Shortage of Doctors Affects Rural U.S.

The Associated Press
Sunday, July 22, 2007; 2:58 AM

GREENWOOD, Miss. -- A national shortage of doctors is hitting poor places the hardest, and efforts to bring in foreign physicians to fill the gap are running into a knot of restrictions from the war on terror and the immigration debate.

Doctors recruited from places such as India, the Philippines and sub-Saharan Africa to work in underserved areas like the Mississippi Delta and the lonesome West already face an arduous and expensive gauntlet of agencies, professional tests and background checks to secure work papers and permanent residency.

Those restrictions have only tightened in the years since 9-11, and now many believe the process will become more difficult after the attempted terrorist bombings in Britain that have been linked to foreign doctors.

"The consensus seems to be that if you have a first name like Mohammed, you can forget it," Dr. Sanjay Chaube, a much-needed internist in Hurricane Katrina-ravaged Bay St. Louis, Miss., and one of more than 40,000 Indian doctors in the U.S. He is working in this country under what is known as a J-1 visa waiver.

The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force.

"And that will mostly be felt in rural America," said Sen. Kent Conrad, D-N.D. He added: "We're facing a real crisis."

America's rural and inner-city poor already are suffering the most. For example, there are 280 doctors for every 100,000 people in the U.S. But there are only 103 for every 100,000 in the 18-county area of the Mississippi Delta, according to the Mississippi State University Social Science Research Center. And the Delta has some of the nation's highest rates of infant mortality, heart disease and other serious illnesses.

Steps are slowly being taken by individual states and universities to enroll more students in medical school. But it takes years to educate a doctor. And even then, many professionals are unconvinced those steps alone will make much difference.

To help relieve the misery in the Delta, Appalachia and other parts of the country in dire need of physicians, the government lets foreign doctors into the country under J-1 visa waivers, dispensed through a variety of state and federal programs.

J-1 visa waivers allow foreign doctors to work in underserved areas for three to five years, with a shot at eventually obtaining permanent residency.

Over each of the past three years, about 1,000 practicing physicians have come to the U.S. on J-1 visa waivers. Many of them are from unstable or undeveloped countries and come here in search of better training, working conditions and pay.

Yet, since 9-11, the federal government has made it more difficult to qualify for the special visas and to obtain permanent residency. The tests are harder, the legal fees are higher, and the rules have been changed by the Department of Health and Human Services in such a way that fewer counties and clinics are designated "underserved" and thus eligible to obtain J-1 doctors.

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