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Greg Siskind on Immigration Law and Policy

AP: SHORTAGE OF DOCTORS AFFECTS RURAL US

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As many of you know, I chair the FMG Taskforce, the coalition of physician immigration law firms that handle the bulk of the nation's physician immigration matters. If you are a doctor and your immigration lawyer handles physician cases regularly, the odds are pretty good that he or she is a member of our group. 



We've been working on legislation to address what the AP is describing in their story from this morning. The article is on the mark in describing the problems associated with fewer foreign doctors going to rural areas. Rather than rolling out the welcome mat to foreign doctors to make them interested in staying in the US and working in areas really needing them, Congress and the White House have been doing a lot more to discourage them.



Case in point - the Department of Health and Human Services. In the story, HHS says that the reason it's program approves less than ten doctors a year is because of a lack of interest because of too few doctors seeking positions in rural areas.



That is a absolutely untrue! HHS killed its waiver program for all intents and purposes in 2002 when it changed its rules to only allow communities with "super-shortages" to apply. HHS promised after 9/11 to take over the Department of Agriculture's waiver program in 2002 after a meeting was held at the White House regarding the future of the waiver program. It opened a relatively good program in the summer of 2002 and had a number of applicants. Then it abruptly shut the program down in September 2002 and reopened in December with a number of rule changes that all but shut the program down completely.



I did an analysis that was cited in a Congressional Research Service report that showed that this rule change alone eliminated more than 80% of qualifying rural facilities. They also barred hospitals and private medical practices from applying and that effectively eliminated almost all of the rest. Senator Conrad recently introduced legislation to force HHS to open up its waiver program - to specialists, to private employers, to ALL shortage areas. Pass that legislation and then let HHS tell us there is no interest in the physician population.



I can't tell you exactly why HHS did what it did, but I can only assume the worst - that it wanted to kill the waiver program all together, but knew politically it could not. So they did the next best thing - make it so unattractive that no one would apply. And they have accomplished that. Hopefully, Senator Conrad will succeed in forcing them to do their jobs.

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Comments

  1. 's Avatar
    Greg,
    Want to address your comment:
    "HHS says that the reason it's program approves less than ten doctors a year is because of a lack of interest because of too few doctors seeking positions in rural areas. That is a absolutely untrue!"
    I agree with your disagreement, but I think the truth is that the article has twisted some of the reasoning. Its more like there is a decrease in interest in coming to the US (rural areas or not) because of all the problems that their friends and family are facing with backlogs and anti-immigration policies. So why would a skilled physician select the US over other more immigrant friendly countries like the UK, Australia and Canada? What is the motivation for them to come here and serve in an under-served area only to be forced to return after a couple of years?

  2. Greg Siskind's Avatar
    The US offers the best medical training in the world so there will be a strong draw for many doctors even if our immigration system is pretty unpleasant. And US salaries are still higher than most countries, particularly as the physician shortage gets more severe. There has been a shift from the J-1 to the H-1B as the visa of choice for doctors coming for residency and fellowship programs. That has to do more with choices made before the H-1B numbers were such a bad problem. And it has to do with scarcity in the J-1 programs. There are 1500 state waiver slots for roughly 6000 doctors. If HHS modified its program, I feel confident that they would get a lot of applications.
  3. 's Avatar
    Greg, I am glad that you are such an advocate for so many people here and for the best interests of the United States. I have read your posts. Whether it is gay immigrant rights, workers (legally in the US) immigrant rights or general fair policies for those who dont have much a voice...you work is truly admirable. Mybe you should run for the next President of the US In all serious though, I want to say a HUGE thank you to you!
  4. EB's Avatar
    Greg, I only recently came across your blog and I am impressed by your dedication and professionalism.

    Regarding other visa options for physicians going to residency, could a physician doing research with currently pending primary AOS start residency on EAD?

    Thanks.
  5. Greg Siskind's Avatar
    EB - This is possible and I've had clients do it in the past. The argument would be that clinical training will enhance one's research skills and open doors to do clinical research. You'll want to talk to your lawyer about it, but it is in the realm of the possible for many.
  6. EB's Avatar
    Greg- may I pm you? My lawyer never had this situation. Thanks.
  7. Greg Siskind's Avatar
    EB- Sure.
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