VISA Programs: Do They Help In Primary Care and Rural Areas?

Robert C. Bowman, M.D.

  Total 1987 - 1999 Class Years Workforce Urban Under-served Rural Under served All Rural Rural Not MMC Major Medical Center Isolated Rural Isolated Under served Military
US Population 2000   10.7% 7.1% 20.0% 17.2% 33.7% 4.2% 2.0% 0.7%
National Averages 100.00% 3.0% 2.7% 9.8% 7.2% 73.4% 1.1% 0.40% 1.8%
Deficit Ratio 1 0.28 0.38 0.49 0.42 2.18 0.26 0.20 2.57
Black,Hispanic,Native FP 3.40% 11.8% 6.6% 12.9% 11.1% 52.4% 1.5% 0.6% 2.0%
Rural US Born FPGP 2.01% 3.2% 12.3% 41.7% 35.2% 40.2% 6.7% 2.43% 6.8%
Foreign Born IMG Off IM 1.97% 5.9% 6.7% 14.4% 12.3% 60.4% 2.2% 1.45% 0.5%

Distribution: Index Concentrations of Physician Distribution - compare and contrast the various types that distribute to rural underserved and urban underserved locations. How do international medical graduate internal medicine physicians compare to family physicians? What does birth origin have to do with practice location?

Preliminary Findings on the Use of J-1 Visa Waivers to Practice in Underserved Communities GAO   Visa waiver programs are increasing in numbers and importance and generally contribute more than NHSC programs although state to state variation is common. Generally the most urban states use waivers the most. The "least desirable" states and those without training programs in close proximity to needs have more difficulties filling the waivers. Visa waiver physicians are not always monitored. No federal agency tracks actual underserved locations or contributions, which remain largely unknown. About 75% of practice location waivers were to allow hospital practice. States requested waivers to insure that J-1 Visa physicians would actually serve the underserved. 14 states feared that giving up unused Visa permits would allow IMGs to wait until the Visa permits were redistributed to larger states considered more desirable. One state noted that it had fewer takers when the Conrad limit was increased from 20 to 30 in 2002. States can use up to 5 positions of their 30 allotment to address needs outside of underserved areas. This level was considered adequate by 27 states.

More Data Needed on J-1 Visa Waiver contributions with repetition of much of the above  Also various violations of the waivers were reported including IMGs not showing up to work, leaving locations without permission, or practicing outside of approved specialty or location. Relatively few violations were reported but monitoring was reported as low and constrained by low budgets for monitoring and supervision of all such activities.

Strategies for Addressing Potential Losses of IMGs

What Could Have Been: Maximal Primary Care Training Capacity

Physician Workforce Studies


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