Physician Shortage Disproportionately Affects Rural, Urban Areas

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A nationwide physician shortage is affecting rural and inner-cityresidents the most and is being exacerbated by restrictions put inplace on foreign doctors who want to practice in the U.S. after theSept. 11, 2001, terrorist attacks, the AP/Philadelphia Inquirer reports. According to the American Medical Association,more than 35 million people live in underserved areas, and it wouldrequire 16,000 physicians to immediately alleviate the shortage ofdoctors in those areas. One government estimate indicates the U.S.could require as many as 24,000 physicians in 2020 to fill theshortage, the AP/Inquirer reports.

To help relievethe shortage in some areas of the U.S., including the Mississippi Deltaregion and Appalachia, the federal government through a number of stateand federal work programs began issuing J-1 visa waivers, which allowforeign physicians to work in rural areas for three to five years andcould allow them to seek permanent residency. The majority of J-1waivers come from a 13-year-old program sponsored by Sen. Kent Conrad(D-N.D.) that issues 30 waivers per state per year. That program is setto expire in 2008, according to the AP/Inquirer.

Since2001, the government has implemented higher fees, harder tests andstricter rules on determining "underserved" areas, making it moredifficult for foreign physicians to attain the visas and obtainpermanent residency, the AP/Inquirer reports. According to the Government Accountability Office,the number of physicians in training with J-1 visa waivers declined bynearly half over the last 10 years, from 11,600 in the 1996-1997academic year to fewer than 6,200 in the 2004-2005 academic year. Inaddition, HHS in 2003 took control of a Department of Agriculture foreign doctor program and has approved 61 J-1 waivers since that time, according to the AP/Inquirer.

Stephen Smith, senior adviser to the Health Resources and Services Administrationadministrator, said, "We just aren't getting that many applicationsbecause the pool is smaller, and the tendency is to go to the statesbecause the rules about what they can do are much broader."

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However,Conrad said the doctor shortage "will mostly be felt in rural America,"adding, "We're facing a real crisis" (Talbott [1], AP/Philadelphia Inquirer, 7/22).

Other Countries

Developing nations in recent years have begun calling on physicians topractice in their home countries rather than in places such as theU.S., the AP/Inquirerreports. Some health policy experts say that although foreign doctorsin the U.S. might be treating underserved, low-income populations, thephysicians are needed more in their home countries.

According to Fitzhugh Mullan of George Washington University, more than 10% of at least 20 countries' physician work forces leave to practice in wealthier nations. The AP/Inquirerreports that the U.S. exports less than one-tenth of 1% of itsphysicians to other nations. Mullan said the holes created whenphysicians leave their countries usually remain unfilled.

Meanwhile, South African Medical AssociationPresident Kgosi Letlape said that the migration of doctors creates atrickle-up effect, adding, "We are in a continuum. What South Africaloses to the developed world, to the United States, say, we gain fromUganda" (Talbott [2], AP/Philadelphia Inquirer, 7/22).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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