Participants in the Exchange Visitor Program enter  the United States with J-1 visas. More than 6,100 foreign physicians with  J-1 visas took part in U.S. graduate medical education programs during  academic year 2004–05. 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 the physician has  agreed to practice in, or work at a facility that treats residents of, an  underserved area for at least 3 years. States and federal agencies may impose  additional limitations on their programs beyond federal statutory  requirements, such as limiting the number of requests they will make for  physicians to practice nonprimary care specialties. No one federal agency is responsible for managing or tracking states’ and  federal agencies’ use of J-1 visa waivers to place physicians in underserved  areas. Waivers Remain a Major Means for Providing Physicians, and States Request Most Waivers

J-1 visa waivers continue to be a major means of supplying physicians to  underserved areas in the United States, with states and federal agencies  reporting that they requested more than 1,000 waivers in each of fiscal  years 2003 through 2005. In contrast to our findings a decade ago, states are now the primary source  of waiver requests for physicians to practice in underserved areas. For example, in fiscal year  2005, about one-quarter of the states requested the maximum of 30  waivers, while slightly more than a quarter requested 10 or fewer (see fig. Some of these states  limited these requests. Such redistribution would require legislation. Most States Reported That the Annual Waiver Limit Was Adequate, While Some Reported the Need for More

About 80 percent of the states reported that the annual limit of 30 waivers  per state was adequate or more than adequate to meet their needs for J-1  visa waiver physicians. However, 13 percent of the states reported that the  30-waiver limit was less than adequate (see fig. States’ Views Differed on Having Unused Waiver Allotments Redistributed

Of the 44 states that did not use all of their waiver allotments in each of  fiscal years 2003 through 2005, slightly over half (25 states) reported that  they would be willing, at least under certain circumstances, to have their  unused waiver allotments redistributed to other states. The 14 states that reported that they would not be willing to have their  unused waiver allotments redistributed to other states cited varied  concerns. Physician location preferences: Three states commented that physicians  seeking J-1 visa waivers might wait until a redistribution period opened so  that they could apply for waivers to practice in preferred states.
Why GAO Did This Study

Many U.S. communities face difficulties attracting physicians to meet their health care needs. To address this problem, states and federal agencies have turned to foreign physicians who have just completed their graduate medical education in the United States under J-1 visas. Ordinarily, these physicians are required to return home after completing their education, but this requirement can be waived at the request of a state or federal agency if the physician agrees to practice in, or work at a facility that treats residents of, an underserved area. In 1996, GAO reported that J-1 visa waivers had become a major means of providing physicians for underserved areas, with over 1,300 requested in 1995. Since 2002, each state has been allotted 30 J-1 visa waivers per year, but some states have expressed interest in more. GAO was asked to report on its preliminary findings from ongoing work on (1) the number of J-1 visa waivers requested by states and federal agencies and (2) states' views on the 30-waiver limit and on their willingness to have unused waiver allotments redistributed. Such redistribution would require legislative action. GAO surveyed the 50 states, the District of Columbia, 3 U.S. insular areas--the 54 entities that are considered states for purposes of requesting J-1 visa waivers--and federal agencies about waivers they requested in fiscal years 2003-05.

What GAO Found

The use of J-1 visa waivers remains a major means of placing physicians in underserved areas of the United States. States and federal agencies reported requesting more than 1,000 waivers in each of the past 3 years. In contrast to a decade ago, states are now the primary source of waiver requests for physicians to practice in underserved areas, accounting for more than 90 percent of such waiver requests in fiscal year 2005. The number of waivers individual states requested that year, however, varied considerably. For example, about one-quarter of the states requested the maximum of 30 waivers, while slightly more than a quarter requested 10 or fewer. Regarding the annual limit on waivers, about 80 percent of the states--including many of those that requested the annual limit or close to it--reported the 30-waiver limit to be adequate for their needs. About 13 percent reported that this limit was less than adequate. Of the 44 states that did not always request the limit, 25 reported that they would be willing to have their unused waiver allotments redistributed, at least under certain circumstances. In contrast, another 14 states reported that they would not be willing to have their unused waiver allotments redistributed. These states cited concerns such as the possibility that physicians seeking waivers would wait until a redistribution period opened and apply to practice in preferred locations in other states.