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[Read More Articles] | [print this article] Shortage of MDs in Rural Areas Calls for Relief
One of the bills that emerged in the lame duck session of the 109 th Congress was H.R. 4997 which seeks to extend the Conrad 30 Program allowing states to bring 30 qualified foreign physicians yearly to work in their respective medically underserved areas for 3 years. After being approved by the Senate by a voice vote on December 9, 2006, H.R. 4997 now awaits enactment by the President .

The American Hospital Association, which represents 5,000 member hospitals, health systems and other healthcare providers nationwide, describes the Conrad 30 as the only source of healthcare for more than 20 million Americans who live in such underserved areas.

The proposal to extend the Conrad 30 Program for another two years, through June 2008, is a welcome development for a healthcare industry sector in critical need of more physicians. Medically underserved areas rely on foreign medical graduates (FMGs) for their hospital staff. But most FMGs enter the US on J-1 visas which require them to go back to their home countries for 2 years after they finish their training.

Unless a waiver of this requirement is obtained, an FMG is not eligible to change his/ her status to H-1B or for permanent residence.


Prior to 1976, a waiver of this requirement could be obtained on several grounds such as a no objection letter from the FMG's home country; recommendation of an interested government agency (IGA) in the US; or on the basis of persecution or exceptional hardship.

When the Health Professionals Educational Assistance Act was passed in 1976, however, it removed the no objection letter as a basis for granting the 2-year residency waiver, thereby leaving J-1 holders with very few options for staying in the US.

State Waiver Recommendations

Initially, the IGA waiver recommendation could only be given by federal government agencies.

Beginning in 1994, the authority to recommend the 2-year residency waivers was expanded by law to include states, subject to certain numerical limitations under the so-called Conrad 20 Program.

The states have now overtaken federal government agencies in issuing recommendations for the 2-year residency waivers for FMGs.

During the first two years of the Conrad 20 Program (1994 to 1996), each state was granted the authority to issue 20 waiver recommendations annually based on the waiver requests of their respective petitioning facilities. The physician must agree to work within 90 days of receiving the waiver approval on a full-time basis in a medically underserved area for at least 3 years.

Changes in the Waiver Systems

In 1996, when Congress extended the program for 6 years, the states were granted the authority to recommend waivers not just for primary care physicians but also for medical specialists.

In 2002, the number of state waivers was increased from 20 to 30 (hence, the program is now called the Conrad State 30 Program or Conrad 30 Program).

Under the 2004 amendment of the Conrad 30 Program, federal IGAs were allowed to recommend waivers to medical specialists and exempted federal waiver beneficiaries from the annual H-1B cap.

Previously only beneficiaries of state waivers were exempted from the H-1B cap. Unfortunately, the program was allowed to expire on June 1, 2006, leaving medical facilities in underserved areas with practically no means to bring in much-needed foreign physicians.

Obviously, the 2-year extension of the Conrad 30 Program through June 2008 will not solve all the problems of medically underserved areas permanently, or even over the long-term.

The history of the program demonstrates how tentative Congress had been over the past 12 years about opening the healthcare system to FMGs, despite the general shortage of healthcare professionals in the US.

Hopefully, the next Congress will have the sense to include a rational and efficient system for allowing FMGs to enter the US in the comprehensive immigration reform plan.
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