Born in India, Transforming Rural Md.

Each time the nearby Patuxent River Naval Base added employees, the practice received a wave of patients. The practice's offices, where employees had once been asked to park in front so business would appear brisk, were soon overflowing.

In 1995, V.K. Shah found an empty lot on Route 235 in Hollywood. Two years later, he opened the Philip J. Bean Medical Center, dedicating it to a late local physician who he said "delivered half the county."

"We said, 'Let's name it after someone who means something to this community,' " Shah said. "I think people should feel good about this place -- it should mean something to them."

But the facility that felt like a palace then is already too small, and the practice, with 65 physicians in 10 locations, is scrambling to recruit more doctors. "Demand is so high across the board," said Shah, 66. "I can't retire."

Plans were announced last week for a 32,000-square-foot addition to the medical center. The extra space will allow specialists from Georgetown University Hospital and Washington Hospital Center to practice there as part of a new partnership.

Because Shah Associates provides so much of the medical care in the region, the partnership will allow the universities to study health patterns over generations, said Leslie Miller, head of the cardiac program at both hospitals.

Shah Associates has compiled its patients' medical records into a database that allows it to track the medical histories of families and look for early warning signs in younger generations. Such locally comprehensive databases might one day help researchers better understand such hereditary conditions as heart problems, he said.

"They are a model of the health care of the future," Miller said. "These guys, on their own, using their own money, have put together this extraordinary system. . . . We want to extend what they have done."

But in many areas that are more rural than Southern Maryland, as in many inner cities, the gap between medical needs and resources remains great, despite government efforts.

In 1994, Congress made foreign doctors who train in the United States while holding a so-called J-1 visa eligible to apply for a green card if they practiced for at least three years in underserved areas. The program, which exempts J-1 holders from a required return home for two years after their training is complete, has placed thousands of doctors in inner-city and rural communities, as well as in prisons.

They continue to flood the United States with residency applications, but each year the program receives fewer applications and fills fewer spots. Last year, only 900 of the 1,620 available waivers were issued.

Rural health experts attribute much of that drop to the popularity of another visa, the H-1B, which allows U.S. companies to temporarily sponsor highly skilled foreign workers in such fields as medicine, architecture and science.