

senior adviser to the Health Resources and Services Administration's

administrator at HHS.

The vast majority of J-1s are being issued instead under a 13-year-old

program sponsored by Conrad. The Conrad State 30, as it is now called,

authorizes 30 J-1s per state per year. But the program will expire

unless reauthorized by Congress in 2008.

Some foreign doctors are giving up on the American dream.

Husband-and-wife Drs. Rohit Panchal and Vaishali Shah were heralded on

a billboard in Greenwood when they arrived. As a pulmonologist with

critical care training and an internist, they treat a patient

population with some of the highest rates of lung cancer, diabetes and

other grave illnesses.

They find the work rewarding, but when their commitment ends they are

considering returning to India instead of trying to obtain permanent

residency.

"It's too long and tedious a process. It's too tiring," Panchal said

during a break from rounds in the Greenwood Leflore Hospital.

The federal government cannot be blamed for everything, said Dr.

Sampatkumar Shivangi, an obstetrician and gynecologist in Jackson,

Miss., who is president-elect of the American Association of

Physicians of Indian Origin.

He once tried unsuccessfully to help a J-1 physician find a position

with a rural Mississippi clinic.

"Some of the physicians in that community didn't want a physician to

come and practice there because it would take away patients," Shivangi

said.

 

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