Rural Health Care Gets Lift

Rural health advocates in California on Wednesday cheered a move by the U.S. Department of Health and Human Services to sponsor visa waivers for foreign physicians who practice in areas plagued by doctor shortages.

The decision, announced by Health and Human Services Secretary Tommy G. Thompson this week, salvages a program jeopardized this year when the U.S. Department of Agriculture -- citing post-Sept. 11 jitters -- opted to no longer participate.

Although states can also sponsor waivers each year -- the limit just rose from 20 to 30 -- those don’t meet the desperate need of California’s rural clinics, state officials and advocates say.

“The big states run out right away, and then spend the rest of the year apologizing to the little clinics,” said L.A. immigration attorney Carl Shusterman, whose specialties include physician waivers. “HHS could really be the safety valve that allows big states like California to survive.”

The USDA’s abrupt departure from the program in February panicked rural clinics that have come to rely on foreign doctors. The department had sponsored more than 3,000 of the waivers since 1994, 232 of them for doctors in rural California. On Wednesday, advocates expressed nothing short of glee.

“We are so excited,” said Cheri Voisine, spokeswoman for the California State Rural Health Assn. “This opens up a lot of opportunities for rural health providers.”

Nancy Oliva is a public health consultant and member of the board of the Oak Valley Hospital District, which includes the underserved community of Waterford east of Modesto. She called the decision “great news ... that means access to care will be stabilized in underserved areas.”

She has recently met with strapped health providers in Del Norte and Tehama counties but was unable to point them to a solution, since the state already met its waiver quota for the year. “Now I can tell them we may have access to international medical graduates again,” she said.

Long hours, antiquated hospital technology and a dearth of cultural activities have kept U.S. medical graduates away from rural practice. But as rural populations in California grow, the need has only increased. Enter foreign medical residents.

J-1 visas require them to return to their home countries for at least two years after they complete their residencies, but that condition can be waived if a greater public need is met.

HHS has sponsored waivers, but only for elite biomedical researchers. It will now take over the role played by the USDA in handling waiver applications for primary care physicians who vow to work in underserved areas.

The move is a logical one for HHS, whose Health Resources and Services Administration already tackles the problem of access to health care through other programs. Among those is the National Health Service Corps, which pays off loans for and provides scholarships to U.S.-trained doctors who serve in areas with physician shortages.

HHS is also in a better position than the USDA to track doctors after the waivers are issued and ensure they’re working where they are supposed to be. It plans to coordinate with state programs to make sure the neediest areas are served.

“We’re hoping to bring some better organization to the whole process,” said Stephen Smith of the Health Resources and Services Administration, which has sought $2.5 million in the 2004 federal budget for the work, he added. Physicians will first be directed to state programs, but if the states where they are seeking work have reached their annual limit, the requests will be processed. HHS plans to issue 300 waivers a year, Smith said.