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Foreign docs finding it harder to get work in U.S.
'Consensus seems to be that if you have a 1st name like Mohammed, you can forget it'

For years, doctors recruited from India, the Philippines and sub-Saharan Africa helped offset the dearth of qualified medical professionals in poverty-stricken US regions.

But in the wake of the terror concerns and the national immigration debate, health officials and some lawmakers worry that increasing restrictions and scrutiny threaten to undermine efforts to bring these doctors to regions where many US-born doctors are loath to work, and exacerbate the shortage of physicians in the country as a whole.

``We're facing a real crisis,'' said US Sen. Kent Conrad, a Democrat who, since 1994, has sponsored a temporary program that would afford each state an allotment of 20 to 30 J-1 visa waivers.

These waivers allow foreign doctors to work in underserved areas for three to five years, with the incentive of eventually securing permanent residency in the US He hopes to make the program permanent.

In all, about 1,000 foreign doctors come to the US each year for work under the various J-1 visa waiver programs.

Following the Sept 11, 2001, terror attacks, however, another J-1 program administered by the US Department of Agriculture and which had brought in about 1,000 doctors per year was shut down.

A new program run by the US Department of Health and Human Services has failed to fill that federal void. The HHS has approved just 61 J-1 visas since the program began in 2003.

Conrad said most of that shortfall will be felt in rural America areas like the Mississippi Delta where the doctors-to-population ratio is almost one-third of the national average, according to one estimate by Mississippi State University researchers. Meanwhile, the region is among the nation's leaders in infant mortality, heart disease and many of the U.S.'s most deadly illnesses.

It was never particularly easy for foreign doctors to get work in the US, despite the need for their help in such regions.

Even before the Sept 11, 2001, terror attacks, these professionals faced an arduous and expensive process that included professional tests and background checks before they could secure work and residency papers. Some doctors hire headhunter agencies to help them through the process.

The Sept 11 attacks made the process more difficult. But health officials and doctors fear that the attempted terror attacks in Great Britain late last month allegedly carried out by foreign doctors will irreparably undermine confidence in foreign physicians.

 ``The consensus seems to be that if you have a first name like Mohammed, you can forget it,'' said Dr. Sanjay Chaube, a much-needed internist in the Hurricane Katrina-ravaged town of Bay St. Louis, Mississippi, and one of more than 40,000 Indian doctors in the US.

``Apparently one of the guys was Indian. I just hang my head in shame because (he has) just tarred an entire community. You know how these things go.''

Health officials worry that new restrictions will not only harm residents of poor areas, but will also deepen a deficit of doctors in the United States currently estimated at 16,000 and affecting a mostly underserved 35 million Americans in every state.

Future projections offer little that is reassuring. While the federal government predicts a shortfall of 24,000 doctors by the year 2020, others see a much wider gulf. A 2005 study predicted the gap could grow to 200,000 in the next 13 years.

By examining adjusted population figures, economic factors and trends such as decreasing doctor effort and an aging work force, the study group led by Dr. Richard Cooper came to the stark conclusion that while the population will continue to grow rapidly, the physician work force will remain flat at best.

Cooper, who conducted his study while at the Medical College of Wisconsin and now works at the University of Pennsylvania, wrote in the journal Health Affairs that it will take 25 new medical schools to alleviate just a third of the impending shortfall.

Dr Edward Hill, chairman of the World Medical Association and past president of the American Medical Association, thinks nothing short of government intervention can halt the doctor shortage.

``We have a deterioration in our number of primary care physicians _ family doctors, internal medicine, (pediatricians), obstetricians and gynecologists,'' Hill said. ``We have a deterioration across the country.''

The shortages are most pronounced in poor areas. While the US average is 280 doctors for every 100,000 people, the 18-county Mississippi Delta region has only 103 for every 100,000, according to the Mississippi State University Social Science Research Center.

Steps are slowly being taken by individual states and medical schools to increase the number of students pursing medical degrees. But it takes years to educate a doctor. And the demographics in both the U.S. and the medical profession are changing so rapidly, many health professionals and studies have suggested that minor increases will not help.

The shortcomings of the current system have not gone unnoticed by the government.

A reported released late last year by the General Accounting Office, Congress' investigative arm, criticized the Health and Human Services Department for not tracking where it places the physicians it brings in under its J-1 program, as well as others in different federal and state programs.

This has left some areas with no help and others with too much. Still, plans to fix the problem have yet to be implemented.

``We haven't seen better results, and partly because of the limitations that (HHS officials) put on their program,'' said Connie Berry, who oversees the placement of waiver physicians in Texas. ``It in no way was an equal replacement to the (now defunct) USDA program.''

By the end of 2005, there were about 3,100 J-1 waivers requested by state and federal programs for physicians to practice in underserved areas, though GAO said no one can say for sure how many are actually in the country.

 The blame does not lie entirely with the federal government, said Dr Sampatkumar Shivangi, an obstetrician and gynecologist in Jackson, Mississippi, who is president elect of the American Association of Physicians of Indian Origin.

He once tried to help a J-1 physician find a position with a rural Mississippi clinic, but was unable to finish the deal despite the need.

``Some of the physicians in that community didn't want a physician to come and practice there because it would take away patients,'' Shivangi said.

When the J-1 programs began, many predicted that the U.S. would not be able to lure foreign doctors to work in poor areas.

``And over time what I saw was exactly the opposite,'' Berry said.

Like most other emigrants to the US the foreign-born doctors come for opportunities, stability and a salary far higher than what they could earn in their home countries. The trade-off of working in an underserved rural area is readily embraced as the price of starting a new life.

But Chaube, the Indian doctor in Mississippi who has already secured a visa waiver, said he and many of his colleagues believe an already cumbersome system will only get more difficult, and for some the promise permanent residency is no longer enough.

Husband-and-wife team Rohit Panchal and Vaishali Shah were heralded on a billboard in Greenwood when they arrived. As a pulomonologist with critical care training and an internist they treat a patient population with some of the highest rates of lung cancer, diabetes and other grave illnesses.

They find the work rewarding, but when their commitment ends they are considering returning to India.

``It's too long and tedious a process. It's too tiring,'' Panchal said during a break from rounds in the Greenwood Leflore Hospital.