They may, however,  obtain a waiver of this requirement from the Department of Homeland  Security at the request of a state or federal agency if they have agreed to  practice in an underserved area for at least 3 years. Federal agencies were first authorized to request J-1 visa  waivers for physicians in graduate medical education in September 1961. States and federal agencies have some discretion in shaping their J-1 visa  waiver programs to address particular needs or priorities. Waivers Remain a Major Means for Providing Physicians to Underserved Areas

States and federal agencies reported requesting more than 1,000 J-1 visa  waivers in each of fiscal years 2003 through 2005 (see fig. In contrast to our findings a decade ago, states have become the primary  source of waiver requests for physicians to practice in underserved areas,  accounting for 90 percent or more of requests in each of fiscal years 2003  through 2005. States varied, however, in the number of waivers they  requested in fiscal years 2003 through 2005. Waivers Were Requested for Physicians to Work in a Variety of Practice Specialties, Settings, and Locations

States and federal agencies requested waivers for physicians to practice a  variety of specialties, with states requesting waivers for physicians to  practice both primary and nonprimary care and federal agencies generally  focusing on primary care. Overall, more than three-quarters (77 percent) of waivers requested by  states and federal agencies in fiscal year 2005 were for physicians to work  in facilities located in HPSAs, and 16 percent were for physicians to work  in facilities located in MUA/Ps that were outside of HPSAs. HHS Lacks Data to Account for Waiver Physicians in Its Efforts to Address Physician Shortages

Although the use of J-1 visa waivers remains a major means of providing  physicians to practice in underserved areas, HHS does not have the  information needed to account for waiver physicians in its efforts to  address physician shortages. Without such information, when considering  where to place NHSC physicians, HHS has no systematic means of  knowing whether the needs of a HPSA are already being met through  waiver physicians. Appendix I: Physician Need and Number of Primary Care Waiver and National Health Service Corps Physicians, by State

This appendix presents the following information for each state as of the  end of fiscal year 2005: (1) the number of primary care physicians the  Department of Health and Human Services (HHS) identified as needed to  remove primary care health professional shortage area (HPSA)  designations, (2) our estimate of the number of J-1 visa waiver physicians  practicing primary care, (3) the number of National Health Service Corps  (NHSC) physicians practicing primary care, and (4) primary care waiver  and NHSC physicians as a percentage of the HHS-identified need. Foreign Physicians: Exchange Visitor Program Becoming Major Route  to Practicing in U.S. Underserved Areas.
Why GAO Did This Study

Many U.S. communities face difficulties attracting physicians. To address this problem, states and federal agencies have turned to foreign physicians who have just completed graduate medical education in the United States under J-1 visas. Ordinarily, these physicians must return home after completing their programs, but this requirement can be waived at the request of a state or federal agency if the physician agrees to practice in an underserved area. In 1996, GAO reported that J-1 visa waivers had become a major source of physicians for underserved areas but were not well coordinated with Department of Health and Human Services (HHS) programs for addressing physician shortages. GAO was asked to examine (1) the number of waivers requested by states and federal agencies; (2) waiver physicians' practice specialties, settings, and locations; and (3) the extent to which waiver physicians are accounted for in HHS's efforts to address physician shortages. GAO surveyed states and federal agencies about waivers they requested in fiscal years 2003-2005 and reviewed HHS data.

What GAO Found

The use of J-1 visa waivers remains a major means of providing physicians to practice in underserved areas of the United States. More than 1,000 waivers were requested in each of fiscal years 2003 through 2005 by states and three federal agencies--the Appalachian Regional Commission, the Delta Regional Authority, and HHS. At the end of fiscal year 2005, the estimated number of physicians practicing in underserved areas through J-1 visa waivers exceeded the number practicing there through the National Health Service Corps (NHSC)--HHS's primary mechanism for addressing physician shortages. In contrast to a decade ago, when federal agencies requested the vast majority of waivers, states have become the primary source of J-1 visa waiver requests, accounting for 90 percent or more of waiver requests in fiscal years 2003 through 2005. States and federal agencies requested waivers for physicians to work in a variety of practice specialties, settings, and locations. In fiscal year 2005, a little less than half of the waiver requests were for physicians to practice exclusively primary care. More than three-quarters of the waiver requests were for physicians to work in hospitals or private practices, and about half were for physicians to practice in rural areas. HHS does not have the information needed to account for waiver physicians in its efforts to address physician shortages. Without such information, when considering where to place NHSC physicians, HHS has no systematic means of knowing if an area's needs are already being met by waiver physicians.