A commonsense way immigrants can help solve the rural physician shortage

Thirty years ago, Congress passed legislation creating the Conrad-30 waiver program. This highly successful initiative has allowed foreign medical graduates to waive the requirement that they return to their home country for two years after their visa expires in return for practicing medicine in a medically underserved or rural community. Since 2001, the program has been an absolute success, allowing more than 21,000 physicians to treat an estimated 44 million Americans in need.

However, our country is still facing a growing physician shortage, especially in my home state of Texas. That’s why I’ve joined my colleagues across the aisle in the House and Senate in leading a promising reform — the Districting Our Country’s Transfer of Residency Slots (DOCTORS) Act.

The Conrad 30 waiver program allows each state 30 visas annually for foreign medical graduates who completed their medical residency in the U.S. to waive the requirement to return to their home country for two years before applying to live and practice medicine in the U.S. — if they agree to practice in a medically underserved or rural area. Some states, like Texas, use all 30 available visas, but other states use none. In 2023, only 18 states used all of their 30 available visas, leaving 395 waivers unused that year.

For context, that’s almost 400 more doctors who specialize in anesthesiology, cardiology, infectious disease, internal medicine, neurology, pediatrics, psychiatry, radiology, transplants, urology and more who could be treating Americans today, but sadly, are not.

My legislation, the DOCTORS Act, harnesses the potential of those hundreds of unused Conrad 30 waivers and distributes them among the states that use all 30 of their waivers. It’s a commonsense proposal to address our nationwide physician shortage, without increasing the number of visas in statute like other proposals.

It’s undeniable that our nation is wrestling with a critical shortage of health care professionals. According to 2024 projections by the American Association of Medical Colleges (AAMC), “the United States will face a physician shortage of up to 86,000 physicians by 2036.” The shortages are particularly acute in rural and underserved regions. A recent AAMC post states, “While 20% of the U.S. population lives in rural communities, only 11% of physicians practice in such areas.”

Tragically, the consequences of these shortages in rural populations present as higher mortality rates, especially among those with chronic lung disease, injuries and cardiovascular ailments. 

In 2022, the Texas Department of Health and Human Services projected, “All primary care specialties are projected to have shortages which, based on current models, will not be remedied through current medical education in Texas alone.” According to a local 25 News interview with Dr. Christian Cable with Baylor College of Medicine, “Texas only has 200 physicians for every 100,000 people compared to 250 doctors for every 100,000 across the nation.” It’s clear that this legislation is needed, especially in Texas, now more than ever.

I will always put America first, so let me be clear: the DOCTORS Act will not take jobs from U.S.-born physicians. A recent National Bureau of Economic Research (NBER) paper found, “Expansion of a visa-waiver program in 2002 enabled more foreign-trained doctors to practice in underserved areas in the US but did not reduce employment of US-trained doctors.”

Members of Congress across the political spectrum can support the DOCTORS Act with confidence that it does not take opportunities from U.S.-born physicians. Reclaiming unused waivers through the DOCTORS Act is a simple, commonsense reform to address the critical nationwide physician shortages in the places where Americans need them the most, including the Lone Star State.

As we celebrate the 30th anniversary of the Conrad 30 waiver program, it’s time for my colleagues in Congress to pass this much-needed reform to ensure we have enough physicians across the country to provide high-quality health care to all Americans.

Troy E. Nehls represents the 22nd District of Texas.