Foreign Physicians

Placing enough doctors in underserved areas is a long-standing problem in the United States. A growing number of locations are turning to non-U.S. citizens who have just finished their medical education in the United States. Waivers that allow foreign graduates of U.S. medical schools to remain in the United States if they agree to practice in areas with shortages of medical personnel have grown dramatically--from 70 in 1990 to more than 1,300 in 1995. However, the program is rudderless, with no single agency responsible for managing and coordinating waiver requests. Monitoring efforts to ensure that physicians fulfill the terms of their agreements remain spotty. In addition, physicians who end up practicing in underserved areas may not actually target those segments of the population that are underserved.

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

Recommendations

Our 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.

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