By David Velasquez and Nishant Uppal, MD candidates, Harvard Medical School
Zehra Syed, MBBS, graduated from medical school in Delhi with the goal of one day treating children born with heart defects. She obtained an H-1B visa to complete a pediatrics residency program in the US. She later realized she should additionally complete a fellowship in cardiology, extending her training in the US and requiring that she exchange her H-1B visa for a J-1 visa. While the J-1 visa allowed Dr. Syed to complete her fellowship, it also required that she subsequently return to her home country for two years before seeking permanent residency here. Dr. Syed’s opportunities to practice pediatric cardiology in the US, her limited options in India, and her hopes of marrying her long-time partner made it difficult for her to fathom leaving the country where her life and career had taken root after years of medical training. (Zehra Syed is a pseudonym, on request.)
For Dr. Syed, like many other international medical graduates (IMGs), it was “frustrating to achieve a level in your career where you think you should be able to get a job doing what you love, but have the fear that none of that might work out because of the idiosyncrasies of the system you live in.” And so she applied for the Conrad 30 Waiver Program, which allows foreign-trained doctors to waive the home-country return requirement if they practice in a medically underserved area of the US for at least three years.
But even after she hired an immigration lawyer to navigate that process, Dr. Syed’s application was denied. “The Conrad program, because of its limitations, was something that was forced on me, and I had no idea how to make my situation any better,” she says. “I just felt very helpless and dejected.” (In an exciting though atypical twist, Dr. Syed subsequently obtained an O-1 visa — a category limited to individuals who can demonstrate extraordinary ability or achievement — and has been able to continue practicing in the US.)
Shaping MMS Policy on Physician Immigration
“The current national spotlight on immigration reform combined with increasing physician shortages and health inequities make for an opportune moment to support the Conrad 30 program. For this reason, we recently co-authored resolution B-201, Reauthorizing and Expanding the Conrad Waiver Program, which the MMS adopted as policy in 2018. Presidential candidates and Congress can champion these causes by acting on bills that expand the Conrad program.”
— David Velasquez and Nishant Uppal, MD candidates, Harvard Medical School
Physicians for Underserved Communities
Over the years, IMGs have proven more likely than US-born physicians to work with America’s poor, elderly, and rural populations, and as primary care providers. The Conrad 30 Waiver Program, introduced in 1994 as the Physicians for Underserved Areas Act, was designed to recruit foreign doctors to regions of the US experiencing physician shortages. The Government Accountability Office has estimated that more foreign-trained physicians with Conrad waivers have practiced in underserved areas than physicians in the National Health Service Corps programs, long considered the primary federal mechanism of addressing physician shortages.
The number of health professional shortage areas — shortages in primary care, dental, or mental health care providers — now exceeds 7,000, affecting nearly 84 million Americans, according to the Health Resources and Services Administration. With the US population continuing to grow faster than the physician workforce, poor and rural areas will be disproportionately affected. Yet relatively few Conrad waivers are available. Each state is granted up to 30 a year, regardless of need. Dr. Syed was 35th in line when she applied for the waiver.
Efforts to Expand the Conrad Program
The Conrad program is set to expire at the end of 2019. Mahsa Khanbabai, who chairs the New England chapter of the American Immigration Lawyers Association, expects it to be renewed. Expanding the program is much more difficult, however. “We try repeatedly to lobby DC,” she says. In 2017, bipartisan expansion bills in both houses did not get past committees. A bipartisan group of congressional representatives has reintroduced the Conrad State 30 & Physician Access Act, which aims to increase the supply of physicians, especially in rural areas. In a letter to House representatives in October, Dr. Maryanne C. Bombaugh, MMS president, wrote, “[W]e are eager to incorporate these highly motivated and well-trained young physicians [from outside the US] into our aging workforce without delay.”
