Bridging the Healthcare Gap: Dissecting the Bipartisan Doctors in Our Borders Act

The U.S. healthcare system stands at a critical juncture. Projections estimate a deficit of up to 86,000 physicians by 2036, threatening access to care, especially in underserved communities. The bipartisan Doctors in Our Borders Act (H.R. 1201), introduced in the 119th Congress by Representatives Mike Lawler (R-NY) and Yvette Clarke (D-NY), seeks to address this looming shortage with a creative implementation and expansion of the Conrad 30 Program for foreign medical graduates.

Understanding the J-1 Visa and Conrad 30 Waiver

Many international medical graduates (IMGs) enter the U.S. on a J-1 exchange visitor visa to complete their residency or fellowship training. However, J-1 visa holders are subject to a two-year foreign residency requirement: they must return to their home country for two years before they can apply for an H-1B work visa or a green card – unless they receive a waiver from the Department of State and USCIS.

The Conrad 30 Waiver Program – established in 1994 – is a federal program that provides a state-based solution to this problem. Under the program, each state can sponsor up to 30 J-1 waiver requests per year for physicians who agree to work in federally designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs). In exchange, these physicians commit to providing full-time clinical care for at least three years in the underserved community.

The Conrad 30 program has traditionally offered a pathway for physicians who are otherwise forced to leave the U.S. despite training in our hospitals and earning board certifications. But many states exhaust their 30 waivers quickly – especially those with large rural populations or overburdened health systems. Meanwhile, other states do not fully use their allotment, resulting in lost opportunities.

Key Provisions within the Doctors in Our Borders Act

The Doctors in Our Borders Act addresses this inequity by introducing a waiver portability provision: if one state has unused waivers, another state with higher demand can use those slots. This makes the system more responsive to actual workforce needs and avoids the unnecessary loss of medical talent due to bureaucratic limits.

Furthermore, expanding the waiver cap to 100 would relieve pressure on both physicians and state public health departments that must prioritize only the most urgent applications each year. For immigrant physicians, this means more opportunities to practice in the U.S. without facing the disruptive and often heartbreaking reality of forced departure.

1. Reauthorization of the Program: The bill reauthorizes the Conrad 30 waiver program for an additional three years. This program allows states to sponsor waivers of the J-1 visa two-year home residency requirement for physicians who agree to work for at least three years in shortage areas.
   
   
2. Pathway to Permanent Residency: It enables physicians who complete their service requirements in underserved areas to apply for permanent residency without being subject to the annual employment-based green card cap, provided they meet certain criteria.
   
   
3. Sharing of Unused Waivers: States are permitted to use waiver slots that remain unused by other states, allowing for a more efficient allocation of physicians to areas with the greatest need.
   
   
4. Job Flexibility and Protection: The legislation includes safeguards that allow physicians to change employers under specific circumstances without losing eligibility, provided the new position also meets the underserved area requirements. This provision is designed to maintain continuity in patient care while protecting physicians from disruptions outside their control.

Bipartisan Support and Stakeholder Endorsements

The Act has garnered bipartisan support, reflecting a shared commitment to bolstering the healthcare workforce.

Organizations such as the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) have endorsed the bill, highlighting its potential to address physician shortages and improve patient care.

Rep. Lawler called the bill a commonsense solution to help address physician shortages impacting communities, and Rep. Clarke added that it will ensure deserving, talented immigrants are recognized for their contributions and potential.

Implications for Healthcare Employers and IMGs

For Healthcare Employers:

• Expanded Recruitment Pool: With increased waiver slots, healthcare facilities have greater opportunities to recruit qualified IMGs, filling critical gaps in care.
  
  
• Streamlined Processes: The redistribution of unused waivers can expedite hiring, reducing administrative delays.

For International Medical Graduates:

• Continued Practice in the U.S.: The Act provides more avenues for IMGs to remain in the U.S., contributing their skills where they are most needed.
  
  
• Pathway to Residency: By serving in underserved areas, IMGs can fulfill requirements that may lead to permanent residency options.

Moving Forward

The Doctors in Our Borders Act represents a strategic approach to mitigating the physician shortage crisis. By expanding and optimizing the Conrad 30 Waiver Program, this legislation seeks to ensure that all communities have access to quality healthcare services.

As the bill progresses through Congress, stakeholders – including healthcare employers and IMGs – should stay informed and engaged, recognizing the potential benefits this legislation offers to the U.S. healthcare landscape.

We will keep you updated on this important legislation.

About Our Author

Mary Kate Fernandez focuses her practice exclusively on business immigration, representing employers across a range of industries. With experience guiding clients through U.S. immigration regulations, she helps businesses sponsor and retain skilled talent from around the world. She also assists employers in addressing a wide range of employment issues related to immigration and international employment, ensuring they remain compliant with regulations. Fernandez has established contacts and experience liaising with the Department of Labor (DOL), U.S. Citizenship and Immigration Services (USCIS), U.S. Coast Guard (USCG), Department of State (DOS), and U.S. consulates worldwide. This network enables her to guide clients effectively through regulatory requirements across different jurisdictions.