Rural, Inner-City Areas Hit Hardest by Physician Shortage
A nationwide physician shortage is affecting rural and inner-city residents the most and is being exacerbated by restrictions put in place on foreign doctors who want to practice in the U.S. after the Sept. 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 would require 16,000 physicians to immediately alleviate the shortage of doctors in those areas. One government estimate indicates the U.S. could require as many as 24,000 physicians in 2020 to fill the shortage, the AP/Inquirer reports.
To help relieve the shortage in some areas of the U.S., including the Mississippi Delta region and Appalachia, the federal government through a number of state and federal work programs began issuing J-1 visa waivers, which allow foreign physicians to work in rural areas for three to five years and could allow them to seek permanent residency. The majority of J-1 waivers 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 set to expire in 2008, according to the AP/Inquirer.
Since 2001, the government has implemented higher fees, harder tests and stricter rules on determining "underserved" areas, making it more difficult for foreign physicians to attain the visas and obtain permanent residency, the AP/Inquirer reports.
According to the Government Accountability Office, the number of physicians in training with J-1 visa waivers declined by nearly half over the last 10 years, from 11,600 in the 1996-1997 academic year to fewer than 6,200 in the 2004-2005 academic year.
In addition, 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 Administration administrator, said, "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."
However, Conrad said the doctor shortage "will mostly be felt in rural America," adding, "We're facing a real crisis" (Talbott , AP/Philadelphia Inquirer, 7/22).
Developing nations in recent years have begun calling on physicians to practice in their home countries rather than in places such as the U.S., the AP/Inquirer reports.
Some health policy experts say that although foreign doctors in the U.S. might be treating underserved, low-income populations, the physicians 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/Inquirer reports that the U.S. exports less than one-tenth of 1% of its physicians to other nations. Mullan said the holes created when physicians leave their countries usually remain unfilled.
Meanwhile, South African Medical Association President Kgosi Letlape said that the migration of doctors creates a trickle-up effect, adding, "We are in a continuum. What South Africa loses to the developed world, to the United States, say, we gain from Uganda" (Talbott , AP/Philadelphia Inquirer, 7/22).