Foreign Physicians
Data on Use of J-1 Visa Waivers Needed to Better Address Physician Shortages Gao ID: GAO-07-52 November 30, 2006Many 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.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-07-52, Foreign Physicians: Data on Use of J-1 Visa Waivers Needed to Better Address Physician Shortages
This is the accessible text file for GAO report number GAO-07-52
entitled 'Foreign Physicians: Data on Use of J-1 Visa Waivers Needed to
Better Address Physician Shortages' which was released on November 30,
2006.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
November 2006:
Foreign Physicians:
Data on Use of J-1 Visa Waivers Needed to Better Address Physician
Shortages:
J-1 Visa Waivers for Physicians:
GAO-07-52:
GAO Highlights:
Highlights of GAO-07-52, a report to congressional requesters
Why GAO Did This Study:
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.
What GAO Found:
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.
Figure: J-1 Visa Waivers Requested by States and Federal Agencies,
Calender Year 1995 and Fiscla years 2003 through 2005:
[See PDF for Image]
Sources: GAO/HEHS-97-26; GAO survey of states, 2005; GAO survey of
federal agencies, 2005.
Note: "States" refers to entities eligible to request waivers under the
authority granted to states including the 50 states, the District of
Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.
[End of Figure]
What GAO Recommends:
GAO recommends that the Secretary of Health and Human Services collect
and maintain data on waiver physicians and use these data when
identifying areas experiencing physician shortages and placing
physicians in these areas. HHS concurred with GAO‘s recommendation.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-52].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Leslie G. Aronovitz at
(312) 220-7600 or aronovitzl@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
Waivers Remain a Major Means for Providing Physicians to Underserved
Areas:
Waivers Were Requested for Physicians to Work in a Variety of Practice
Specialties, Settings, and Locations:
Most States and Federal Agencies Reported That They Conducted
Monitoring Activities:
HHS Lacks Data to Account for Waiver Physicians in Its Efforts to
Address Physician Shortages:
Conclusions:
Recommendation for Executive Action:
Agency Comments and our Evaluation:
Appendix I: Physician Need and Number of Primary Care Waiver and
National Health Service Corps Physicians, by State:
Appendix II: States' and Federal Agencies' Requests for J-1 Visa
Waivers:
Appendix III: Comments from the Department of Health and Human
Services:
Appendix IV: Contact and Acknowledgments:
Related GAO Products:
Tables:
Table 1: Physicians Needed and Number of Primary Care Waiver and NHSC
Physicians, by State, as of September 30, 2005:
Table 2: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by State, Fiscal Years
2003 through 2005:
Table 3: J-1 Visa Waivers Requested by Federal Agencies for Physicians
to Practice in Underserved Areas, by State, Fiscal Years 2003 through
2005:
Table 4: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by Practice Specialty,
Fiscal Years 2003 through 2005:
Table 5: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by Practice Setting,
Fiscal Years 2003 through 2005:
Table 6: States' and Federal Agencies' Policies for Requesting J-1 Visa
Waivers, Fiscal Year 2005:
Figures:
Figure 1: Process to Apply for and Obtain a J-1 Visa Waiver for a
Physician to Work in an Underserved Area:
Figure 2: J-1 Visa Waivers Requested by States and Federal Agencies,
Calendar Year 1995 and Fiscal Years 2003 through 2005:
Figure 3: J-1 Visa Waivers Requested by States, Fiscal Year 2005:
Figure 4: Practice Specialties of Physicians for Whom States and
Federal Agencies Requested J-1 Visa Waivers, Fiscal Year 2005:
Figure 5: J-1 Visa Waivers Requested by States and Federal Agencies, by
Practice Specialty, Fiscal Year 2005:
Figure 6: Practice Settings of Physicians for Whom States Requested J-
1 Visa Waivers, Fiscal Year 2005:
Figure 7: Proportion of J-1 Visa Waivers Requested by States and
Federal Agencies for Physicians to Practice in Rural and Nonrural
Areas, Fiscal Year 2005:
Figure 8: Monitoring Activities That States and Federal Agencies
Requesting J-1 Visa Waivers Reported Conducting in Fiscal Year 2005:
Figure 9: States' and Federal Agencies' Practices to Help Ensure
Physicians Meet Their Waiver Agreements:
Abbreviations:
ARC: Appalachian Regional Commission:
DRA: Delta Regional Authority:
ECFMG: Educational Commission for Foreign Medical Graduates:
FTE: full-time equivalent:
HHS: Department of Health and Human Services:
HPSA: health professional shortage area:
MUA/P: medically underserved area or population:
NHSC: National Health Service Corps:
USCIS: U.S. Citizenship and Immigration Services:
VA: Department of Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
November 30, 2006:
The Honorable Sheila Jackson Lee:
Ranking Minority Member:
Subcommittee on Immigration, Border Security, and Claims:
Committee on the Judiciary:
House of Representatives:
The Honorable Kent Conrad:
United States Senate:
Many communities throughout the country experience difficulties in
attracting physicians to meet their health care needs. To address the
need for physicians in underserved areas,[Footnote 1] states and
federal agencies have turned to foreign physicians who have just
completed their graduate medical education in the United States. Many
of these foreign physicians entered the United States on temporary
visas, called J-1 visas. Once they have completed their graduate
medical education, these physicians are required to return to their
home country or country of last legal residence for at least 2 years
before they may apply to stay permanently in the United States or for
certain temporary work visas. This foreign residence requirement can,
however, be waived in certain circumstances, including at the request
of a state or federal agency if the physician agrees to practice in an
underserved area for at least 3 years.[Footnote 2] J-1 visa waivers are
granted by the Department of Homeland Security at the recommendation of
the Department of State.[Footnote 3]
In 1996, we reported that the number of J-1 visa waivers requested by
states and federal agencies for physicians to work in underserved areas
had risen dramatically--from 70 in 1990 to more than 1,300 in 1995--and
that requesting waivers had become a major means of placing physicians
in underserved areas. We estimated that in 1995, the number of waiver
physicians practicing in underserved areas exceeded the number of
physicians practicing in such areas through National Health Service
Corps (NHSC) programs--the Department of Health and Human Services'
(HHS) primary mechanism for addressing shortages of physicians and
other primary care health professionals.[Footnote 4] We reported that
slightly over half of these waiver physicians practiced internal
medicine and that nearly 40 percent of them practiced in nonprofit
community or migrant health centers. Further, we noted that controls
for ensuring that these physicians met the terms of their waiver
agreements were somewhat weak, and we found cases in which physicians
were not meeting their waiver agreements, such as not practicing at the
facilities or in the underserved areas for which the physicians'
waivers were granted. Finally, we reported that the use of waivers was
not effectively coordinated with HHS programs addressing underservice,
such as NHSC programs. As a result, some states had more physicians
than HHS identified as needed to alleviate shortages, while other
states were still experiencing shortages.[Footnote 5]
You expressed an interest in how J-1 visa waivers are being used to
place physicians in underserved areas. In May 2006, we testified on
preliminary findings from our work, focusing primarily on states'
requests for J-1 visa waivers.[Footnote 6] This report provides
information on both states' and federal agencies' J-1 visa waiver
requests and addresses (1) the number of waivers requested by states
and federal agencies in fiscal years 2003 through 2005; (2) the
practice specialties, settings, and locations in which waiver
physicians work; (3) the activities states and federal agencies
undertake to help ensure that physicians are meeting their agreements
to work in underserved areas; and (4) the extent to which waiver
physicians are accounted for in HHS's efforts to address physician
shortages.
To address these issues, we administered a Web-based survey to the
entities eligible to request J-1 visa waivers under the authority
granted to the states: the 50 states, the District of Columbia, Guam,
Puerto Rico, and the U.S. Virgin Islands (hereafter referred to as
"states").[Footnote 7] We also surveyed the three federal agencies that
requested waivers for physicians to practice in underserved areas in
fiscal years 2003 through 2005--the Appalachian Regional Commission
(ARC),[Footnote 8] the Delta Regional Authority (DRA),[Footnote 9] and
HHS--using a structured data collection instrument. We sent the surveys
to the officials in each state or federal agency authorized to sign
waiver requests or to his or her designee. The surveys asked each state
and federal agency to provide information on the number of waivers
requested in each of fiscal years 2003 through 2005;[Footnote 10] the
practice specialties, settings, and locations of physicians for whom
waivers were requested; the state's or federal agency's policies for
requesting waivers; activities undertaken to help ensure that waiver
physicians are meeting their agreements to work in underserved
areas;[Footnote 11] and incidents in which physicians were not meeting
their waiver agreements.[Footnote 12] The response rate to both surveys
was 100 percent. We reviewed the survey responses for internal
consistency and for outliers, and we followed up with respondents to
resolve discrepancies and clarify responses; we did not, however,
verify the accuracy of the responses. Regarding federal agencies' J-1
visa waiver programs, we interviewed officials from ARC, DRA, and HHS
and obtained from them data on their waiver requests by state. We
reviewed states' and federal agencies' policies and guidelines
pertaining to their J-1 visa waiver programs as of September 30, 2005;
reviewed relevant laws, regulations, and documents; and interviewed
officials involved in recommending and granting waivers at the
Department of State and the Department of Homeland Security.
To examine how the use of J-1 visa waivers is accounted for in HHS's
efforts to address physician shortages, we interviewed officials from
HHS's Health Resources and Services Administration and obtained from
them data on the number of NHSC physicians practicing in each state and
the number of physicians needed to remove shortage designations in each
state as of September 30, 2005. We estimated the number of waiver
physicians practicing primary care in each state as of September 2005,
using states' and federal agencies' responses to our survey. (See app.
I for detailed information on this analysis.) In addition, we
interviewed officials at the Educational Commission for Foreign Medical
Graduates (ECFMG), the organization that sponsors foreign physicians as
exchange visitors for graduate medical education. We conducted our work
from August 2005 through November 2006 in accordance with generally
accepted government auditing standards.
Results in Brief:
The use of J-1 visa waivers remains a major means of providing
physicians to practice in underserved areas of the United States, with
more than 1,000 waivers requested by states and federal agencies in
each of fiscal years 2003 through 2005. Similar to what we found in
1995, the estimated number of waiver physicians practicing in
underserved areas at the end of fiscal year 2005 exceeded the number of
physicians practicing there through HHS's NHSC programs. In contrast to
1995, when we found that federal agencies requested the vast majority
of waivers, states have become the primary source of waiver requests,
accounting for 90 percent or more of requests in each of fiscal years
2003 through 2005. In fiscal year 2005, every state except Puerto Rico
and the U.S. Virgin Islands reported requesting at least one J-1 visa
waiver.
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; a slightly smaller
proportion were for physicians to practice exclusively nonprimary care
specialties, such as anesthesiology or cardiology.[Footnote 13]
Regarding practice settings, more than three-quarters of states' waiver
requests were for physicians to work in hospitals or private practices.
Overall, about half of the waiver requests were for physicians to
practice in rural areas.
Most states and federal agencies that requested waivers for physicians
reported that they conducted some monitoring activities to help ensure
that physicians were meeting their agreements to work in underserved
areas. While monitoring waiver physicians is not explicitly required of
states and federal agencies that request waivers, more than 85 percent
of states and two of the three federal agencies that requested waivers
in any fiscal year from 2003 through 2005 reported that they had
conducted at least one monitoring activity in fiscal year 2005. The
most common activity reported was requiring periodic reports from
waiver physicians or their employers. For example, some states and
federal agencies required written reports that included information
such as the number of hours the physician worked. Six states and one
federal agency--which together accounted for about 13 percent of waiver
requests in fiscal year 2005--reported that they did not conduct any
activities to monitor waiver physicians in fiscal year 2005.
Although thousands of physicians are practicing in underserved areas
through the use of J-1 visa waivers, HHS--the federal agency with
primary responsibility for addressing physician shortages--does not
have the information needed to account for waiver physicians in its
efforts to address physician shortages. Lacking such data, HHS is not
able to consider waiver physicians working in underserved areas when
placing physicians through its NHSC programs. The lack of information
on waiver physicians could also affect HHS's efforts to revise how it
identifies areas with shortages of physicians and other health care
providers--its health professional shortage area (HPSA) designation
system. According to HHS officials, the department has been working on
a proposal to revise the HPSA designation system that would, among
other things, account for the presence of waiver physicians practicing
in underserved areas. HHS officials acknowledged, however, that the
department lacks complete data on waiver physicians, needed to
implement such a provision.
To better account for physicians practicing in underserved areas
through the use of J-1 visa waivers, we are recommending that the
Secretary of Health and Human Services collect and maintain data on
waiver physicians and use this information when identifying areas
experiencing physician shortages and placing physicians in these areas.
In commenting on a draft of this report, HHS concurred with our
recommendation. HHS commented that the department's goal is to assure
that the limited resources of the J-1 visa waiver program and other
programs addressing areas and populations with limited access to health
care professionals are targeted most effectively. HHS added that the
availability of data on these additional providers would enhance the
data used to identify shortage areas.
Background:
Many foreign physicians who enter U.S. graduate medical education
programs do so as participants in the Department of State's Exchange
Visitor Program--an educational and cultural exchange program aimed at
increasing mutual understanding between the peoples of the United
States and other countries. Participants in the Exchange Visitor
Program enter the United States with J-1 visas.[Footnote 14] Nearly
6,200 foreign physicians with J-1 visas took part in U.S. graduate
medical education programs during academic year 2004-05.
Physicians participating in graduate medical education on J-1 visas are
required to return to their home country or country of last legal
residence for at least 2 years before they may apply for an immigrant
visa, permanent residence, or certain nonimmigrant work visas.[Footnote
15] They may, however, obtain a waiver of this requirement from the
Department of Homeland Security at the request of a state or federal
agency if they have agreed to practice in an underserved area for at
least 3 years.[Footnote 16] States were first authorized to request J-
1 visa waivers on behalf of foreign physicians in October
1994.[Footnote 17] Federal agencies were first authorized to request J-
1 visa waivers for physicians in graduate medical education in
September 1961.[Footnote 18]
In general, waiver physicians must practice in areas that HHS has
designated as underserved. HHS has specified that waiver physicians may
practice in HPSAs or medically underserved areas or populations (MUA/
P).[Footnote 19] HPSAs are geographic areas, population groups within
areas, or facilities that HHS has designated as having a shortage of
health professionals; HPSAs for primary care are generally identified
on the basis of the ratio of population to primary care physicians and
other factors.[Footnote 20] MUA/Ps are areas or populations that HHS
has designated as having shortages of health care services; these are
identified using several factors in addition to the ratio of population
to primary care physicians. HPSAs and MUA/Ps can overlap; as a result,
a facility can be located in both a HPSA and an MUA/P.
States and federal agencies have some discretion in shaping their J-1
visa waiver programs to address particular needs or priorities. For
example, while states and federal agencies can request waivers for
physicians to work in both primary care and nonprimary care specialties
and in a variety of practice settings, they may choose to limit the
number of waivers they request for physicians to practice nonprimary
care or require that waiver physicians work in certain practice
settings.[Footnote 21] States and federal agencies may also choose to
conduct monitoring activities to help ensure that physicians are
meeting their waiver agreements--for example, that they are working at
the facilities for which their waivers were granted.
Although states and federal agencies are generally subject to the same
statutory provisions regarding requests for J-1 visa waivers for
physicians, there are two notable distinctions. First, states are
limited in the number of waivers that may be granted in response to
their requests each year. Initially, states were authorized to request
waivers for up to 20 physicians each fiscal year; in 2002, the limit
was increased to 30 waivers per state per year. Federal agencies are
not statutorily limited in the number of waivers that may be granted in
response to their requests each year. Second, while federal agencies'
waiver requests must be for physicians to practice in underserved
areas, Congress gave states the flexibility, in December 2004, to use
up to 5 of their 30 waiver allotments each year for physicians to work
in facilities located outside of HHS-designated undeserved areas,
provided that the facilities treat patients who reside in underserved
areas.[Footnote 22] We refer to these waivers as "flexible
waivers."[Footnote 23]
Obtaining a J-1 visa waiver at the request of a state or federal agency
to practice in an underserved area involves multiple steps (see fig.
1). A physician must submit an application to obtain a case number from
the Department of State and must secure a bona fide offer of employment
from a health care facility that is located in an underserved area or,
in the case of flexible waivers, from a health care facility that
treats residents of an underserved area. The physician, the prospective
employer, or both apply to a state or federal agency to request a
waiver on the physician's behalf. If, after reviewing the application,
the state or federal agency decides to request a waiver, the state or
federal agency submits a letter of request to the Department of State
affirming that it is in the public interest for the physician to remain
in the United States. If the Department of State decides to recommend
the waiver, it forwards its recommendation to the Department of
Homeland Security's U.S. Citizenship and Immigration Services (USCIS).
USCIS is responsible for making the final determination and notifying
the physician when the waiver is granted. According to officials
involved in recommending and approving waivers at the Department of
State and USCIS, after a review for compliance with statutory
requirements and security issues, nearly all waiver requests are
recommended and granted. Once the physician is granted the waiver, the
employer petitions USCIS for the physician to obtain H-1B status (a
nonimmigrant classification used by foreign nationals employed
temporarily in a specialty occupation). The physician must work at the
facility specified in the waiver application for a minimum of 3 years,
unless the physician obtains approval from USCIS to transfer to another
facility. USCIS considers transfer requests only in extenuating
circumstances, such as closure of the physician's assigned facility.
Once the physician fulfills the employment contract, the physician may
apply for permanent residence, continued H-1B status, or other
nonimmigrant status, if the physician wishes to remain in the United
States.
Figure 1: Process to Apply for and Obtain a J-1 Visa Waiver for a
Physician to Work in an Underserved Area:
[See PDF for image]
Source: GAO.
[A] Waivers requested by ARC are first reviewed for eligibility and
completeness by the state in which the physician seeks to practice,
then forwarded to ARC for final review and processing.
[End of figure]
No single federal agency is responsible for managing or tracking the
use of J-1 visa waivers for physicians to practice in underserved
areas. HHS is the primary federal agency responsible for addressing
physician shortages, both in terms of administering NHSC programs that
place physicians and other providers in areas experiencing shortages of
health professionals and in designating areas as underserved. HHS's
oversight of waiver physicians practicing in underserved areas,
however, has generally been limited to the few physicians for whom it
has requested J-1 visa waivers. USCIS and the Department of State
process J-1 visa waiver requests but do not maintain comprehensive
information about waiver physicians' numbers, practice locations, and
practice specialties.[Footnote 24] States and federal agencies that
request waivers maintain such information for the physicians for whom
they request waivers, but this information is not centrally collected
and maintained by any federal agency.
Although the use of J-1 visa waivers has not been systematically
tracked, available data indicate that the pool of physicians who could
seek waivers--that is, the number of foreign physicians in graduate
medical education with J-1 visas--has declined in recent years. In
academic year 1996-97, a little more than 11,600 foreign physicians
took part in U.S. graduate medical education programs with J-1 visas;
by academic year 2004-05 this number had decreased more than 45 percent
to slightly less than 6,200. The reasons for this decrease are not
completely understood.[Footnote 25]
Waivers Remain a Major Means for Providing Physicians to Underserved
Areas:
States and federal agencies reported requesting more than 1,000 J-1
visa waivers in each of fiscal years 2003 through 2005 (see fig.
2).[Footnote 26] We estimated that, at the end of fiscal year 2005,
there were roughly one and a half times as many waiver physicians
practicing in underserved areas (3,128) as U.S. physicians practicing
in underserved areas through NHSC programs (2,054).[Footnote 27]
Figure 2: J-1 Visa Waivers Requested by States and Federal Agencies,
Calendar Year 1995 and Fiscal Years 2003 through 2005:
[See PDF for image]
Source: GAO/HEH-97-26; GAO survey of states, 2005; GAO survey of
federal agencies, 2006.
Note: In 1995, up to 20 waivers per year could be granted in response
to each state's requests. Since 2002, the annual limit has been 30
waivers per state. There are no limits on the number of waivers that
may be granted in response to federal agencies' requests each year.
[A] In our May 2006 testimony on preliminary findings (GAO-06-773T), we
reported that federal agencies requested 110 waivers and that states
and federal agencies requested a total of 1,093 waivers in fiscal year
2003. Our final analysis of agency data determined that federal
agencies requested 108 waivers and that states and federal agencies
requested a total of 1,091 waivers that year.
[End of figure]
In contrast to our findings a decade ago, states have become the
primary source of waiver requests for physicians to practice in
underserved areas, accounting for 90 percent or more of requests in
each of fiscal years 2003 through 2005. The number of states that
reported ever having requested a J-1 visa waiver has grown steadily
since they were first authorized to do so, from 20 states in fiscal
year 1995 to 53 states (all but Puerto Rico) as of fiscal year 2005.
States varied, however, in the number of waivers they requested in
fiscal years 2003 through 2005. For example, in fiscal year 2005, about
one-quarter of the 54 states requested the maximum of 30 waivers, about
one-quarter requested 10 or fewer, and two (Puerto Rico and the U.S.
Virgin Islands) requested no waivers (see fig. 3).
Figure 3: J-1 Visa Waivers Requested by States, Fiscal Year 2005:
[See PDF for image]
Sources: GAO survey of states, 2005; copyright Corel Corp., all rights
reserved (map).
Notes: Guam, Puerto Rico, and the U.S. Virgin Islands are not shown.
Guam requested 2 waivers in fiscal year 2005; Puerto Rico and the U.S.
Virgin Islands requested no waivers that year. Additionally, ARC
requested 36 waivers for physicians to practice in eight states, DRA
requested 16 waivers for physicians to practice in six states, and HHS
requested 4 waivers for physicians to practice in four states.
[End of figure]
The number of waivers requested by federal agencies has decreased
significantly since 1995, with the exit of the two agencies that
requested the most waivers for physicians to practice in underserved
areas that year. The Department of Agriculture, which stopped
requesting waivers for physicians to practice in underserved areas in
2002, and the Department of Housing and Urban Development, which
stopped in 1996, together requested more than 1,100 waivers for
physicians to practice in 47 states in 1995, providing a significant
source of physicians for some states. Federal agencies accounted for
about 94 percent of waiver requests that year, in contrast to fiscal
year 2005, when federal agencies made about 6 percent of requests. Of
the 1,012 waivers requested by states and federal agencies in fiscal
year 2005, ARC, DRA, and HHS accounted for 56 requests for physicians
to practice in 14 states.[Footnote 28]
Waivers Were Requested for Physicians to Work in a Variety of Practice
Specialties, Settings, and Locations:
States and federal agencies requested waivers for physicians to
practice a variety of specialties, with states requesting waivers for
physicians to practice both primary and nonprimary care and federal
agencies generally focusing on primary care. Although the waivers
states and federal agencies requested were for physicians to work in
diverse practice settings, most were for physicians to work in
hospitals and private practices. These practice settings were about
equally divided between rural and nonrural areas. Additionally, less
than half of the states opted to request flexible waivers for
physicians to work outside of designated underserved areas.
Overall, a little less than half (46 percent) of the waivers requested
by states and federal agencies in fiscal year 2005 were for physicians
to practice exclusively primary care, while a slightly smaller
proportion (39 percent) were for physicians to practice exclusively
nonprimary care (see fig. 4). A small proportion of waiver requests (5
percent) were for physicians to practice both primary and nonprimary
care--for example, for individual physicians to practice both internal
medicine and cardiology. An additional 7 percent of waiver requests in
fiscal year 2005 were for physicians to practice psychiatry.
Figure 4: Practice Specialties of Physicians for Whom States and
Federal Agencies Requested J-1 Visa Waivers, Fiscal Year 2005:
[See PDF for image]
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2006.
Notes: Percentages are based on 956 waivers requested by 52 states and
56 waivers requested by three federal agencies in fiscal year 2005.
Puerto Rico and the U.S. Virgin Islands requested no waivers that year.
Psychiatry is reported separately from primary care and nonprimary care
specialties because some states and federal agencies consider primary
care to include psychiatry while others do not.
[End of figure]
States and federal agencies differed, however, in the proportion of
waivers they requested for physicians to practice primary versus
nonprimary care (see fig. 5). Less than 50 percent of the waivers
requested by states in fiscal year 2005 were for physicians to practice
exclusively primary care, compared with 80 percent of those requested
by federal agencies.
Figure 5: J-1 Visa Waivers Requested by States and Federal Agencies, by
Practice Specialty, Fiscal Year 2005:
[See PDF for image]
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2006.
Notes: Percentages are based on 956 waivers requested by 52 states and
56 waivers requested by three federal agencies in fiscal year 2005.
Puerto Rico and the U.S. Virgin Islands requested no waivers that year.
Psychiatry is reported separately from primary care and nonprimary care
specialties because some states and federal agencies consider primary
care to include psychiatry while others do not.
[End of figure]
Nearly all of the states and DRA reported that their fiscal year 2005
policies allowed them to request waivers for physicians to practice
nonprimary care.[Footnote 29] Twenty-seven of these states, however,
reported placing some limits on such requests, including limiting the
number of requests for physicians to practice nonprimary care or
restricting the number of hours a physician could practice a nonprimary
care specialty. Even with these limitations, the number of waivers
requested for physicians to practice nonprimary care increased among
both states and federal agencies over the 3-year period beginning in
fiscal year 2003. Overall, requests for physicians to practice
exclusively nonprimary care increased from about 300 (28 percent) in
fiscal year 2003 to nearly 400 (39 percent) in fiscal year 2005. States
and federal agencies reported requesting waivers in fiscal year 2005
for physicians to practice more than 40 nonprimary care specialties
(e.g., anesthesiology) and subspecialties (e.g., pediatric cardiology);
the most common of these were anesthesiology, cardiology, and
pulmonology (the study and treatment of respiratory diseases).
Regarding practice settings, more than three-quarters of the waivers
requested by states in fiscal year 2005 were for physicians to practice
in hospitals (37 percent) and private practices (41 percent) (see fig.
6).[Footnote 30] In addition, 16 percent were for physicians to
practice in federally qualified health centers (facilities that provide
primary care services in underserved areas) and rural health clinics
(facilities that provide outpatient primary care services in rural
areas). Although the largest proportion of waivers that states
requested was for physicians to work in private practices, more than 80
percent of the states and all three federal agencies reported that
their fiscal year 2005 policies required the facilities where waiver
physicians work--regardless of practice setting--to accept some
patients who are uninsured or covered by Medicaid.
Figure 6: Practice Settings of Physicians for Whom States Requested J-
1 Visa Waivers, Fiscal Year 2005:
[See PDF for image]
Source: GAO survey of states, 2006.
Note: Percentages are based on 956 waivers requested by 52 states in
fiscal year 2005. Puerto Rico and the U.S. Virgin Islands requested no
waivers that year.
[End of figure]
Overall, about half of all waiver requests in fiscal year 2005 were for
physicians to practice in areas that respondents considered rural,
although the proportions differed between states' and federal agencies'
requests. States' waiver requests in fiscal year 2005, which accounted
for the vast majority of total requests that year, were about equally
divided between those for physicians to work in areas respondents
considered rural and those they considered nonrural. Federal agencies'
waiver requests were mostly (93 percent) for physicians to work in
areas considered rural (see fig. 7).
Figure 7: Proportion of J-1 Visa Waivers Requested by States and
Federal Agencies for Physicians to Practice in Rural and Nonrural
Areas, Fiscal Year 2005:
[See PDF for image]
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2006.
Note: Percentages are based on 956 waivers requested by 52 states and
56 waivers requested by three federal agencies in fiscal year 2005.
Puerto Rico and the U.S. Virgin Islands requested no waivers that year.
[End of figure]
Most of the waivers requested by states and federal agencies in fiscal
year 2005 were for physicians to practice in HPSAs. While federal
regulations generally permit states and federal agencies to request
waivers for physicians to work in HPSAs or MUA/Ps, about a quarter of
the states and two federal agencies (ARC and HHS) had policies in place
in fiscal year 2005 that limited at least some types of physicians to
practicing in HPSAs. Overall, more than three-quarters (77 percent) of
waivers requested by states and federal agencies in fiscal year 2005
were for physicians to work in facilities located in HPSAs, and 16
percent were for physicians to work in facilities located in MUA/Ps
that were outside of HPSAs. Additionally, less than half of the states
(23 states) reported taking advantage of the option to request flexible
waivers--those for physicians to work in facilities that, while located
outside of HHS-designated underserved areas, treat patients residing in
underserved areas. Requests for flexible waivers in fiscal year 2005,
the first year such waivers were allowed, accounted for 7 percent of
all waiver requests that year.
Most States and Federal Agencies Reported That They Conducted
Monitoring Activities:
Most states and federal agencies reported that they conducted
monitoring activities to help ensure that physicians were meeting their
agreements to work in underserved areas. Although monitoring is not
explicitly required of states and federal agencies that request
waivers, more than 85 percent of states and two of the three federal
agencies that requested waivers in any fiscal year from 2003 through
2005 reported that they conducted at least one monitoring activity in
fiscal year 2005. These activities included actions to help determine,
for example, whether physicians were working in the locations for which
their waivers were requested or whether they were treating the intended
patients, such as those who were uninsured or covered by Medicaid. The
most common monitoring activity--reported by 40 states, ARC, and DRA--
was to require periodic reports from physicians or employers (see fig.
8). For example, some states and federal agencies required written
reports submitted once or twice a year that included information such
as the number of hours waiver physicians worked or the number of
patients for whom Medicaid claims were submitted. States and federal
agencies that requested waivers also reported that they monitored
waiver physicians through regular communications with employers and
physicians, such as through phone calls, and through site visits to
waiver physicians' practice locations. In addition, a small number of
states reported conducting other monitoring activities. For example,
one state official said the state's J-1 visa waiver program used
Medicaid data to confirm that waiver physicians were treating patients
covered by Medicaid.
Figure 8: Monitoring Activities That States and Federal Agencies
Requesting J-1 Visa Waivers Reported Conducting in Fiscal Year 2005:
[See PDF for image]
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2006.
Note: Our surveys asked states and federal agencies that requested
waivers whether they conducted any of these specific activities in
fiscal year 2005 to help ensure that physicians were meeting their
waiver agreements. Data are for the 53 states and three federal
agencies that requested waivers in any fiscal year from 2003 through
2005. Puerto Rico did not request waivers during this period.
[End of figure]
Although most states and federal agencies reported conducting at least
one monitoring activity, the number of monitoring activities varied.
Ten states and DRA reported conducting at least four different
activities, while six states and HHS--together accounting for about 13
percent of waiver requests in fiscal year 2005--reported that they did
not conduct any monitoring activities in fiscal year 2005. Four of the
six states that reported they did not conduct monitoring activities
reported requesting more than 25 waivers in each of fiscal years 2003
through 2005.
States and federal agencies reported identifying relatively few
incidents in fiscal years 2003 through 2005 in which physicians were
not meeting their waiver agreements.[Footnote 31] These incidents
included cases in which the physician was not working in the practice
specialty or at the facility specified in his or her waiver agreement,
was not seeing the intended patients, or did not serve the entire 3-
year employment contract. The most common issue cited was physicians'
transferring to another location or employer without the approval of
the state or federal agency that requested their waivers.[Footnote 32]
In addition, several states reported that they had identified cases in
which waiver physicians never reported to work. Officials from these
states cited examples in which physicians simply failed to appear at
the practice sites and did not contact the state that had made the
waiver requests on the physicians' behalf. According to states and
federal agencies that reported identifying any incidents, physicians
were not solely responsible in all cases in which they did not meet
their waiver agreements. Some state officials provided examples of
employers who directed physicians to work in locations other than those
for which their waivers were requested, including locations outside of
underserved areas.
States and federal agencies that requested waivers reported that they
use a variety of practices to prevent or respond to cases of
physicians' not meeting their waiver agreements (see fig. 9). For
example, 38 states and HHS reported that it is their practice to bar
employers who are responsible for problems involving waiver physicians
from consideration for future J-1 visa waiver physician placements,
either temporarily or permanently. Forty states and two federal
agencies reported that it is their practice to inform USCIS if they
identify physicians who are not meeting their waiver agreements.
Physicians not meeting their waiver agreements would again be subject
to the 2-year foreign residence requirement and would need to return to
their home country or country of last legal residence before they could
apply for an immigrant visa, permanent residence, or certain
nonimmigrant work visas. USCIS officials said that reports of
physicians not meeting their waiver agreements have been relatively
rare. Some states and federal agencies that requested waivers also
reported that they require physicians' contracts to stipulate fees to
be imposed if the physicians fail to meet their waiver agreements.
These requirements include, for example, liquidated damages clauses,
which set a particular amount that physicians agree to pay employers if
the physicians break their employment contracts. Other practices that
states reported included reporting problems with waiver physicians to
state medical boards.
Figure 9: States' and Federal Agencies' Practices to Help Ensure
Physicians Meet Their Waiver Agreements:
[See PDF for image]
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2005.
Note: Our surveys asked states and federal agencies that requested
waivers whether they use any of these specific practices to help ensure
that physicians meet their waiver agreements. Data are for the 53
states and three federal agencies that requested waivers in any fiscal
year from 2003 through 2005. Puerto Rico did not request waivers during
this period.
[End of figure]
States cited a number of factors affecting their ability to monitor or
take other actions that they believed could help them ensure that
physicians meet their waiver agreements. More than one-quarter of the
states reported that funding and staffing constraints limited their
ability to carry out monitoring activities.[Footnote 33] For example,
four states commented that time and staff constraints limited their
ability to conduct visits to physicians' practice sites. Several states
noted that they have little or no authority to take actions that would
help ensure that physicians meet their waiver agreements. For example,
one state commented that beyond reporting physicians who do not meet
their waiver agreements to USCIS, it has no authority over waiver
physicians. In addition, a few states noted that their ability to
effectively monitor physicians is limited by the fact that they are not
notified when USCIS grants waivers or approves transfers. Consequently,
states may not know with certainty which physicians USCIS has
authorized to work in, or move to or from, their states.[Footnote 34]
One federal agency (ARC) cited two factors that positively affected its
ability to help ensure that physicians meet their waiver agreements:
the liquidated damages clauses for violating employment agreements that
ARC requires to be in physicians' employment contracts, and site visits
by staff of ARC's Office of Inspector General. According to a senior
ARC official, these unannounced visits have occasionally resulted in
the discovery of physicians working at sites other than those at which
the physicians were authorized to work. The official commented that the
visits have also had a deterrent effect.
HHS Lacks Data to Account for Waiver Physicians in Its Efforts to
Address Physician Shortages:
Although the use of J-1 visa waivers remains a major means of providing
physicians to practice in underserved 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
whether the needs of a HPSA are already being met through waiver
physicians. Our analysis indicates that some states could have had more
waiver and NHSC physicians practicing primary care in HPSAs than HHS
identified as needed, while other states were below HHS's identified
need. Although data were not available to determine the number of
waiver physicians practicing primary care specifically in HPSAs, our
analysis showed that in seven states the estimated number of waiver
physicians practicing primary care in all locations (including HPSAs,
MUA/Ps, and nondesignated areas), combined with the number of NHSC
physicians practicing primary care in HPSAs at the end of fiscal year
2005, exceeded the number of physicians HHS identified as needed to
remove the primary care HPSA designations in the state.[Footnote 35] In
six of these seven states, the estimated number of primary care waiver
and NHSC physicians exceeded by at least 20 percent the number needed
to remove primary care HPSA designations. Meanwhile, in each of 25
states, the estimated number of primary care waiver and NHSC physicians
was less than half of the state's identified need for primary care
physicians.
The lack of information on waiver physicians could also affect HHS's
efforts to revise how it designates primary care HPSAs and other
underserved areas. Multiple federal programs use HHS's primary care
HPSA designation system to allocate resources or provide benefits, but
as we have reported, the designation system does not account for all
primary care providers practicing in underserved areas, including
waiver physicians.[Footnote 36] Specifically, waiver physicians
practicing primary care in an area are not counted in the ratio of
population to primary care physicians, one of the factors used to
determine whether an area may be designated as a primary care HPSA. HHS
has been working on a proposal--in process since 1998--to revise the
primary care HPSA designation system, which would, among other things,
account for waiver physicians, according to HHS officials. HHS
officials acknowledged, however, that the department lacked complete
data on waiver physicians, needed to implement such a
provision.[Footnote 37]
Recognizing the lack of a comprehensive database with information on J-
1 visa waiver physicians and other international medical
graduates,[Footnote 38] HHS in 2003 contracted with ECFMG--the
organization that sponsors all foreign physicians with J-1 visas
participating in graduate medical education--to assess the feasibility
of developing a database that would provide access to information on
the U.S. practice locations of, populations served by, and other
information about international medical graduates. ECFMG completed the
study and in 2004 submitted a draft report to HHS that included
recommendations. As of September 2006, a final report had not been
published.
Conclusions:
The use of J-1 visa waivers remains a major means of placing physicians
in underserved areas of the United States, supplying even more
physicians to these areas than NHSC programs. Although thousands of
physicians practice in underserved areas through the use of J-1 visa
waivers, comprehensive data on their overall numbers, practice
locations, and practice specialties are not routinely collected and
maintained by HHS. Only by surveying states and federal agencies that
requested waivers were we able to collect information for this report.
Having comprehensive data on waiver physicians could help HHS more
effectively target the placement of NHSC physicians and implement
proposed changes to designating underserved areas.
Recommendation for Executive Action:
To better account for physicians practicing in underserved areas
through the use of J-1 visa waivers, we recommend that the Secretary of
Health and Human Services 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.
Agency Comments and our Evaluation:
We provided a draft copy of this report to the five federal agencies
that are involved with waivers for physicians to practice in
underserved areas: ARC, DRA, HHS, the Department of Homeland Security,
and the Department of State. We received written comments on the draft
report from HHS (see app. III). HHS concurred with our recommendation
that data should be collected and maintained to track waiver
physicians. HHS noted that the department had also discussed,
internally, tracking other physicians who are working under H-1B visas,
stating that this would allow a more complete accounting of the actual
number of physicians providing care in underserved areas. HHS commented
that the department's goal is to assure that the limited resources of
the J-1 visa waiver program and other programs addressing areas and
populations with limited access to health care professionals are
targeted most effectively and that the availability of complete data on
these additional providers would enhance the data used to identify such
shortage areas.
HHS also commented that the draft report may have overstated, to a
degree, the "oversupply" of physicians in some states. HHS acknowledged
that we made important adjustments in our analysis for physicians
practicing nonprimary care and psychiatry. The department, however,
expressed concern that our calculations did not address the fact that
some J-1 visa waiver placements are not in HPSAs, referring to our
finding that 23 percent of waivers requested in fiscal year 2005 were
for physicians to practice outside of HPSAs. We believe that applying
this percentage to our analysis would be inappropriate for several
reasons. First, this percentage pertained to waiver physicians
practicing all specialties, including primary care, nonprimary care,
and psychiatry, while our analysis focused on physicians practicing
primary care. Further, the 23 percent figure represents waivers
requested in only one fiscal year (fiscal year 2005), while our
analysis covered waivers requested in 3 fiscal years. In addition,
fiscal year 2005 was the only year in our analysis in which states
could request waivers for physicians to practice in nondesignated
areas. In our draft report, we did not use the term "oversupply," but
we acknowledge that our report should clearly specify the limitations
in the data used in our analysis. To do so, we clarified the text
describing our methodology and results.
We also received technical comments from HHS and the Department of
Homeland Security's USCIS, which we incorporated as appropriate. Three
agencies--ARC, DRA, and Department of State--said that they did not
have comments on the draft report.
We are sending copies of this report to the Secretary of Health and
Human Services, the Secretary of Homeland Security, the Secretary of
State, the Federal Co-chair of ARC, the Federal Co-chairman of DRA, and
appropriate congressional committees. We will also provide copies to
others upon request. In addition, the report is available at no charge
on the GAO Web site at [Hyperlink, http://www.gao.gov].
If you or your staff members have any questions about this report,
please contact me at (312) 220-7600 or aronovitzl@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. GAO staff who made major
contributions to this report are listed in appendix IV.
Signed by:
Leslie G. Aronovitz:
Director, Health Care:
[End of section]
Appendix I: Physician Need and Number of Primary Care Waiver and
National Health Service Corps Physicians, by State:
This appendix presents the following information for each state as of
the end of fiscal year 2005: (1) the number of primary care physicians
the Department of Health and Human Services (HHS) identified as needed
to remove primary care health professional shortage area (HPSA)
designations, (2) our estimate of the number of J-1 visa waiver
physicians practicing primary care, (3) the number of National Health
Service Corps (NHSC) physicians practicing primary care, and (4)
primary care waiver and NHSC physicians as a percentage of the HHS-
identified need.
To determine the need for primary care physicians in each state, we
used the number of physicians HHS reported as needed to remove primary
care HPSA designations in the state, a measurement used by HHS to
identify the need for physicians. Specifically, we used summary data
from HHS's Health Resources and Services Administration on the number
of additional full-time equivalent (FTE) primary care physicians needed
to remove primary care HPSA designations in the state as of September
30, 2005. HHS determines the number of additional full-time primary
care physicians needed to remove primary care HPSA designations for
geographic areas, population groups, and facilities. For geographic
areas, HHS's threshold for the ratio of population to primary care
physicians is 3,500 to 1 (or 3,000 to 1 under special circumstances);
for population groups, it is 3,000 to 1; for facilities that are state
or federal correctional institutions, it is 1,000 to 1.[Footnote 39] In
calculating the ratio of population to primary care physicians, HHS
does not take into account waiver physicians and most NHSC physicians.
In addition to HPSAs, waiver physicians may also practice in designated
medically underserved areas or populations (MUA/P). HHS does not,
however, have a similar measure of the number of physicians needed in
MUA/Ps.[Footnote 40]
To determine the number of NHSC physicians practicing primary care in
HPSAs in each state as of September 30, 2005, we used data obtained
from the Health Resources and Services Administration on the number of
primary care physicians practicing through the NHSC Scholarship, NHSC
Loan Repayment, and NHSC Ready Responder programs.[Footnote 41] NHSC
physicians are required to practice in HPSAs.
Although data are not available on the number of physicians granted J-
1 visa waivers and practicing primary care in underserved areas at any
given time, we estimated this number using data on waivers requested by
states and by three federal agencies--the Appalachian Regional
Commission (ARC), the Delta Regional Authority (DRA), and HHS. We
estimated the number of waiver physicians practicing primary care in
each state as of September 30, 2005, by using the number of waivers
requested in fiscal years 2003 through 2005 for such physicians. This
number represents the number of primary care physicians expected to be
fulfilling the minimum 3-year employment contract at the end of fiscal
year 2005 or who had waivers in process to do so.[Footnote 42] Our
estimate includes all waiver physicians practicing primary care in the
state (including those practicing in HPSAs, MUA/Ps, and nondesignated
areas). Data were not available to distinguish waiver physicians
practicing primary care in HPSAs from those practicing in MUA/Ps or
nondesignated areas.[Footnote 43]
Table 1 shows the estimated number of waiver and NHSC physicians
practicing primary care at the end of fiscal year 2005 and the number
of physicians needed to remove primary care HPSA designations in each
state.
Table 1: Physicians Needed and Number of Primary Care Waiver and NHSC
Physicians, by State, as of September 30, 2005:
State: Alabama;
Physicians needed to remove primary care HPSA designations[A]: 218;
Estimated number of primary care waiver physicians[B]: State: 20.0;
Estimated number of primary care waiver physicians[B]: ARC: 8.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: ;
Estimated number of primary care waiver physicians[B]: Total: 28.0;
Number of primary care NHSC physicians[C]: 40;
Total number of primary care waiver and NHSC physicians: 68.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 31.2%.
State: Alaska;
Physicians needed to remove primary care HPSA designations[A]: 29;
Estimated number of primary care waiver physicians[B]: State: 0.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 0.5;
Number of primary care NHSC physicians[C]: 9;
Total number of primary care waiver and NHSC physicians: 9.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 32.8.
State: Arizona;
Physicians needed to remove primary care HPSA designations[A]: 272;
Estimated number of primary care waiver physicians[B]: State: 69.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 70.0;
Number of primary care NHSC physicians[C]: 58;
Total number of primary care waiver and NHSC physicians: 128.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 47.1.
State: Arkansas;
Physicians needed to remove primary care HPSA designations[A]: 71;
Estimated number of primary care waiver physicians[B]: State: 26.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: 5.0;
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 31.0;
Number of primary care NHSC physicians[C]: 6;
Total number of primary care waiver and NHSC physicians: 37.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 52.1.
State: California;
Physicians needed to remove primary care HPSA designations[A]: 816;
Estimated number of primary care waiver physicians[B]: State: 73.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 4.0;
Estimated number of primary care waiver physicians[B]: Total: 77.0;
Number of primary care NHSC physicians[C]: 72;
Total number of primary care waiver and NHSC physicians: 149.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 18.3.
State: Colorado;
Physicians needed to remove primary care HPSA designations[A]: 144;
Estimated number of primary care waiver physicians[B]: State: 9.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 9.5;
Number of primary care NHSC physicians[C]: 35;
Total number of primary care waiver and NHSC physicians: 44.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 30.9.
State: Connecticut;
Physicians needed to remove primary care HPSA designations[A]: 57;
Estimated number of primary care waiver physicians[B]: State: [D];
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: [D];
Number of primary care NHSC physicians[C]: 15;
Total number of primary care waiver and NHSC physicians: [D];
Primary care waiver and NHSC physicians as a percentage of physicians
needed: [D].
State: Delaware;
Physicians needed to remove primary care HPSA designations[A]: 12;
Estimated number of primary care waiver physicians[B]: State: 27.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 27.0;
Number of primary care NHSC physicians[C]: 10;
Total number of primary care waiver and NHSC physicians: 37.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 308.3.
State: District of Columbia;
Physicians needed to remove primary care HPSA designations[A]: 35;
Estimated number of primary care waiver physicians[B]: State: 8.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 8.0;
Number of primary care NHSC physicians[C]: 40;
Total number of primary care waiver and NHSC physicians: 48.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 137.1.
State: Florida;
Physicians needed to remove primary care HPSA designations[A]: 774;
Estimated number of primary care waiver physicians[B]: State: 74.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 9.0;
Estimated number of primary care waiver physicians[B]: Total: 83.0;
Number of primary care NHSC physicians[C]: 105;
Total number of primary care waiver and NHSC physicians: 188.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 24.3.
State: Georgia;
Physicians needed to remove primary care HPSA designations[A]: 347;
Estimated number of primary care waiver physicians[B]: State: 53.5;
Estimated number of primary care waiver physicians[B]: ARC: 6.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 59.5;
Number of primary care NHSC physicians[C]: 53;
Total number of primary care waiver and NHSC physicians: 112.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 32.4.
State: Guam;
Physicians needed to remove primary care HPSA designations[A]: 5;
Estimated number of primary care waiver physicians[B]: State: 0.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 0.5;
Number of primary care NHSC physicians[C]: 0;
Total number of primary care waiver and NHSC physicians: 0.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 10.0.
State: Hawaii;
Physicians needed to remove primary care HPSA designations[A]: 16;
Estimated number of primary care waiver physicians[B]: State: 6.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 6.5;
Number of primary care NHSC physicians[C]: 8;
Total number of primary care waiver and NHSC physicians: 14.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 90.6.
State: Idaho;
Physicians needed to remove primary care HPSA designations[A]: 58;
Estimated number of primary care waiver physicians[B]: State: 1.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 2.0;
Estimated number of primary care waiver physicians[B]: Total: 3.0;
Number of primary care NHSC physicians[C]: 19;
Total number of primary care waiver and NHSC physicians: 22.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 37.9.
State: Illinois;
Physicians needed to remove primary care HPSA designations[A]: 404;
Estimated number of primary care waiver physicians[B]: State: 78.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: 3.0;
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 82.0;
Number of primary care NHSC physicians[C]: 75;
Total number of primary care waiver and NHSC physicians: 157.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 38.9.
State: Indiana;
Physicians needed to remove primary care HPSA designations[A]: 107;
Estimated number of primary care waiver physicians[B]: State: 47.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: ;
Estimated number of primary care waiver physicians[B]: HHS: 2.0;
Estimated number of primary care waiver physicians[B]: Total: 49.0;
Number of primary care NHSC physicians[C]: 20;
Total number of primary care waiver and NHSC physicians: 69.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 64.5.
State: Iowa;
Physicians needed to remove primary care HPSA designations[A]: 58;
Estimated number of primary care waiver physicians[B]: State: 33.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: ;
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 33.0;
Number of primary care NHSC physicians[C]: 11;
Total number of primary care waiver and NHSC physicians: 44.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 75.9.
State: Kansas;
Physicians needed to remove primary care HPSA designations[A]: 98;
Estimated number of primary care waiver physicians[B]: State: 29.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: ;
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 29.0;
Number of primary care NHSC physicians[C]: 11;
Total number of primary care waiver and NHSC physicians: 40.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 40.8.
State: Kentucky;
Physicians needed to remove primary care HPSA designations[A]: 99;
Estimated number of primary care waiver physicians[B]: State: 48.5;
Estimated number of primary care waiver physicians[B]: ARC: 41.0;
Estimated number of primary care waiver physicians[B]: DRA: 1.0;
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 90.5;
Number of primary care NHSC physicians[C]: 11;
Total number of primary care waiver and NHSC physicians: 101.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 102.5.
State: Louisiana;
Physicians needed to remove primary care HPSA designations[A]: 161;
Estimated number of primary care waiver physicians[B]: State: 30.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: 3.0;
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 33.5;
Number of primary care NHSC physicians[C]: 15;
Total number of primary care waiver and NHSC physicians: 48.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 30.1.
State: Maine;
Physicians needed to remove primary care HPSA designations[A]: 24;
Estimated number of primary care waiver physicians[B]: State: 19.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 19.5;
Number of primary care NHSC physicians[C]: 19;
Total number of primary care waiver and NHSC physicians: 38.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 160.4.
State: Maryland;
Physicians needed to remove primary care HPSA designations[A]: 79;
Estimated number of primary care waiver physicians[B]: State: 45.5;
Estimated number of primary care waiver physicians[B]: ARC: 1.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 2.0;
Estimated number of primary care waiver physicians[B]: Total: 48.5;
Number of primary care NHSC physicians[C]: 23;
Total number of primary care waiver and NHSC physicians: 71.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 90.5.
State: Massachusetts;
Physicians needed to remove primary care HPSA designations[A]: 60;
Estimated number of primary care waiver physicians[B]: State: 37.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 37.0;
Number of primary care NHSC physicians[C]: 36;
Total number of primary care waiver and NHSC physicians: 73.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 121.7.
State: Michigan;
Physicians needed to remove primary care HPSA designations[A]: 274;
Estimated number of primary care waiver physicians[B]: State: 72.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 3.0;
Estimated number of primary care waiver physicians[B]: Total: 75.0;
Number of primary care NHSC physicians[C]: 63;
Total number of primary care waiver and NHSC physicians: 138.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 50.4.
State: Minnesota;
Physicians needed to remove primary care HPSA designations[A]: 73;
Estimated number of primary care waiver physicians[B]: State: 36.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 36.0;
Number of primary care NHSC physicians[C]: 13;
Total number of primary care waiver and NHSC physicians: 49.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 67.1.
State: Mississippi;
Physicians needed to remove primary care HPSA designations[A]: 173;
Estimated number of primary care waiver physicians[B]: State: 31.0;
Estimated number of primary care waiver physicians[B]: ARC: 11.0;
Estimated number of primary care waiver physicians[B]: DRA: 10.5;
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 53.5;
Number of primary care NHSC physicians[C]: 24;
Total number of primary care waiver and NHSC physicians: 77.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 44.8.
State: Missouri;
Physicians needed to remove primary care HPSA designations[A]: 356;
Estimated number of primary care waiver physicians[B]: State: 12.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: 4.0;
Estimated number of primary care waiver physicians[B]: HHS: 3.0;
Estimated number of primary care waiver physicians[B]: Total: 19.0;
Number of primary care NHSC physicians[C]: 67;
Total number of primary care waiver and NHSC physicians: 86.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 24.2.
State: Montana;
Physicians needed to remove primary care HPSA designations[A]: 56;
Estimated number of primary care waiver physicians[B]: State: 4.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 4.0;
Number of primary care NHSC physicians[C]: 15;
Total number of primary care waiver and NHSC physicians: 19.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 33.9.
State: Nebraska;
Physicians needed to remove primary care HPSA designations[A]: 17;
Estimated number of primary care waiver physicians[B]: State: 9.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 9.0;
Number of primary care NHSC physicians[C]: 2;
Total number of primary care waiver and NHSC physicians: 11.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 64.7.
State: Nevada;
Physicians needed to remove primary care HPSA designations[A]: 95;
Estimated number of primary care waiver physicians[B]: State: 52.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 52.0;
Number of primary care NHSC physicians[C]: 10;
Total number of primary care waiver and NHSC physicians: 62.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 65.3.
State: New Hampshire;
Physicians needed to remove primary care HPSA designations[A]: 17;
Estimated number of primary care waiver physicians[B]: State: 6.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 6.5;
Number of primary care NHSC physicians[C]: 5;
Total number of primary care waiver and NHSC physicians: 11.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 67.6.
State: New Jersey;
Physicians needed to remove primary care HPSA designations[A]: 28;
Estimated number of primary care waiver physicians[B]: State: 5.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 5.0;
Number of primary care NHSC physicians[C]: 8;
Total number of primary care waiver and NHSC physicians: 13.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 46.4.
State: New Mexico;
Physicians needed to remove primary care HPSA designations[A]: 130;
Estimated number of primary care waiver physicians[B]: State: 34.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 34.0;
Number of primary care NHSC physicians[C]: 32;
Total number of primary care waiver and NHSC physicians: 66.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 50.8.
State: New York;
Physicians needed to remove primary care HPSA designations[A]: 325;
Estimated number of primary care waiver physicians[B]: State: 26.0;
Estimated number of primary care waiver physicians[B]: ARC: 7.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 5.0;
Estimated number of primary care waiver physicians[B]: Total: 38.0;
Number of primary care NHSC physicians[C]: 79;
Total number of primary care waiver and NHSC physicians: 117.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 36.0.
State: North Carolina;
Physicians needed to remove primary care HPSA designations[A]: 143;
Estimated number of primary care waiver physicians[B]: State: 31.0;
Estimated number of primary care waiver physicians[B]: ARC: 1.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 32.0;
Number of primary care NHSC physicians[C]: 38;
Total number of primary care waiver and NHSC physicians: 70.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 49.0.
State: North Dakota;
Physicians needed to remove primary care HPSA designations[A]: 33;
Estimated number of primary care waiver physicians[B]: State: 17.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 17.0;
Number of primary care NHSC physicians[C]: 3;
Total number of primary care waiver and NHSC physicians: 20.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 60.6.
State: Ohio;
Physicians needed to remove primary care HPSA designations[A]: 144;
Estimated number of primary care waiver physicians[B]: State: 25.0;
Estimated number of primary care waiver physicians[B]: ARC: 13.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 38.0;
Number of primary care NHSC physicians[C]: 30;
Total number of primary care waiver and NHSC physicians: 68.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 47.2.
State: Oklahoma;
Physicians needed to remove primary care HPSA designations[A]: 69;
Estimated number of primary care waiver physicians[B]: State: 9.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 10.0;
Number of primary care NHSC physicians[C]: 13;
Total number of primary care waiver and NHSC physicians: 23.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 33.3.
State: Oregon;
Physicians needed to remove primary care HPSA designations[A]: 45;
Estimated number of primary care waiver physicians[B]: State: 31.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 31.5;
Number of primary care NHSC physicians[C]: 24;
Total number of primary care waiver and NHSC physicians: 55.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 123.3.
State: Pennsylvania;
Physicians needed to remove primary care HPSA designations[A]: 173;
Estimated number of primary care waiver physicians[B]: State: 16.0;
Estimated number of primary care waiver physicians[B]: ARC: 4.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 20.0;
Number of primary care NHSC physicians[C]: 50;
Total number of primary care waiver and NHSC physicians: 70.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 40.5.
State: Puerto Rico;
Physicians needed to remove primary care HPSA designations[A]: 263;
Estimated number of primary care waiver physicians[B]: State: [Empty];
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 0.0;
Number of primary care NHSC physicians[C]: 9;
Total number of primary care waiver and NHSC physicians: 9.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 3.4.
State: Rhode Island;
Physicians needed to remove primary care HPSA designations[A]: 12;
Estimated number of primary care waiver physicians[B]: State: 51.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 51.0;
Number of primary care NHSC physicians[C]: 9;
Total number of primary care waiver and NHSC physicians: 60.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 500.0.
State: South Carolina;
Physicians needed to remove primary care HPSA designations[A]: 117;
Estimated number of primary care waiver physicians[B]: State: 26.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 27.0;
Number of primary care NHSC physicians[C]: 36;
Total number of primary care waiver and NHSC physicians: 63.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 53.8.
State: South Dakota;
Physicians needed to remove primary care HPSA designations[A]: 104;
Estimated number of primary care waiver physicians[B]: State: 8.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 8.0;
Number of primary care NHSC physicians[C]: 2;
Total number of primary care waiver and NHSC physicians: 10.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 9.6.
State: Tennessee;
Physicians needed to remove primary care HPSA designations[A]: 149;
Estimated number of primary care waiver physicians[B]: State: 43.0;
Estimated number of primary care waiver physicians[B]: ARC: 5.0;
Estimated number of primary care waiver physicians[B]: DRA: 6.0;
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 55.0;
Number of primary care NHSC physicians[C]: 31;
Total number of primary care waiver and NHSC physicians: 86.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 57.7.
State: Texas;
Physicians needed to remove primary care HPSA designations[A]: 664;
Estimated number of primary care waiver physicians[B]: State: 33.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 19.0;
Estimated number of primary care waiver physicians[B]: Total: 52.0;
Number of primary care NHSC physicians[C]: 63;
Total number of primary care waiver and NHSC physicians: 115.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 17.3.
State: U.S. Virgin Islands;
Physicians needed to remove primary care HPSA designations[A]: 2;
Estimated number of primary care waiver physicians[B]: State: 1.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 1.0;
Number of primary care NHSC physicians[C]: 1;
Total number of primary care waiver and NHSC physicians: 2.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 100.0.
State: Utah;
Physicians needed to remove primary care HPSA designations[A]: 66;
Estimated number of primary care waiver physicians[B]: State: 4.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 4.5;
Number of primary care NHSC physicians[C]: 23;
Total number of primary care waiver and NHSC physicians: 27.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 41.7.
State: Vermont;
Physicians needed to remove primary care HPSA designations[A]: 2;
Estimated number of primary care waiver physicians[B]: State: 1.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 1.0;
Number of primary care NHSC physicians[C]: 1;
Total number of primary care waiver and NHSC physicians: 2.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 100.0.
State: Virginia;
Physicians needed to remove primary care HPSA designations[A]: 106;
Estimated number of primary care waiver physicians[B]: State: 38.5;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 38.5;
Number of primary care NHSC physicians[C]: 22;
Total number of primary care waiver and NHSC physicians: 60.5;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 57.1.
State: Washington;
Physicians needed to remove primary care HPSA designations[A]: 146;
Estimated number of primary care waiver physicians[B]: State: 49.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: 1.0;
Estimated number of primary care waiver physicians[B]: Total: 50.0;
Number of primary care NHSC physicians[C]: 33;
Total number of primary care waiver and NHSC physicians: 83.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 56.8.
State: West Virginia;
Physicians needed to remove primary care HPSA designations[A]: 58;
Estimated number of primary care waiver physicians[B]: State: 8.0;
Estimated number of primary care waiver physicians[B]: ARC: 7.0;
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 15.0;
Number of primary care NHSC physicians[C]: 16;
Total number of primary care waiver and NHSC physicians: 31.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 53.4.
State: Wisconsin;
Physicians needed to remove primary care HPSA designations[A]: 126;
Estimated number of primary care waiver physicians[B]: State: 58.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 58.0;
Number of primary care NHSC physicians[C]: 23;
Total number of primary care waiver and NHSC physicians: 81.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 64.3.
State: Wyoming;
Physicians needed to remove primary care HPSA designations[A]: 27;
Estimated number of primary care waiver physicians[B]: State: 3.0;
Estimated number of primary care waiver physicians[B]: ARC: [Empty];
Estimated number of primary care waiver physicians[B]: DRA: [Empty];
Estimated number of primary care waiver physicians[B]: HHS: [Empty];
Estimated number of primary care waiver physicians[B]: Total: 3.0;
Number of primary care NHSC physicians[C]: 12;
Total number of primary care waiver and NHSC physicians: 15.0;
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 55.6.
State: Total;
Physicians needed to remove primary care HPSA designations[A]: 7,937;
Estimated number of primary care waiver physicians[B]: State:
1,477.5[E];
Estimated number of primary care waiver physicians[B]: ARC: 104.0;
Estimated number of primary care waiver physicians[B]: DRA: 32.5;
Estimated number of primary care waiver physicians[B]: HHS: 57.0;
Estimated number of primary care waiver physicians[B]: Total:
1,670.0[E];
Number of primary care NHSC physicians[C]: 1,448;
Total number of primary care waiver and NHSC physicians: 3,103.0[E];
Primary care waiver and NHSC physicians as a percentage of physicians
needed: 39.1[E].
Sources: GAO survey of states, 2005; data provided by ARC, DRA, and
HHS; Health Resources and Services Administration.
Note: Data are presented in terms of FTE physicians.
[A] The number of additional FTE physicians HHS identified as needed as
of September 30, 2005, to remove primary care HPSA designations in the
state.
[B] The estimated number of primary care waiver physicians practicing
in HPSAs, MUA/Ps, and nondesignated areas as of September 30, 2005.
Data were not available to distinguish waiver physicians practicing
primary care in HPSAs from those practicing in MUA/Ps or nondesignated
areas. Physicians for whom waivers were requested to practice both
primary and nonprimary care (e.g., physicians who practiced both
internal medicine and cardiology) were counted as 0.5 FTE.
[C] The number of primary care NHSC physicians practicing in primary
care HPSAs as of September 30, 2005.
[D] Data were not available to estimate the number of waiver physicians
practicing primary care in Connecticut or to make associated
calculations.
[E] Total does not include waiver physicians who may have been
practicing primary care in Connecticut.
[End of table]
[End of section]
Appendix II: States' and Federal Agencies' Requests for J-1 Visa
Waivers:
This appendix summarizes states' and federal agencies' responses to
selected questions from GAO's surveys, as well as data obtained from
ARC, DRA, and HHS on their waiver requests by state. The following
tables present data on the number of waivers states and federal
agencies requested in each of fiscal years 2003 through 2005, in total
(table 2), by federal agency (table 3), by practice specialty (table
4), and by practice setting (table 5). We also present data on states'
and federal agencies' policies for requesting waivers (table 6).
Table 2: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by State, Fiscal Years
2003 through 2005:
State: Alabama;
Number of waivers requested: 2003: State: 18;
Number of waivers requested: 2003: Federal agencies: 3;
Number of waivers requested: 2004: State: 19;
Number of waivers requested: 2004: Federal agencies: 3;
Number of waivers requested: 2005: State: 24;
Number of waivers requested: 2005: Federal agencies: 4;
Number of waivers requested: Total 2003-2005: 71.
State: Alaska;
Number of waivers requested: 2003: State: 5;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: [Empty];
Number of waivers requested: 2004: Federal agencies: ;
Number of waivers requested: 2005: State: 1;
Number of waivers requested: 2005: Federal agencies: ;
Number of waivers requested: Total 2003-2005: 6.
State: Arizona;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: ;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: ;
Number of waivers requested: Total 2003-2005: 91.
State: Arkansas;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 5;
Number of waivers requested: 2005: State: 29;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 95.
State: California;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 3;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 94.
State: Colorado;
Number of waivers requested: 2003: State: 11;
Number of waivers requested: 2003: Federal agencies: ;
Number of waivers requested: 2004: State: 3;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 5;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 19.
State: Connecticut;
Number of waivers requested: 2003: State: 27;
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 26;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 84.
State: Delaware;
Number of waivers requested: 2003: State: 21;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 21;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 16;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 58.
State: District of Columbia;
Number of waivers requested: 2003: State: 3;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 9;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 3;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 15.
State: Florida;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 10;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 100.
State: Georgia;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 5;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 1;
Number of waivers requested: 2005: State: 28;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 94.
State: Guam;
Number of waivers requested: 2003: State: [Empty];
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 1;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 2;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 3.
State: Hawaii;
Number of waivers requested: 2003: State: 2;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 1;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 4;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 7.
State: Idaho;
Number of waivers requested: 2003: State: [Empty];
Number of waivers requested: 2003: Federal agencies: 2;
Number of waivers requested: 2004: State: [Empty];
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 1;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 3.
State: Illinois;
Number of waivers requested: 2003: State: 28;
Number of waivers requested: 2003: Federal agencies: 3;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 92.
State: Indiana;
Number of waivers requested: 2003: State: 27;
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 89.
State: Iowa;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 28;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 88.
State: Kansas;
Number of waivers requested: 2003: State: 14;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 26;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 17;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 57.
State: Kentucky;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 25;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 13;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 9;
Number of waivers requested: Total 2003-2005: 137.
State: Louisiana;
Number of waivers requested: 2003: State: 15;
Number of waivers requested: 2003: Federal agencies: 2;
Number of waivers requested: 2004: State: 13;
Number of waivers requested: 2004: Federal agencies: 1;
Number of waivers requested: 2005: State: 10;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 41.
State: Maine;
Number of waivers requested: 2003: State: 29;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 18;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 25;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 72.
State: Maryland;
Number of waivers requested: 2003: State: 15;
Number of waivers requested: 2003: Federal agencies: 3;
Number of waivers requested: 2004: State: 22;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 29;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 69.
State: Massachusetts;
Number of waivers requested: 2003: State: 28;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 88.
State: Michigan;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 2;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 93.
State: Minnesota;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 15;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 21;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 66.
State: Mississippi;
Number of waivers requested: 2003: State: 19;
Number of waivers requested: 2003: Federal agencies: 5;
Number of waivers requested: 2004: State: 17;
Number of waivers requested: 2004: Federal agencies: 7;
Number of waivers requested: 2005: State: 18;
Number of waivers requested: 2005: Federal agencies: 14;
Number of waivers requested: Total 2003-2005: 80.
State: Missouri;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 2;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 4;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 3;
Number of waivers requested: Total 2003-2005: 99.
State: Montana;
Number of waivers requested: 2003: State: 2;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 1;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 2;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 5.
State: Nebraska;
Number of waivers requested: 2003: State: 15;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 7;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 13;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 35.
State: Nevada;
Number of waivers requested: 2003: State: 26;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 18;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 13;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 57.
State: New Hampshire;
Number of waivers requested: 2003: State: 6;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 11;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 15;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 32.
State: New Jersey;
Number of waivers requested: 2003: State: 2;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 1;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 2;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 5.
State: New Mexico;
Number of waivers requested: 2003: State: 29;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 27;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 29;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 85.
State: New York;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 5;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 3;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 8;
Number of waivers requested: Total 2003-2005: 106.
State: North Carolina;
Number of waivers requested: 2003: State: 10;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 11;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 16;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 38.
State: North Dakota;
Number of waivers requested: 2003: State: 11;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 13;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 6;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 30.
State: Ohio;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 7;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 5;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 7;
Number of waivers requested: Total 2003-2005: 109.
State: Oklahoma;
Number of waivers requested: 2003: State: [Empty];
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 17;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 12;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 30.
State: Oregon;
Number of waivers requested: 2003: State: 20;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 19;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 22;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 61.
State: Pennsylvania;
Number of waivers requested: 2003: State: 13;
Number of waivers requested: 2003: Federal agencies: 7;
Number of waivers requested: 2004: State: 16;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 22;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 58.
State: Puerto Rico;
Number of waivers requested: 2003: State: [Empty];
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: [Empty];
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: [Empty];
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: [Empty].
State: Rhode Island;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 90.
State: South Carolina;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 1;
Number of waivers requested: 2004: State: 26;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 21;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 78.
State: South Dakota;
Number of waivers requested: 2003: State: 10;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 6;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 6;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 22.
State: Tennessee;
Number of waivers requested: 2003: State: 21;
Number of waivers requested: 2003: Federal agencies: 4;
Number of waivers requested: 2004: State: 27;
Number of waivers requested: 2004: Federal agencies: 6;
Number of waivers requested: 2005: State: 12;
Number of waivers requested: 2005: Federal agencies: 3;
Number of waivers requested: Total 2003-2005: 73.
State: Texas;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 10;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: 8;
Number of waivers requested: 2005: State: 30;
Number of waivers requested: 2005: Federal agencies: 1;
Number of waivers requested: Total 2003-2005: 109.
State: U.S. Virgin Islands;
Number of waivers requested: 2003: State: 1;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: [Empty];
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: [Empty];
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 1.
State: Utah;
Number of waivers requested: 2003: State: 4;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 6;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 5;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 15.
State: Vermont;
Number of waivers requested: 2003: State: [Empty];
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 1;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 2;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 3.
State: Virginia;
Number of waivers requested: 2003: State: 17;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 13;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 19;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 49.
State: Washington;
Number of waivers requested: 2003: State: 30;
Number of waivers requested: 2003: Federal agencies: 2;
Number of waivers requested: 2004: State: 30;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 28;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 90.
State: Wisconsin;
Number of waivers requested: 2003: State: 29;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 23;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 12;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 64.
State: West Virginia;
Number of waivers requested: 2003: State: 22;
Number of waivers requested: 2003: Federal agencies: 4;
Number of waivers requested: 2004: State: 14;
Number of waivers requested: 2004: Federal agencies: 2;
Number of waivers requested: 2005: State: 18;
Number of waivers requested: 2005: Federal agencies: 2;
Number of waivers requested: Total 2003-2005: 62.
State: Wyoming;
Number of waivers requested: 2003: State: 3;
Number of waivers requested: 2003: Federal agencies: [Empty];
Number of waivers requested: 2004: State: 3;
Number of waivers requested: 2004: Federal agencies: [Empty];
Number of waivers requested: 2005: State: 4;
Number of waivers requested: 2005: Federal agencies: [Empty];
Number of waivers requested: Total 2003-2005: 10.
Total;
Number of waivers requested: 2003: State: 983;
Number of waivers requested: 2003: Federal agencies: 108;
Number of waivers requested: 2004: State: 965;
Number of waivers requested: 2004: Federal agencies: 60;
Number of waivers requested: 2005: State: 956;
Number of waivers requested: 2005: Federal agencies: 56;
Number of waivers requested: Total 2003-2005: 3,128.
Sources: GAO survey of states, 2005; data provided by ARC, DRA, and
HHS.
Note: A blank cell indicates that no waivers were requested.
[End of table]
Table 3: J-1 Visa Waivers Requested by Federal Agencies for Physicians
to Practice in Underserved Areas, by State, Fiscal Years 2003 through
2005:
State: Alabama;
Number of waivers requested: 2003: ARC: 3;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 3;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 4;
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Arizona;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Arkansas;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: 5;
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: 1;
Number of waivers requested: 2005: HHS: [Empty].
State: California;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 3;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: 1.
State: Connecticut;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Florida;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 10;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Georgia;
Number of waivers requested: 2003: ARC: 5;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 1;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Idaho;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 2;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Illinois;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: 2;
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: 1;
Number of waivers requested: 2005: HHS: [Empty].
State: Indiana;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: 1.
State: Kentucky;
Number of waivers requested: 2003: ARC: 25;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 13;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 8;
Number of waivers requested: 2005: DRA: 1;
Number of waivers requested: 2005: HHS: [Empty].
State: Louisiana;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: 2;
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: 1;
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Maryland;
Number of waivers requested: 2003: ARC: 1;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 2;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Michigan;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: 2;
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Mississippi;
Number of waivers requested: 2003: ARC: 4;
Number of waivers requested: 2003: DRA: 1;
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 4;
Number of waivers requested: 2004: DRA: 2;
Number of waivers requested: 2004: HHS: 1;
Number of waivers requested: 2005: ARC: 5;
Number of waivers requested: 2005: DRA: 9;
Number of waivers requested: 2005: HHS: [Empty].
State: Missouri;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: 1;
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: 3;
Number of waivers requested: 2004: HHS: 1;
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: 2;
Number of waivers requested: 2005: HHS: 1.
State: New York;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 5;
Number of waivers requested: 2004: ARC: 3;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 8;
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: North Carolina;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 1;
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Ohio;
Number of waivers requested: 2003: ARC: 7;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 5;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 7;
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Oklahoma;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Pennsylvania;
Number of waivers requested: 2003: ARC: 7;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: South Carolina;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: Tennessee;
Number of waivers requested: 2003: ARC: 2;
Number of waivers requested: 2003: DRA: 1;
Number of waivers requested: 2003: HHS: 1;
Number of waivers requested: 2004: ARC: 3;
Number of waivers requested: 2004: DRA: 3;
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 1;
Number of waivers requested: 2005: DRA: 2;
Number of waivers requested: 2005: HHS: [Empty].
State: Texas;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 10;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: 8;
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: 1.
State: Washington;
Number of waivers requested: 2003: ARC: [Empty];
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: 2;
Number of waivers requested: 2004: ARC: [Empty];
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: [Empty];
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
State: West Virginia;
Number of waivers requested: 2003: ARC: 4;
Number of waivers requested: 2003: DRA: [Empty];
Number of waivers requested: 2003: HHS: [Empty];
Number of waivers requested: 2004: ARC: 2;
Number of waivers requested: 2004: DRA: [Empty];
Number of waivers requested: 2004: HHS: [Empty];
Number of waivers requested: 2005: ARC: 2;
Number of waivers requested: 2005: DRA: [Empty];
Number of waivers requested: 2005: HHS: [Empty].
Total;
Number of waivers requested: 2003: ARC: 58;
Number of waivers requested: 2003: DRA: 7;
Number of waivers requested: 2003: HHS: 43;
Number of waivers requested: 2004: ARC: 34;
Number of waivers requested: 2004: DRA: 14;
Number of waivers requested: 2004: HHS: 12;
Number of waivers requested: 2005: ARC: 36;
Number of waivers requested: 2005: DRA: 16;
Number of waivers requested: 2005: HHS: 4.
Sources: Data provided by ARC, DRA, and HHS.
Notes: Only states where federal agencies requested waivers in any
fiscal year from 2003 through 2005 are shown; federal agencies
requested no waivers for other states. A blank cell indicates that no
waivers were requested.
[End of table]
Table 4: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by Practice Specialty,
Fiscal Years 2003 through 2005:
States: Exclusively primary care;
Number of waivers requested (percentage): 2003: 525;
Number of waivers requested (percentage): 2003: (53);
Number of waivers requested (percentage): 2004: 462;
Number of waivers requested (percentage): 2004: (48);
Number of waivers requested (percentage): 2005: 424;
Number of waivers requested (percentage): 2005: (44).
States: Exclusively nonprimary care;
Number of waivers requested (percentage): 2003: 302;
Number of waivers requested (percentage): 2003: (31);
Number of waivers requested (percentage): 2004: 356;
Number of waivers requested (percentage): 2004: (37);
Number of waivers requested (percentage): 2005: 390;
Number of waivers requested (percentage): 2005: (41).
States: Both primary and nonprimary care;
Number of waivers requested (percentage): 2003: 49;
Number of waivers requested (percentage): 2003: (5);
Number of waivers requested (percentage): 2004: 35;
Number of waivers requested (percentage): 2004: (4);
Number of waivers requested (percentage): 2005: 49;
Number of waivers requested (percentage): 2005: (5).
States: Psychiatry[A];
Number of waivers requested (percentage): 2003: 80;
Number of waivers requested (percentage): 2003: (8);
Number of waivers requested (percentage): 2004: 82;
Number of waivers requested (percentage): 2004: (8);
Number of waivers requested (percentage): 2005: 67;
Number of waivers requested (percentage): 2005: (7).
States: No answer;
Number of waivers requested (percentage): 2003: 27;
Number of waivers requested (percentage): 2003: (3);
Number of waivers requested (percentage): 2004: 30;
Number of waivers requested (percentage): 2004: (3);
Number of waivers requested (percentage): 2005: 26;
Number of waivers requested (percentage): 2005: (3).
States: Total;
Number of waivers requested (percentage): 2003: 983;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 965;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 956;
Number of waivers requested (percentage): 2005: (100).
Federal agencies: Exclusively primary care;
Number of waivers requested (percentage): 2003: 93;
Number of waivers requested (percentage): 2003: (86);
Number of waivers requested (percentage): 2004: 55;
Number of waivers requested (percentage): 2004: (92);
Number of waivers requested (percentage): 2005: 45;
Number of waivers requested (percentage): 2005: (80).
Federal agencies: Exclusively nonprimary care;
Number of waivers requested (percentage): 2003: 0;
Number of waivers requested (percentage): 2003: (0);
Number of waivers requested (percentage): 2004: 1;
Number of waivers requested (percentage): 2004: (2);
Number of waivers requested (percentage): 2005: 2;
Number of waivers requested (percentage): 2005: (4).
Federal agencies: Both primary and nonprimary care;
Number of waivers requested (percentage): 2003: 0;
Number of waivers requested (percentage): 2003: (0);
Number of waivers requested (percentage): 2004: 0;
Number of waivers requested (percentage): 2004: (0);
Number of waivers requested (percentage): 2005: 1;
Number of waivers requested (percentage): 2005: (2).
Federal agencies: Psychiatry[A];
Number of waivers requested (percentage): 2003: 15;
Number of waivers requested (percentage): 2003: (14);
Number of waivers requested (percentage): 2004: 4;
Number of waivers requested (percentage): 2004: (7);
Number of waivers requested (percentage): 2005: 8;
Number of waivers requested (percentage): 2005: (14).
Federal agencies: No answer;
Number of waivers requested (percentage): 2003: 0;
Number of waivers requested (percentage): 2003: (0);
Number of waivers requested (percentage): 2004: 0;
Number of waivers requested (percentage): 2004: (0);
Number of waivers requested (percentage): 2005: 0;
Number of waivers requested (percentage): 2005: (0).
Federal agencies: Total;
Number of waivers requested (percentage): 2003: 108;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 60;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 56;
Number of waivers requested (percentage): 2005: (100).
States and federal agencies combined: Exclusively primary care;
Number of waivers requested (percentage): 2003: 618;
Number of waivers requested (percentage): 2003: (57);
Number of waivers requested (percentage): 2004: 517;
Number of waivers requested (percentage): 2004: (50);
Number of waivers requested (percentage): 2005: 469;
Number of waivers requested (percentage): 2005: (46).
States and federal agencies combined: Exclusively nonprimary care;
Number of waivers requested (percentage): 2003: 302;
Number of waivers requested (percentage): 2003: (28);
Number of waivers requested (percentage): 2004: 357;
Number of waivers requested (percentage): 2004: (35);
Number of waivers requested (percentage): 2005: 392;
Number of waivers requested (percentage): 2005: (39).
States and federal agencies combined: Both primary and nonprimary care;
Number of waivers requested (percentage): 2003: 49;
Number of waivers requested (percentage): 2003: (4);
Number of waivers requested (percentage): 2004: 35;
Number of waivers requested (percentage): 2004: (3);
Number of waivers requested (percentage): 2005: 50;
Number of waivers requested (percentage): 2005: (5).
States and federal agencies combined: Psychiatry[A];
Number of waivers requested (percentage): 2003: 95;
Number of waivers requested (percentage): 2003: (9);
Number of waivers requested (percentage): 2004: 86;
Number of waivers requested (percentage): 2004: (8);
Number of waivers requested (percentage): 2005: 75;
Number of waivers requested (percentage): 2005: (7).
States and federal agencies combined: No answer;
Number of waivers requested (percentage): 2003: 27;
Number of waivers requested (percentage): 2003: (2);
Number of waivers requested (percentage): 2004: 30;
Number of waivers requested (percentage): 2004: (3);
Number of waivers requested (percentage): 2005: 26;
Number of waivers requested (percentage): 2005: (3).
States and federal agencies combined: Total;
Number of waivers requested (percentage): 2003: 1,091;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 1,025;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 1,012;
Number of waivers requested (percentage): 2005: (100).
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2005.
Note: Percentages may not add to 100 because of rounding.
[A] Psychiatry is reported separately from primary care and nonprimary
care specialties because some states and federal agencies consider
primary care to include psychiatry while others do not.
[End of table]
Table 5: J-1 Visa Waivers Requested by States and Federal Agencies for
Physicians to Practice in Underserved Areas, by Practice Setting,
Fiscal Years 2003 through 2005:
States: Federally qualified health center;
Number of waivers requested (percentage): 2003: 91;
Number of waivers requested (percentage): 2003: (9);
Number of waivers requested (percentage): 2004: 97;
Number of waivers requested (percentage): 2004: (10);
Number of waivers requested (percentage): 2005: 101;
Number of waivers requested (percentage): 2005: (11).
States: Rural health clinic;
Number of waivers requested (percentage): 2003: 50;
Number of waivers requested (percentage): 2003: (5);
Number of waivers requested (percentage): 2004: 39;
Number of waivers requested (percentage): 2004: (4);
Number of waivers requested (percentage): 2005: 45;
Number of waivers requested (percentage): 2005: (5).
States: Hospital;
Number of waivers requested (percentage): 2003: 261;
Number of waivers requested (percentage): 2003: (27);
Number of waivers requested (percentage): 2004: 296;
Number of waivers requested (percentage): 2004: (31);
Number of waivers requested (percentage): 2005: 353;
Number of waivers requested (percentage): 2005: (37).
States: Private individual or group practice;
Number of waivers requested (percentage): 2003: 486;
Number of waivers requested (percentage): 2003: (49);
Number of waivers requested (percentage): 2004: 452;
Number of waivers requested (percentage): 2004: (47);
Number of waivers requested (percentage): 2005: 394;
Number of waivers requested (percentage): 2005: (41).
States: Other settings;
Number of waivers requested (percentage): 2003: 35;
Number of waivers requested (percentage): 2003: (4);
Number of waivers requested (percentage): 2004: 51;
Number of waivers requested (percentage): 2004: (5);
Number of waivers requested (percentage): 2005: 33;
Number of waivers requested (percentage): 2005: (3).
States: No answer;
Number of waivers requested (percentage): 2003: 60;
Number of waivers requested (percentage): 2003: (6);
Number of waivers requested (percentage): 2004: 30;
Number of waivers requested (percentage): 2004: (3);
Number of waivers requested (percentage): 2005: 30;
Number of waivers requested (percentage): 2005: (3).
States: Total;
Number of waivers requested (percentage): 2003: 983;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 965;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 956;
Number of waivers requested (percentage): 2005: (100).
Federal agencies[A]: Federally qualified health center;
Number of waivers requested (percentage): 2003: 6;
Number of waivers requested (percentage): 2003: (6);
Number of waivers requested (percentage): 2004: 6;
Number of waivers requested (percentage): 2004: (10);
Number of waivers requested (percentage): 2005: 3;
Number of waivers requested (percentage): 2005: (5).
Federal agencies[A]: Rural health clinic;
Number of waivers requested (percentage): 2003: 3;
Number of waivers requested (percentage): 2003: (3);
Number of waivers requested (percentage): 2004: 11;
Number of waivers requested (percentage): 2004: (18);
Number of waivers requested (percentage): 2005: 7;
Number of waivers requested (percentage): 2005: (13).
Federal agencies[A]: Hospital;
Number of waivers requested (percentage): 2003: 4;
Number of waivers requested (percentage): 2003: (4);
Number of waivers requested (percentage): 2004: 6;
Number of waivers requested (percentage): 2004: (10);
Number of waivers requested (percentage): 2005: 6;
Number of waivers requested (percentage): 2005: (11).
Federal agencies[A]: Private individual or group practice;
Number of waivers requested (percentage): 2003: 34;
Number of waivers requested (percentage): 2003: (31);
Number of waivers requested (percentage): 2004: 3;
Number of waivers requested (percentage): 2004: (5);
Number of waivers requested (percentage): 2005: 4;
Number of waivers requested (percentage): 2005: (7).
Federal agencies[A]: Other settings;
Number of waivers requested (percentage): 2003: 3;
Number of waivers requested (percentage): 2003: (3);
Number of waivers requested (percentage): 2004: 0;
Number of waivers requested (percentage): 2004: (0);
Number of waivers requested (percentage): 2005: 0;
Number of waivers requested (percentage): 2005: (0).
Federal agencies[A]: No answer;
Number of waivers requested (percentage): 2003: 58;
Number of waivers requested (percentage): 2003: (54);
Number of waivers requested (percentage): 2004: 34;
Number of waivers requested (percentage): 2004: (57);
Number of waivers requested (percentage): 2005: 36;
Number of waivers requested (percentage): 2005: (64).
Federal agencies[A]: Total;
Number of waivers requested (percentage): 2003: 108;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 60;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 56;
Number of waivers requested (percentage): 2005: (100).
States and federal agencies combined: Federally qualified health
center;
Number of waivers requested (percentage): 2003: 97;
Number of waivers requested (percentage): 2003: (9);
Number of waivers requested (percentage): 2004: 103;
Number of waivers requested (percentage): 2004: (10);
Number of waivers requested (percentage): 2005: 104;
Number of waivers requested (percentage): 2005: (10).
States and federal agencies combined: Rural health clinic;
Number of waivers requested (percentage): 2003: 53;
Number of waivers requested (percentage): 2003: (5);
Number of waivers requested (percentage): 2004: 50;
Number of waivers requested (percentage): 2004: (5);
Number of waivers requested (percentage): 2005: 52;
Number of waivers requested (percentage): 2005: (5).
States and federal agencies combined: Hospital;
Number of waivers requested (percentage): 2003: 265;
Number of waivers requested (percentage): 2003: (24);
Number of waivers requested (percentage): 2004: 302;
Number of waivers requested (percentage): 2004: (29);
Number of waivers requested (percentage): 2005: 359;
Number of waivers requested (percentage): 2005: (35).
States and federal agencies combined: Private individual or group
practice;
Number of waivers requested (percentage): 2003: 520;
Number of waivers requested (percentage): 2003: (48);
Number of waivers requested (percentage): 2004: 455;
Number of waivers requested (percentage): 2004: (44);
Number of waivers requested (percentage): 2005: 398;
Number of waivers requested (percentage): 2005: (39).
States and federal agencies combined: Other settings;
Number of waivers requested (percentage): 2003: 38;
Number of waivers requested (percentage): 2003: (3);
Number of waivers requested (percentage): 2004: 51;
Number of waivers requested (percentage): 2004: (5);
Number of waivers requested (percentage): 2005: 33;
Number of waivers requested (percentage): 2005: (3).
States and federal agencies combined: No answer;
Number of waivers requested (percentage): 2003: 118;
Number of waivers requested (percentage): 2003: (11);
Number of waivers requested (percentage): 2004: 64;
Number of waivers requested (percentage): 2004: (6);
Number of waivers requested (percentage): 2005: 66;
Number of waivers requested (percentage): 2005: (7).
States and federal agencies combined: Total;
Number of waivers requested (percentage): 2003: 1,091;
Number of waivers requested (percentage): 2003: (100);
Number of waivers requested (percentage): 2004: 1,025;
Number of waivers requested (percentage): 2004: (100);
Number of waivers requested (percentage): 2005: 1,012;
Number of waivers requested (percentage): 2005: (100).
Sources: GAO survey of states, 2005; GAO survey of federal agencies,
2005.
Note: Percentages may not add to 100 because of rounding.
[A] Data on practice settings are for DRA and HHS;
"no answer" represents waivers requested by ARC, which reported that it
does not track waiver physicians' practice settings.
[End of table]
Table 6: States' and Federal Agencies' Policies for Requesting J-1 Visa
Waivers, Fiscal Year 2005:
State: Alabama;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Alaska;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Arizona;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Arkansas;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: California;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: X;
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [C].
State: Colorado;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Connecticut;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Delaware;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: District of Columbia;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Florida;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Georgia;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Guam;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: Hawaii;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Idaho;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: X;
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [C].
State: Illinois;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Indiana;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Iowa;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Kansas;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Kentucky;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Louisiana;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Maine;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Maryland;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Massachusetts;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Michigan;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Minnesota;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Mississippi;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Missouri;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: Montana;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Nebraska;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Nevada;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: New Hampshire;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: New Jersey;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: New Mexico;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: New York;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: North Carolina;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: North Dakota;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Ohio;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: Oklahoma;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Oregon;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Pennsylvania;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Rhode Island;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: South Carolina;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: South Dakota;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Tennessee;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Texas;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Utah;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: Vermont;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Virginia;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Washington;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Wisconsin;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: West Virginia;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: Wyoming;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: X;
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: X.
State: Federal agency;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: [Empty];
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: ARC;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: X;
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [C].
State: DRA;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: [Empty];
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: X;
Requests for primary care physicians limited to HPSAs[B]: [Empty];
Requests for nonprimary care physicians limited to HPSAs: [Empty].
State: HHS;
Facilities where waiver physicians work required to accept some
patients who are uninsured or covered by Medicaid: X;
Nonprimary care physicians not eligible: X;
Nonprimary care physicians eligible with limitations[A]: [Empty];
Nonprimary care physicians eligible without limitations: [Empty];
Requests for primary care physicians limited to HPSAs[B]: X;
Requests for nonprimary care physicians limited to HPSAs: [C].
Sources: GAO survey of states, 2005;
GAO survey of federal agencies, 2005.
Note: Responses are for the 52 states and three federal agencies that
requested any waivers in fiscal year 2005. Puerto Rico and the U.S.
Virgin Islands requested no waivers that year.
[A] Examples of limitations provided in the survey question included
policies limiting the number of nonprimary care physicians allowed and
the number of practice hours allowed in a specialty outside primary
care.
[B] HPSAs are health professional shortage areas, as designated by the
Secretary of Health and Human Services under section 332 of the Public
Health Service Act (42 U.S.C. § 254e).
[C] California, Idaho, ARC, and HHS reported that their fiscal year
2005 policies did not allow them to request waivers for physicians to
practice nonprimary care.
[End of table]
[End of section]
Appendix III: Comments from the Department of Health and Human
Services:
Office of the Assistant Secretary for Legislation:
Department Of Health & Human Services:
Washington, D.C. 20201:
Nov 7 2006:
Leslie Aronovitz:
Director of Health Care:
U.S. Government Accountability Office:
Washington, DC 20548:
Dear Ms. Aronovitz:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO) draft report entitled, "Foreign
Physicians: Data on use of J-I Visa Waivers Needed to Better Address
Physicians Shortages" (GAO-07-52), before its publication.
The Department provided several technical comments directly to your
staff.
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Vincent J. Ventimiglia, Jr.
Assistant Secretary for Legislation:
Comments From The Department Of Health And Human Services On Foreign
Physicians: Data On Use Of J-1 Visa Waivers Needed To Better Address
Physician Shortages" GAO-07-52:
HHS Comments:
HHS concurs with the recommendation that data should be collected and
maintained to track the J-1 Visa Waiver physicians. HHS has also
discussed internally the tracking of other physicians who are working
under the H-1 B Visa, which would allow a more complete accounting of
the actual number of physicians providing care in underserved areas.
Such a system would involve coordination across multiple departments
and agencies and is not the sole responsibility of HRSA or the
Department of Health and Human Services.
HHS's goal is to assure that the limited resources of the J-1 Visa
waiver program and other programs in addressing areas and populations
with limited access to health care professionals are targeted most
effectively. The availability of complete data on these additional
providers would enhance the data used to identify such shortage areas.
Physician Need and Number of Primary Care Waiver and National Health
Service Corps Physicians, by State, Fiscal Year 2005:
It is HHS's opinion that the report as currently drafted may overstate,
to a degree, the "oversupply" in some states, based on the number of
physicians exceeding the number needed to reach the non-designation
threshold. Adjustments have been made for the non-primary care and
psychiatry physicians, which is important. However, the calculations do
not address the fact that 23 percent of the J-1 Visa waiver placements
are not in the Health Professional Shortage Areas (HPSAs) at all. Based
on the numbers in the report, 17 percent are placed in Medically
Underserved Areas (MUAs) that are not also HPSAs, and 6 percent are
placed in non-designated areas. Since these areas are not reflected in
the "need" calculations, it may be misleading to count them as
"oversupply."
[End of section]
Appendix IV: Contact and Acknowledgments:
GAO Contact:
Leslie G. Aronovitz, (312) 220-7600 or aronovitzl@gao.gov:
Acknowledgments:
In addition to the contact named above, Kim Yamane, Assistant Director;
Ellen W. Chu; Jill Hodges; Julian Klazkin; Linda Y.A. McIver; and Perry
Parsons made key contributions to this report.
[End of section]
Related GAO Products:
Health Professional Shortage Areas: Problems Remain with Primary Care
Shortage Area Designation System. GAO-07-84. Washington, D.C.: October
24, 2006.
Foreign Physicians: Preliminary Findings on the Use of J-1 Visa Waivers
to Practice in Underserved Areas. GAO-06-773T. Washington, D.C.: May
18, 2006.
State Department: Stronger Action Needed to Improve Oversight and
Assess Risks of the Summer Work Travel and Trainee Categories of the
Exchange Visitor Program. GAO-06-106. Washington, D.C.: October 14,
2005.
Health Workforce: Ensuring Adequate Supply and Distribution Remains
Challenging. GAO-01-1042T. Washington, D.C.: August 1, 2001.
Health Care Access: Programs for Underserved Populations Could Be
Improved. GAO/T-HEHS-00-81. Washington, D.C.: March 23, 2000.
Foreign Physicians: Exchange Visitor Program Becoming Major Route to
Practicing in U.S. Underserved Areas. GAO/HEHS-97-26. Washington, D.C.:
December 30, 1996.
Health Care Shortage Areas: Designations Not a Useful Tool for
Directing Resources to the Underserved. GAO/HEHS-95-200. Washington,
D.C.: September 8, 1995.
FOOTNOTES
[1] In this report, we use the term "underserved areas" to refer to
areas, population groups within areas, and facilities with shortages of
health care professionals; areas or population groups with shortages of
health care services; or both. The Department of Health and Human
Services has established specific criteria for identifying these
underserved areas, which are described in more detail later in this
report.
[2] 8 U.S.C. §§ 1182(e), 1184(l)(1)(D).
[3] In this report, we refer to a waiver of the 2-year foreign
residence requirement for foreign medical graduates as a "J-1 visa
waiver" or "waiver."
[4] NHSC places physicians and other health care professionals who are
U.S. citizens or U.S. nationals in underserved areas, primarily through
its scholarship and educational loan repayment programs. Participating
students and health professionals are required to practice in
underserved areas for at least 2 years.
[5] See GAO, Foreign Physicians: Exchange Visitor Program Becoming
Major Route to Practicing in U.S. Underserved Areas, GAO/HEHS-97-26
(Washington, D.C.: Dec. 30, 1996), and "Related GAO Products" at the
end of this report.
[6] See GAO, Foreign Physicians: Preliminary Findings on the Use of J-
1 Visa Waivers to Practice in Underserved Areas, GAO-06-773T
(Washington, D.C.: May 18, 2006).
[7] The Immigration and Nationality Act defines "state" to include the
District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. 8
U.S.C. §1101(a)(36).
[8] ARC is a federal-state economic development partnership between the
federal government and 13 states. The commission initiates economic and
community development programs and serves as an advocate for the people
of the Appalachian Region, including all of West Virginia and parts of
12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New
York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee,
and Virginia.
[9] DRA is a federal-state partnership between the federal government
and eight states. The authority was created to remedy severe and
chronic economic distress by stimulating economic development and
fostering partnerships that will have a positive impact on the economy
of the region. The authority covers 240 counties and parishes in
Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi,
Missouri, and Tennessee.
[10] Comprehensive data on the precise number of J-1 visa waivers
granted at the request of states and federal agencies for physicians to
practice in underserved areas are not available. The federal agencies
responsible for recommending and granting waiver requests (the
Department of State and the Department of Homeland Security) indicated,
however, that after review for compliance with statutory requirements
and security issues, nearly all states' and federal agencies' waiver
requests are recommended and approved.
[11] For the purposes of this report, reference to waiver physicians'
meeting their agreements to work in underserved areas refers to
complying with the relevant statutory and regulatory requirements,
along with the terms and conditions of any agreements physicians enter
into with their employers or with the states or federal agencies that
requested their waivers. Terms and conditions may include practicing in
a certain specialty or serving patients who are uninsured or covered by
Medicaid, the joint federal-state program that finances health care for
certain low-income individuals.
[12] We also asked states about their views on the adequacy of the
annual limit on the number of waivers that may be granted in response
to their requests (states are limited to 30 waivers per state per year)
and on having their unused waiver allotments redistributed. For states'
views on these issues, see GAO-06-773T.
[13] For this report, we define primary care to include family
practice, internal medicine, obstetrics/gynecology, and pediatrics.
Psychiatry is reported separately from primary care and nonprimary care
specialties because some states and federal agencies consider primary
care to include psychiatry while others do not.
[14] In addition to foreign physicians who come to the United States
for graduate medical education, other categories of exchange visitors
include professors and research scholars, short-term scholars,
trainees, college and university students, teachers, secondary school
students, specialists, international visitors, government visitors,
camp counselors, au pairs, and summer work travel. See generally 22
C.F.R. pt. 62. Exchange visitors in these other categories are subject
to the 2-year foreign residence requirement under certain
circumstances. See 8 U.S.C. § 1182(e)(i), (ii). For more information on
the Exchange Visitor Program, see GAO, State Department: Stronger
Action Needed to Improve Oversight and Assess Risks of the Summer Work
Travel and Trainee Categories of the Exchange Visitor Program, GAO-06-
106 (Washington, D.C.: Oct. 14, 2005).
[15] 8 U.S.C. § 1182(e). Such foreign medical graduates with J-1 visas
are also prohibited from changing to any other type of nonimmigrant
status. 8 U.S.C. § 1258(2).
[16] 8 U.S.C. §§ 1182(e), 1184 (l)(1)(D). Physicians with J-1 visas may
also obtain a waiver at the request of the Department of Veterans
Affairs (VA) if the physician has agreed to practice at a VA facility
for at least 3 years. To obtain a waiver to practice in an underserved
area or at a VA facility, such employment must also be determined by
the Department of Homeland Security to be in the public interest.
Physicians with J-1 visas may also obtain a waiver of the 2-year
foreign residence requirement if the Department of Homeland Security
determines that their departure from the United States would create an
exceptional hardship for the physician's U.S. citizen or permanent
resident spouse or child or if the return to the physician's home
country or country of last legal residence would subject the physician
to persecution because of race, religion, or political opinions.
[17] Pub. L. No. 103-416, § 220, 108 Stat. 4305, 4319.
[18] Pub. L. No. 87-256, § 109(c), 75 Stat. 527, 534.
[19] 60 Fed. Reg. 48515-6 (Sept. 19, 1995).
[20] Separate HPSA designations exist for primary care and for other
health care fields, such as mental health. For primary care HPSAs,
designation is generally based on the ratio of population to the number
of primary care physicians and other factors, such as health care
resources available in neighboring areas. Some facilities, however, are
not required to meet a specific ratio of population to primary care
physicians to be designated as a primary care HPSA.
[21] States and federal agencies requesting waivers for physicians to
practice nonprimary care specialties are required to demonstrate,
according to their own criteria, a shortage of health care
professionals able to provide services in that medical specialty to the
patients who would be served by that physician. 8 U.S.C. §
1184(l)(1)(D)(iii).
[22] Pub. L. No. 108-441, § 1(d), 118 Stat. 2630.
[23] In this report, unless otherwise noted, when referring to waiver
physicians practicing or working in underserved areas, we include
physicians practicing with flexible waivers.
[24] According to USCIS officials, the agency's data systems are not
able to identify J-1 visa waivers granted specifically for physicians
to practice in underserved areas and do not include information on
waiver physicians' practice specialties. According to Department of
State officials, the department maintains data on the number of J-1
visa waivers it has recommended but does not maintain data on the
physicians' practice locations or specialties.
[25] Foreign physicians also enter the United States for graduate
medical education using other visa types, such as H-1B visas, temporary
work visas for foreign nationals employed in certain specialty
occupations. These other visa types may require the physician to meet
additional statutory or regulatory requirements, such as evidence that
the physician has a license to practice medicine in a particular state.
Reliable data are not available on the extent to which these other visa
types are used.
[26] See appendix II for states' and federal agencies' responses to
selected survey questions, including the number of J-1 visa waivers
requested, in total, by federal agency, by practice specialty, and by
practice setting.
[27] Although data are not available on the number of physicians
granted J-1 visa waivers and practicing in underserved areas at any
given time, we estimated that number by totaling the number of waiver
requests in each of fiscal years 2003 through 2005. This number
represents the physicians expected to be fulfilling the minimum 3-year
employment contract at the end of fiscal year 2005 or who had waivers
in process to do so. We compared that estimate to the number of
physicians practicing in underserved areas through NHSC programs in the
50 states, District of Columbia, Guam, Puerto Rico, and the U.S. Virgin
Islands as of September 30, 2005.
[28] In our May 2006 testimony on preliminary findings (GAO-06-773T),
we reported that ARC, DRA, and HHS requested waivers for physicians to
practice in 15 states in fiscal year 2005. Our final analysis of agency
data determined that these agencies requested waivers for physicians to
practice in 14 states that year (see app. II).
[29] See appendix II for states' and federal agencies' responses to
selected survey questions, including their policies for requesting
waivers.
[30] Data on practice settings were not available for all federal
agencies. ARC, which requested 36 waivers in fiscal year 2005 (more
than half of all federally requested waivers that year), reported that
it does not track waiver physicians' practice settings. (See app. II
for available data on practice settings reported by federal agencies.)
[31] States and federal agencies reported identifying a total of 81
incidents of physicians not meeting their waiver agreements in fiscal
years 2003 through 2005;
we did not independently verify these incidents. We estimated that at
the end of fiscal year 2005, more than 3,000 waiver physicians were
working in underserved areas.
[32] Most of the states and the one federal agency that reported
identifying physicians who had transferred without their approval had
policies or guidelines requiring physicians seeking transfers to notify
or obtain approval from their J-1 visa waiver programs in addition to
obtaining the required approval from USCIS.
[33] Six states and DRA reported charging application fees ranging from
$200 to $2,000 in fiscal year 2005 to help fund their J-1 visa waiver
programs. Our survey results showed no statistically significant
relationship between charging application fees and the number of
monitoring activities conducted.
[34] According to USCIS officials, as of September 2006, the agency did
not notify states and federal agencies when it approved waiver and
transfer requests. The officials said that the agency was working with
the Department of State to develop a system to do so and expected such
a system to be in place in fiscal year 2007.
[35] See appendix I for detailed information on this analysis. Data
were not available to determine the areas (HPSA, MUA/P, or
nondesignated areas) where waiver physicians were practicing primary
care at the end of fiscal year 2005.
[36] See GAO, Health Care Shortage Areas: Designations Not a Useful
Tool for Directing Resources to the Underserved, GAO/HEHS-95-200
(Washington, D.C.: Sept. 8, 1995).
[37] In October 2006, we recommended that the Secretary of Health and
Human Services complete and publish the proposal to revise the HPSA
designation system and address the shortcomings that have been
identified. See GAO, Health Professional Shortage Areas: Problems
Remain with Primary Care Shortage Area Designation System, GAO-07-84
(Washington, D.C.: Oct. 24, 2006). In commenting on that report, HHS
agreed with this recommendation.
[38] International medical graduates are physicians who completed their
medical education in schools outside the United States and Canada; they
include U.S. citizens and permanent residents as well as foreign
nationals.
[39] Certain facilities, including all federally qualified health
centers and certain rural health clinics, are not required to meet a
specific ratio of population to primary care physicians for primary
care HPSA designation. Because data were not available to identify
which waiver and NHSC physicians were working in these facility HPSAs,
these physicians were included in physician counts for this analysis.
[40] HHS has been working on a proposal to revise the MUA/P designation
system. As of September 2006, this proposal was in the department's
clearance process.
[41] A total of 499 physicians practicing in the states through two
other NHSC programs--the State Loan Repayment and Community Scholarship
programs--were not included in the total number of NHSC physicians for
this analysis because, according to HHS officials, they are already
counted as physicians practicing in HPSAs when HHS identifies the
number of additional primary care physicians required to remove HPSA
designations.
[42] Physicians for whom waivers were requested to practice both
primary and nonprimary care (e.g., physicians who practiced both
internal medicine and cardiology) were counted as 0.5 FTE. We excluded
from our analysis 1,051waivers requested in fiscal years 2003 through
2005 for physicians to practice exclusively nonprimary care. We also
excluded 256 waivers requested during that time for physicians to
practice psychiatry because psychiatrists are not included in physician
counts for primary care HPSAs.
[43] Data were not available to determine the areas (HPSA, MUA/P, or
nondesignated area) where physicians whose waivers were requested in
fiscal years 2003-2005 were practicing primary care. For all physicians
whose waivers were requested in fiscal year 2005--including those
requested to practice primary care, nonprimary care or psychiatry--we
found that 77 percent worked in facilities located in HPSAs, 16 percent
worked in MUA/Ps that were not also in HPSAs, and 7 percent worked
outside of HPSAs and MUA/Ps.
GAO's Mission:
The Government Accountability Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site (www.gao.gov). Each weekday, GAO posts
newly released reports, testimony, and correspondence on its Web site.
To have GAO e-mail you a list of newly posted products every afternoon,
go to www.gao.gov and select "Subscribe to Updates."
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office 441 G Street NW, Room LM
Washington, D.C. 20548:
To order by Phone: Voice: (202) 512-6000 TDD: (202) 512-2537 Fax: (202)
512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 U.S.
Government Accountability Office, 441 G Street NW, Room 7125
Washington, D.C. 20548:
Public Affairs:
Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800
U.S. Government Accountability Office, 441 G Street NW, Room 7149
Washington, D.C. 20548:
