As the 30th year of the Conrad 30 program approaches in September 2024, it is appropriate to look back on the successful role it has played in expanding access to healthcare in rural America and the continued need for modernization to keep up with rising healthcare demands.
Conrad Turns 30: A Congressional Briefing
On May 8, 2024, the American Medical Association, the American Academy of Neurology, and Physicians for American Healthcare Access (PAHA) hosted a congressional briefing to celebrate the program's 30 years of ensuring U.S.-trained doctors are placed in rural communities across the U.S.
Since the program's inception, at least 22,000 U.S.-trained doctors have committed to providing full-time healthcare in the most rural, underserved communities in the U.S. where access to healthcare is at a critical low.
The event began with remarks from Senator Klobuchar (D-MN), the lead Senate sponsor of legislation to reauthorize the Conrad 30 program (S. 665) and Representative Valadao (CA), one of the lead sponsors of the House reauthorization (H.R. 4942).
The briefing was then followed by a panel of experts, including Dr. Omolola Taiwo, Executive Director of the New Jersey Office of Primary Care and Rural Health; Dr. Umer Najib, Associate Professor, Vice Chair for Clinical Operations and Director, West Virginia University Headache Center; Dr. David Watson, Professor and Chair, West Virginia University Department of Neurology; and Sarah Peterson, Fragomen Partner and Healthcare Practice Leader, who provided unique insights on why reforming the Conrad 30 program is needed today, and the positive impact it has had in communities from West Virginia to New Jersey to Minnesota and beyond.
One of the significant challenges the Conrad programs face is that they are incredibly competitive, unpredictable, and oversubscribed. Each state has different criteria to ensure their particular demographics and needs are considered. States update these points and do so sometimes as late as August each year.
Because the program opens in October, it makes it incredibly difficult for employers to plan for patient care. Despite this, almost half of the states received more than 30 Conrad waiver applications last year and another eight had more than 25.
Further, International Medical Graduates (IMGs) are only allowed to file in one state, so if they are not selected, most have very few options to remain in the U.S. And despite this unpredictable, complex process, data shows that 28% of IMGs stay more than five years in these underserved communities compared to 11% of their U.S. counterparts, which is important for continuity of care in rural communities.
During the briefing, the Chair of the Department of Neurology at West Virginia University explained that in the states that do not fill each year, it is out of a fear to pursue a Conrad number given each Conrad filing requires extensive time, resources, and money, so employers are hesitant to pursue this option given the unpredictability that even after having documented the inability to fill their shortages, they may not ultimately receive a Conrad number.
Our immigration system should provide a reliable, predictable pathway for U.S. employers to be able to recruit and retain U.S.-trained IMGs, which is what the Conrad modernization bill provides.
Conrad 30 History
The Conrad 30 program has been pivotal in increasing access to medical care in rural and underserved areas since 1994. IMGs who come to the U.S. to receive medical training on a J-1 visa are required to return to their home country for two years upon the end of their training program.
Until this requirement is completed, a physician will not be able to obtain the most common U.S. work visa, an H-1B visa, or pursue permanent resident status in the U.S. So instead of having these highly U.S. trained doctors leave the U.S., the Conrad J-1 waiver program provided a different option. IMGs who agree to practice in federally designated medically underserved areas for at least three years may obtain a waiver of the two-year home residency requirement. Most stay much longer.
Each year, every state is granted up to 30 waivers to allocate within their state as needed. For the past 30 years, this program has facilitated the placement of approximately 22,000 physicians in rural and underserved areas across the U.S., significantly increasing access to medical care where it is needed most.
While the Conrad 30 program has overall been a resounding success, the congressional briefing also focused on calling attention to the need for modernization. In its 30 years, the only modernization that has occurred was in 2002 when Congress increased the available numbers from 20 waivers per state to 30 waivers per state.
Throughout the past 30 years, the growing physician shortage in the US is well documented and projected to continue rising across all specialties in the coming years. The U.S. is not alone in its shortages, and much of the rest of the world is harnessing immigration as a viable, short-term solution to addressing physician shortages.
Yet, despite the documented and growing physician shortages, Congress still has not passed legislation to modernize Conrad 30 to improve access to medical care in the U.S.
The Critical Role of IMGs
IMGs have long played a critical role in ensuring access to healthcare in the U.S. IMGs are individuals who received their medical degree abroad and may either be U.S. citizens or noncitizens. As the looming physician shortage threatens access to healthcare in underserved communities, the role of IMGs cannot be understated.
The role of IMGs in healthcare is especially prevalent in specialties like Neurology and Internal Medicine, where IMGs make up a high percentage of residents, fellows, and physicians. For example, according to the American Academy of Neurology, IMGs make up approximately 40% of neurology trainees in the US.
The Need for Modernizing the Conrad 30 Program
The Conrad State 30 and Physician Access Reauthorization Act [S.665/ HR.4942] is a bipartisan effort that modifies the program to allow states to exceed 30 waivers in a fiscal year dependent on the state's healthcare needs.
This bill would continue increasing access to medical care in rural and underserved areas, in a time where expansion is critical. Constituents can call on their representatives and make their voices heard to pass bills, such as the Conrad Reauthorization Bill, to continue increasing medical care access through smart immigration reform.
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