- Three senators recently introduced a rural healthcare bill that would extend the Conrad State 30 Program until 2021 to help alleviate the physician shortage in designated Health Professions Shortage Areas or Medically Underserved Areas.
Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), and Heidi Heitkamp (D-ND) proposed the Conrad State 30 Program and Physician Access Act of 2017 to allow the rural healthcare initiative to continue after its scheduled end on April 28.
Since 1994, state health departments can request J-1 visa waivers for up to 30 foreign physicians per year to fill physician shortages in rural and underserved areas under the Conrad State 30 Program.
Current law requires foreign-educated and non-US citizen physicians to enter the country on a J-1 visa to take graduate medical education programs. However, the physicians must return to their home country for at least two years before they are eligible to apply for a work visa in the US.
By bypassing the two-year restriction, the federal government intended to help underserved and rural areas gain access to more primary care providers. Although the program recently expanded to specialists.
The program’s namesake, former Senator Kent Conrad (D-ND), attempted to make the initiative permanent in 2008 through a reauthorization act. But Congress approved the program’s extension as a sunset law, meaning it will require future reauthorization.
With the latest reauthorization set to end later this month, the most recent bill aims to keep the rural healthcare initiative going while also increasing the number of foreign physicians that states can employ in designated Health Professions Shortage Areas or Medically Underserved Areas.
The senators proposed to increase the number to 35 foreign physicians per year to make up the physician shortfall in rural and underserved areas.
The country currently faces a substantial physician shortage and researchers recently projected the shortfall to increase. The Association of American Medical Colleges revealed last month that the shortage is estimated to grow to up to 104,000 providers by 2030.
Physician shortfalls are up from the organization’s 2015 predictions of a 90,000-provider shortage by 2025.
Access to physicians is especially problematic in rural areas. Former CMS Administrator Andy Slavitt reported in October 2016 that the lack of providers in rural areas accounted for 65 percent of the healthcare professional shortage.
Even though 20 percent of the population lives in a rural area, only 10 percent of physicians practice in these regions, he added.
The physician shortage in rural areas is even worse for specialists, particularly behavioral health providers. Slavitt stated that one in eight rural counties did not have a behavioral health specialist and counties that did have the specialist only had one-third to one-half of the employment levels compared to urban settings.
“Access to specialists is one of the biggest challenges, and that becomes more important as the health needs of the population become more complex,” he wrote. “With prescription drug abuse, increasing suicide rates, and the opioid epidemic taking its toll, our shortages of psychiatrists and psychologists– a problem everywhere– are deeper in rural counties.”
Safety-net healthcare organizations are also facing workforce challenges. For example, 95 percent of all health centers experienced at least one clinical vacancy in 2016, according to a National Association of Community Health Centers report.
Health centers also had an average 13 percent of their clinical workforce positions vacant with the vacancy rate significantly higher for family physicians at 25 percent.
With safety-net health centers typically treating residents in underserved areas, the physician shortage reduced clinical capacity.
The American Hospital Association recently voiced their support for the recently-proposed Conrad State 30 Program and Physician Access Act of 2017 as a way to relieve physician shortages and care access obstacles in underserved and rural areas.
“We urge swift action to extend this vital program,” wrote Thomas P. Nickels, AHA Executive Vice President. “Without timely reauthorization, many communities that have benefited from these physicians may find themselves without access to such services. We support the enactment of the program improvements contained in the Conrad State 30 and Physician Access Act as part of this extension and stand ready to work with you and your colleagues to accomplish this goal.”
The bill is currently in the hands of the Senate Committee on the Judiciary.