Doctor Shortage Affects Rural America

Doctor Shortage Affects Rural America
But Obstacles Hinder Efforts to Recruit Foreign Physicians
Saturday, July 21, 2007 01:22 PDT


GREENWOOD, Mississippi -- A national shortage of doctors is hitting poor
places the hardest, and efforts to bring in foreign physicians to fill the
gap are running into a knot of restrictions from the war on terror and the
immigration debate.

Doctors recruited from places such as India, the Philippines and sub-Saharan
Africa to work in underserved areas like the Mississippi Delta and the
lonesome West already face an arduous and expensive gauntlet of agencies,
professional tests and background checks to secure work papers and permanent
residency.

Those restrictions have only tightened in the years since 9-11-01, and now
many believe the process will become more difficult after the attempted
terrorist bombings in Britain that have been linked to foreign doctors.

"The consensus seems to be that if you have a first name like Mohammed, you
can forget it," Dr. Sanjay Chaube, a much-needed internist in Hurricane
Katrina-ravaged Bay St. Louis, Mississippi, and one of more than 40,000
Indian doctors in the U.S. He is working in this country under what is
known as a J-1 visa waiver.

The government estimates that more than 35,000,000 Americans live in
underserved areas, and it would take 16,000 doctors to immediately fill that
need, according to the American Medical Association. And the gap is expected
to widen dramatically over the next several years, reaching 24,000 in 2020
by one government estimate. A 2005 study in the journal Health Affairs said
it could hit an astonishing 200,000 by then, based on a rising population
and an aging work force.

"And that will mostly be felt in rural America," said Sen. Kent Conrad,
D-N.D. He added: "We're facing a real crisis."

America's rural and inner-city poor already are suffering the most. For
example, there are 280 doctors for every 100,000 people in the U.S. But
there are only 103 for every 100,000 in the 18-county area of the
Mississippi Delta, according to the Mississippi State University Social
Science Research Center. And the Delta has some of the nation's highest
rates of infant mortality, heart disease and other serious illnesses.

Steps are slowly being taken by individual states and universities to enroll
more students in medical school. But it takes years to educate a doctor. And
even then, many professionals are unconvinced those steps alone will make
much difference.

To help relieve the misery in the Delta, Appalachia and other parts of the
country in dire need of physicians, the government lets foreign doctors into
the country under J-1 visa waivers, dispensed through a variety of state and
federal programs.

J-1 visa waivers allow foreign doctors to work in underserved areas 3 to 5
years, with a shot at eventually obtaining permanent residency.

Over each of the past 3 years, about 1,000 practicing physicians have come
to the U.S. on J-1 visa waivers. Many of them are from unstable or
undeveloped countries and come here in search of better training, working
conditions and pay.

Yet, since 9-11-01, the federal government has made it more difficult to
qualify for the special visas and to obtain permanent residency. The tests
are harder, the legal fees are higher, and the rules have been changed by
the Department of Health and Human Services in such a way that fewer
counties and clinics are designated "underserved" and thus eligible to
obtain J-1 doctors.

As a result, some foreigners are choosing to leave after their commitment is
up, or are not applying to come to the U.S. at all.

The number of physicians in training with J-1 visa waivers has fallen by
almost half over the past decade, from 11,600 in academic year 1996-97 to
fewer than 6,200 in 2004-05, according to the Government Accountability
Office. And federal and state requests for J-1s for doctors dropped from
1,374 in 1995 to 1,012 in 2005.

Medical professionals and others have put much of the blame on HHS.

Before 9-11-01, the Department of Agriculture operated a program that
brought more than 1,000 doctors a year to the United States, but it was shut
down after 9-11-01. HHS then took charge of a new program in 2003 with
tighter rules, and has approved just 61 J-1 visas since.

But the HHS said the numbers dropped because of a lack of interest among
doctors.

"We just aren't getting that many applications because the pool is smaller
and the tendency is to go to the states because the rules about what they
can do are much broader," said Stephen R. Smith, senior adviser to the
Health Resources and Services Administration's administrator at HHS.

The vast majority of J-1s are being issued instead under a 13-year-old
program sponsored by Conrad. The Conrad State 30, as it is now called,
authorizes 30 J-1s per state per year. But the program will expire in 2008
unless reauthorized by Congress.

Some foreign doctors are giving up on the American dream.

Husband-and-wife Drs. Rohit Panchal and Vaishali Shah were heralded on a
billboard in Greenwood when they arrived. As a pulmonologist with critical
care training and an internist, they treat a patient population with some of
the highest rates of lung cancer, diabetes and other grave illnesses.

They find the work rewarding, but when their commitment ends they are
considering returning to India instead of trying to obtain permanent
residency.

"It's too long and tedious a process. It's too tiring," Panchal said during
a break from rounds in the Greenwood Leflore Hospital.

The federal government cannot be blamed for everything, said Dr. Sampatkumar
Shivangi, an obstetrician and gynecologist in Jackson, Miss., who is
president-elect of the American Association of Physicians of Indian Origin.

He once tried unsuccessfully to help a J-1 physician find a position with a
rural Mississippi clinic.

"Some of the physicians in that community didn't want a physician to come
and practice there because it would take away patients," Shivangi said.


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