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The Conrad State 30 and Physician Access Reauthorization Act

Chris Sherin

Assistant Director, Division of Congressional Affairs

AMA

2023 Medical Student Advocacy Conference

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The United States is Facing a Shortage of Physicians

The US is facing a shortage of between 37,800 and 124,000 physicians by 2034.

This trend is very likely to be further exacerbated by the COVID-19 pandemic, which fostered more burnout and stress

This shortage of physicians is particularly acute in rural and underserved communities.

Lack of access to highly skilled physicians, especially in rural and underserved communities, is a threat to patient access and leads to poor health care outcomes.

What are some federal policy solutions to combat this alarming problem?

In addition to promoting a greater number of Medicare supported Graduate Medical Education (GME) slots, targeted federal immigration reforms can help address the impending workforce crisis facing the American health care system

Legislation providing long-term reauthorization and targeted improvements to the Conrad 30 program is the preferred targeted immigration reform policy supported by the AMA.

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The J-1 Visa

International Medical Graduates (IMGs) come to the United States to complete their residency on a variety of different visas. Yet, the J-1 visa remains one of the most common ways for IMGs to complete their medical training.

The J-1 visa is a temporary “nonimmigrant” visa reserved for participants in the U.S. State Department’s Exchange Visitor Program.

The Exchange Visitor Program seeks to allow participants the chance to engage broadly with Americans, share their culture, strengthen their English language abilities, and learn new skills to help them in future careers.

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J-1 Visa Continued

Professors/Research Scholars
Short-term scholars
Trainees
Camp Counselors
Specialists
Interns (not medical)
College/University students

Teachers
Secondary School Students
Au Pairs
Government Visitors
International Visitors
Summer Work Travel Program
Alien Physicians

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The Educational Commission for Foreign Medical Graduates (ECFMG) is designated by the State Department as the visa sponsor for all J-1 “alien physicians” who participate in clinical US training programs.

There are at least 14 different categories of participants under the Exchange Visitor Program:

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Number of J-1 Visa Holders Continues to Increase

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J-1 Exchange Visitor Physicians Overwhelmingly Pursue Primary Care

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J-1 Visa Continued

In keeping with the program’s goals for international exchange, J-1 physicians are required to return to their country-of-origin for two years following the completion of their residency before becoming eligible for another visa or green card.

Yet, in 2017, nearly 30 percent of medical residents in the US were IMGs with about half working as physicians in the US on “nonimmigrant” visas, such as the J-1.

While it makes sense for professors, au pairs, and government/international visitors to be required to return to their country-of-origin, applying this same restriction to “alien physicians” is truly a missed opportunity to address the workforce issue plaguing American healthcare.

J-1 visa holders can play a key role in addressing the shortage of primary care physicians

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The Conrad State 30 Program

Created in 1994 and named after former Senator Kent Conrad (D-ND), the Conrad 30 program grants each state the opportunity to issue 30 waivers for J-1 physicians from the requirement to return to their country-of-origin in exchange for working in an underserved community for three years.

Senator Kent Conrad + 30 State Waivers = “Conrad 30 Program”

The Conrad 30 program is typically reauthorized annually through the Congressional appropriations process.

The program was most recently reauthorized through September 30^th (end of the fiscal year) following passage of the Consolidated Appropriations Act, 2023

Upon becoming a Conrad 30 participant, physicians essentially transfer from a J-1 visa to an H-1B visa once hired by a physician practice located in a health professional shortage area (HPSA).

H-1B visa holders are not subjected to the two-year home country requirement

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Conrad 30 Legislation

The Conrad State 30 and Physician Access Reauthorization Program makes a variety of targeted improvements to the program including:

Reauthorizes the program for 3 years from the date of enactment (no more appropriations process)
Establishes a process for increasing the total waivers from 30 to 45 (it would be renamed the Conrad 45)

Number increases to 35 waivers (and further increases by 5) in years when 90% of the waivers are used (excluding rural states).
To increase beyond 45 waivers, 95% of the authorized waivers must be used and no states can be excluded from the calculation.
Number of waivers can contract but not permitted to drop below 30.

Greater employment protections: 1) extending the amount of time between when a doctor receives the waiver and when they must begin work; 2) transparency around hours, locations, and medical malpractice insurance coverage
Spouses and children of J-1 visa holders will not be subjected to the two-year home country requirement

Plus, physicians who agree to work in an underserved community or VA facility for 5 years receive priority consideration and will not be subjected to the per-country green card cap.

While you do not need to be a Conrad 30 participant to receive this benefit, the three years in the program count towards the 5 total years of service needed for priority consideration
The bill does not increase the total number of green cards (140,000), nor does it eliminate the existing 7% per-country green card cap
Instead, these physicians essentially move to the “head of the line” for a green card
Tremendous benefit for Indian and Chinese physicians who wait decades for a green card

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Conrad 30 Legislation Continued

Last Congress, members of the House and Senate introduced H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act:

Introduced by Senators Amy Klobuchar (D-MN) and Susan Collins (R-ME), S. 1810 generated 25 bipartisan cosponsors (13 Rs, 12 Ds)
Introduced by Reps. Brad Schneider (D-IL) and Don Bacon (R-NE), H.R. 3541 generated 111 bipartisan cosponsors (77 Ds, 34 Rs)

Senators Klobuchar and Collins and Reps. Schneider and Bacon are expected to introduce the same legislation without modification in the 118^th Congress.

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Conrad 30 Legislative “Ask”

During your Capitol Hill meetings, please do the following:

House- Urge your Representative to cosponsor the Conrad State 30 and Physician Access Reauthorization Act, upon introduction.
Senate- Urge your Senators to cosponsor the Conrad State 30 and Physician Access Reauthorization Act, upon introduction.

Before you complete your meeting, visit Congress.gov, type in H.R. 3541 or S. 1810, and check to see if your Representative/Senator cosponsored the bill in the 117^th Congress.

If so, please thank them for their support and urge them to cosponsor it again!

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Questions?

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