Valadao, legislators push to bring more doctors to America

Jul. 31—In an effort to bring more doctors to understaffed hospitals nationwide, bipartisan legislation is working its way through Washington.

Titled the Conrad State 30 and Physician Access Reauthorization Act, or S 665, the bill is an extension to the existing Conrad State 30 and Physician Access Act, which has since its passage in 1994 allowed states to request J-1 visa waivers for foreign physicians to work in federally designated shortage and underserved areas.

"Rural communities like many throughout the Central Valley too often lack basic and necessary healthcare services, forcing people to drive long distances for routine medical treatments or forgo care altogether," said Rep. David Valadao, R-Hanford, who co-led the bill. "Programs like Conrad 30 are a critical part of correcting this problem by helping bring qualified physicians into rural and medically underserved areas across the country. I'm proud to join my colleagues in introducing the Conrad State 30 and Physician Access Reauthorization Act to fill this critical need for our underserved communities."

Unlike HB-1 visas, foreign doctors working in the states on J-1 visas are required to return to their home country for two years after their residency before they can apply for another visa or green card. The Conrad 30 program — the "30" refers to the number of doctors per state who can participate — allows doctors and residents to stay in the country if they agree to practice in an underserved area for three years.

According to a news release on Monday, the program has led to the staffing of 15,000 physicians in underserved areas over the past three decades. And while the program is continually renewed — even expanded in part in 2013 — the number of waivers available per state has remained the same, despite a severe shortage in the medical field.

Beyond reauthorization, the bill would extend the program for three years; increase the physician per state maximum to 35; require more transparency in employment contract terms; allow flexibility for spouses and children of participants; and streamline the process of obtaining a J-1 visa.

Reauthorization has received bipartisan support, including 130 members across the House and Senate, as well as dozens of national health organizations, such as the American Medical Association.

"The physician workforce crisis, exacerbated by the COVID-19 pandemic and other sources of burnout, threatens patient access to care, especially in rural and underserved communities," said AMA President Jack Resneck. "One way to address this problem is through smart, targeted immigration reforms."

Unlike major cities, small-town America relies on a steady flow of doctors from around the world to deliver babies, treat ailing hearts and address its residents' medical needs. And while foreign doctors make up a small percentage in Kern County, officials understand what would be at stake if the program didn't exist.

"We've known for a long time that the Kern County community has been underserved," said Dr. Glenn Goldis, the chief medical officer at Kern Medical. "Many citizens here have difficulty accessing medical services and care."

The California Health and Human Services Agency regularly declares Kern County as both a Medically Underserved Area and a Health Professional Shortage Area for primary care. Goldis said the largest barrier to entry for those interested in entering the field is money — medical school is expensive — and the lack of available residency programs.

Kern Medical's four residency programs — Emergency Medicine, Internal Medicine, Psychiatry and OBGYN — are the only programs available in the county. Its Internal Medicine residency, for instance, offers 13 internal medicine resident slots per year. The number of applicants: just over 2,000.

"Within a 100-mile radius, it's us," Goldis said. "Just an example of what we're up against."

And of the four programs, which together train 120 residents per year, Goldis said they retain about 30% of them.

"But on the other hand, we supply our community with 30% of our graduates from our program, so I guess it depends on how you look at it," he said.

Why residency slots are so few is also mixed. Some existing programs are simply understaffed, unable to accommodate the pending workforce they need. Others cannot rationalize a loss in profit, Goldis said.

"Many institutions are not willing to absorb the loss in educating medical students or residents because you're not making money off of them, you're losing money," he said.

Goldis maintained that it was important to reassure students there are resources to help cover the cost of medical school here in Bakersfield, such as through Bakersfield College's MESA program.

"(Students here) come from an underprivileged background where they often are saddled with a responsibility to be a breadwinner or provider of income for the family," he said. "So they are hesitant to enter the expense and time needed to train to become a physician."