Foreign Physicians:

Exchange Visitor Program Becoming Major Route to Practicing in U.S. Underserved Areas

HEHS-97-26: Published: Dec 30, 1996. Publicly Released: Dec 30, 1996.

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GAO reviewed the extent to which state and federal agencies used waivers to meet physician shortages in medically underserved areas, focusing on: (1) how many foreign physicians with J-1 visas receive waivers, where they practice, and their medical specialties; (2) whether federal agencies and states effectively coordinate policies and procedures for granting these waivers; and (3) the extent to which foreign physicians who receive waivers comply with waiver requirements to practice in underserved areas.

GAO found that: (1) the number of waivers for physicians with J-1 visas to work in underserved areas has risen from 70 in 1990 to over 1,300 in 1995; (2) requesting waivers for physicians with J-1 visas has become a major means of providing physicians for underserved areas; (3) in 1994 and 1995, the number of waivers processed for these physicians equaled about one-third of the total identified need for physicians in the country; (4) almost all of these waiver physicians have primary care medical specialties and they are practicing in 49 states and the District of Columbia; (5) nearly 30 federal and state agencies were processing waiver requests for physicians from hospitals, health centers, and other health care facilities by 1995; (6) among them, no agency has clear responsibility for ensuring that placement efforts are coordinated; (7) although the federal agencies are now working together informally, they still have differing policies, overlapping jurisdictions, and varying communication with the states; (8) the Department of Health and Human Services (HHS) believes that the physicians should return home after completing their training to meet the intent of the exchange visitor program, and the other agencies view the waiver provision as a means to secure physicians to meet the health care needs of their constituents; (9) while more than 9 of every 10 physicians whose waivers were processed between 1994 and 1995 were practicing at their locations in January 1996, controls are somewhat weak for ensuring that physicians continue to meet the terms of their agreements; (10) even when the physicians and facilities follow the agencies' rules, the rules do not restrict physicians from working with those segments of the population that already are adequately served; and (11) proposed regulations published by the United States Information Agency and developed in working with the informal interagency group, coupled with recent amendments to the Immigration and Nationality Act would address many of the coordination and compliance problems, but not all of them.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: No plans exist to introduce needed legislation.

    Matter: If Congress wants to continue to address medical underservice in the United States through the use of waivers for physicians with J-1 visa requirements, it should consider requiring that the use of such waivers be managed as a program. Specifically, Congress should consider clarifying how the use of waivers for these physicians fits into the overall federal strategy to address medical underservice. This should include determining the size of the waiver program and establishing how it should be coordinated with other federal programs.

  2. Status: Closed - Not Implemented

    Comments: The implementing legislation has not been introduced.

    Matter: If Congress wants to continue to address medical underservice in the United States through the use of waivers for physicians with J-1 visa requirements, it should consider requiring that the use of such waivers be managed as a program. Specifically, Congress should consider designating leadership responsibility for managing the program. This responsibility could be given to a single federal agency, such as HHS, to several federal agencies, for example, through a memorandum of understanding, or it could be delegated to the states.

  3. Status: Closed - Not Implemented

    Comments: The implementing legislation has not been introduced.

    Matter: If Congress wants to continue to address medical underservice in the United States through the use of waivers for physicians with J-1 visa requirements, it should consider requiring that the use of such waivers be managed as a program. Specifically, Congress should consider establishing penalties against facilities that fail to comply with requirements of the waiver.

  4. Status: Closed - Not Implemented

    Comments: The implementing legislation has not been introduced.

    Matter: If Congress wants to continue to address medical underservice in the United States through the use of waivers for physicians with J-1 visa requirements, it should consider requiring that the use of such waivers be managed as a program. Specifically, Congress should consider directing the entity managing the program to implement procedures and criteria for the selection and placement of physicians and for monitoring compliance with waiver requirements. These procedures and criteria could include requiring the state to clearly support the use of the physician for addressing unmet need and to show that it has sought other options for fulfilling this need.

 

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