HHS Reopens Limited Clinical J-1 Waiver Program
Posted Jan 02, 2004

The U.S. Department of Health and Human Services (HHS) reopened its physician J-1 waiver program for clinical work in Health Professional Shortage Areas. As regular MurthyBulletin and MurthyDotCom readers will recall, the HHS program was closed on October 1, 2003, shortly after it began in June 2003. [See our Oct 31, 2003 MurthyBulletin article, HHS J-1 Physician Waiver Suspended for Clinical Care, available on MurthyDotCom.] Unfortunately, the reopened program is far more restrictive than the previous one. According to the HHS WebSite, the changes are for fiscal year 2004 and are targeting the communities and populations in greatest need.

The changes include accepting applications only for positions located within Health Professional Shortage Areas (HPSA) with a score of 14. Scores range from 1 to 25, for the purpose of determining the need and priority for assignment of clinicians. A higher score reflects a greater need. Interested physicians can locate these HPSA areas by going to the HHS WebSite, Health Resources and Services Administration (HRSA), Bureau of Health Professions, and following the links to search the HPSA database. The criteria on the form used for searching will need to be set to select only those locations with a score of 14 or higher. Prior to this change, facilities in any HPSA or Medically Underserved Area (MUA) could offer positions for the waiver program.

In addition to these restrictions, even within qualified HPSAs only certain facilities will be eligible to sponsor a waiver position. The waivers are only available to physicians who will be working within health centers qualified under the Public Health Service Act, or rural facilities as defined by the Social Security Act, or Native American / Alaskan Native tribal medical facilities as defined by the Indian Self-Determination and Education Assistance Act. The HHS WebSite states that it is not known how many of these facilities are recruiting or interested in recruiting J-1 physicians.

It would seem that HHS would have reviewed demand within the narrow areas permitted before creating the restrictions. If the point of the restrictions is to target certain extremely underserved or needy areas, but medical facilities are unable or unwilling to take part in the program, then no interest will be served. There are highly qualified J-1 physicians who would be very willing to work in many underserved areas for the required three years. There is a need for physicians in many parts of the U.S., which is why the privilege of a J-1 waiver is only extended to those physicians who can help ameliorate doctor shortages in certain areas in the United States. HHS has stated that only 43 applications were received even under its prior, less restrictive program. Therefore, it is difficult to understand why additional restrictions were needed. We hope that this change will be reversed in fiscal year 2005, if not earlier. Those physicians who are interested may obtain the application for an HHS waiver, as well as additional information on the program, from the Global Health section of the HSS WebSite.