Foreign Physicians: Data on Use of J-1 Visa Waivers Needed to Better Address Physician Shortages

GAO-07-52 Published: Nov 30, 2006. Publicly Released: Nov 30, 2006.
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Highlights

Many U.S. communities face difficulties attracting physicians. To address this problem, states and federal agencies have turned to foreign physicians who have just completed graduate medical education in the United States under J-1 visas. Ordinarily, these physicians must return home after completing their programs, but this requirement can be waived at the request of a state or federal agency if the physician agrees to practice in an underserved area. In 1996, GAO reported that J-1 visa waivers had become a major source of physicians for underserved areas but were not well coordinated with Department of Health and Human Services (HHS) programs for addressing physician shortages. GAO was asked to examine (1) the number of waivers requested by states and federal agencies; (2) waiver physicians' practice specialties, settings, and locations; and (3) the extent to which waiver physicians are accounted for in HHS's efforts to address physician shortages. GAO surveyed states and federal agencies about waivers they requested in fiscal years 2003-2005 and reviewed HHS data.

The use of J-1 visa waivers remains a major means of providing physicians to practice in underserved areas of the United States. More than 1,000 waivers were requested in each of fiscal years 2003 through 2005 by states and three federal agencies--the Appalachian Regional Commission, the Delta Regional Authority, and HHS. At the end of fiscal year 2005, the estimated number of physicians practicing in underserved areas through J-1 visa waivers exceeded the number practicing there through the National Health Service Corps (NHSC)--HHS's primary mechanism for addressing physician shortages. In contrast to a decade ago, when federal agencies requested the vast majority of waivers, states have become the primary source of J-1 visa waiver requests, accounting for 90 percent or more of waiver requests in fiscal years 2003 through 2005. States and federal agencies requested waivers for physicians to work in a variety of practice specialties, settings, and locations. In fiscal year 2005, a little less than half of the waiver requests were for physicians to practice exclusively primary care. More than three-quarters of the waiver requests were for physicians to work in hospitals or private practices, and about half were for physicians to practice in rural areas. HHS does not have the information needed to account for waiver physicians in its efforts to address physician shortages. Without such information, when considering where to place NHSC physicians, HHS has no systematic means of knowing if an area's needs are already being met by waiver physicians.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To better account for physicians practicing in underserved areas through the use of J-1 visa waivers, the Secretary of Health and Human Services should collect and maintain data on waiver physicians--including information on their numbers, practice locations, and practice specialties--and use this information when identifying areas experiencing physician shortages and placing physicians in these areas.
Closed – Not Implemented
HHS concurred with our recommendation and, in response, has since taken steps to collect information on J-1 visa waiver physicians, but it is not using this information in a way that is consistent with our report. In September 2022, officials from HHS's Health Resources and Services Administration (HRSA) reported that the agency had begun capturing data on physicians with J-1 visa waivers in its Shortage Designation and Management System (SDMS). The SDMS-which is used by state primary care offices to manage their health workforce data and by HRSA to review shortage designation applications-includes a field for state primary care offices to note whether a physician employed in the area is a J-1 visa waiver holder. This provides HRSA with the data identified in our recommendation. In our 2007 report, though, we also noted that these data were needed to ensure that HRSA was counting J-1 visa waiver holders along with other primary care physicians when it makes shortage designations. Specifically, we reported that without the data, the agency had no systematic means of knowing whether the needs of a shortage area were already being met through waiver physicians. However, in September 2022, HRSA officials reported that the agency is using these data to exclude J-1 visa waiver holders from the count of physicians working in area. We recognize HRSA's substantial and important efforts to collect and maintain a centralized source of information on J-1 visa waiver physicians. However, because the agency is excluding these physicians when determining areas experiencing physician shortages as intended in our recommendation, our recommendation is no longer valid for the program and we are closing this recommendation as unimplemented.

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