Born in India, Transforming Rural Md.

In 2000, to make more H-1B visas available for technology companies, Congress exempted research institutions and universities, including their hospitals, from a cap on the hard-to-get visas. The popularity of the J-1 waiver program plummeted, and the pipeline that once channeled doctors to underserved areas narrowed.

Today, no medical facilities in Southern Maryland are eligible to sponsor physicians under the J-1 waiver program. A majority of the nearly 30 Maryland primary medical care centers designated as having a specialist shortage are in Baltimore. The District has 13 sites, including the D.C. jail. Virginia has nearly 120, two of which are in the Washington area.

With baby boomers beginning to retire, the American Medical Association says, the country could be short as many as 200,000 doctors before 2020 -- a shortage that is expected to hurt already-underserved areas the most.

V.K. Shah, who is also vice president of the American Association of Physicians of Indian Origin, said a shortage could be prevented by drastically increasing the number of medical schools in the United States, relying more on nurses and nurse practitioners or by allowing more qualified international medical graduates to practice in the United States.

But to practice, foreign doctors must first complete training in a U.S. residency program, for which spots are scarce. Last year, 46 percent of foreign applicants received residencies, compared with 93 percent of American graduates, according to the National Resident Match Program, which facilitates the application process for more than 1,000 U.S. institutions.

Each year, Shah Associates hosts a handful of graduates from foreign medical schools, encouraging them to seek opportunities beyond big cities. This summer, four recent graduates of Mumbai medical schools traveled to Southern Maryland on tourist visas for an unpaid crash course in American medicine.

The graduates watched as the Shahs cracked jokes with their patients, reassured them about upcoming operations and gently recommended diet changes. Mitesh Lotia, 24, one of the graduates, said that the one-on-one interaction held great appeal.

"In India, we would see 100, 150 patients a day," he said. "There was no time to get to know patients. I want to practice here. I'll go anywhere."