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Health professionals: Foreign docs can bridge rural health gap, but rules get in the way

RALEIGH — More foreign-born doctors educated in the U.S. are seeking visa waivers to practice medicine in North Carolina. But health care professionals say federal rules must be changed to help plug physician gaps in medically underserved areas of the state.

That was among topics discussed Friday at the first of six public meetings the N.C. Department of Health and Human Services’ Office of Rural Health is holding around the state. The goal is to increase awareness of its programs and collect feedback on loan repayment programs, visa waivers, and other incentives to lure health care providers to low-income communities.

State lawmakers are concerned about rural-urban health disparities. In 2017, they passed House Bill 998 directing Office of Rural Health to study incentives to reduce physician shortages. The listening tour will provide information for a report due to the General Assembly by Oct. 1.

Rural residents die at higher rates than their urban counterparts from ailments including strokes, heart disease, and even unintentional injuries resulting from events such as auto accidents, said Maggie Sauer, director of the Office of Rural Health.

Sauer’s office works to address physician shortages with safety net organizations such as community health centers, free and charitable clinics, rural health clinics, and county health departments. The shortages force rural residents to travel long distances for care. The Office of Rural Health spent $31.6 million in state, federal and philanthropic funds in 2018 on its mission.

The Office of Rural Health, created 45 years ago, is the state agency of its type in the nation, Sauer said. It facilitates a variety of state and federal loan repayment programs.

The General Assembly appropriates $1.5 million every July for the state loan repayment program. Doctors and dentists can get up to $100,000 for a four-year commitment to work in a rural area.

“That money is generally gone by October, so there’s a lot of need out there,” Sauer said.

One way to boost the supply of physicians is with international doctors.

Karen Gliarmis, recruiter for medical placement services, said the Office of Rural Health oversees a federal J-1 visa waiver program. The waiver allows foreign medical students who complete their studies in the U.S. to skip a requirement to return home for two years.

Federal law grants states 30 waivers for foreign medical graduates to help reduce doctor shortages. In North Carolina waivers are awarded on a first-come, first-served basis.

Twenty slots are reserved for family practice, general internal medicine, general pediatrics, obstetrics/gynecology, or psychiatry physicians practicing in an area of need. The other 10 positions are for specialists.

Pitt, Cumberland, and Robeson counties have recruited the highest number of physicians through the J-1 visa waiver program from 2014-18, Gliarmis said.


JoAnn Barnhill, Vidant Health physician recruiter, said interest from foreign doctors this year has spiked.

Brian Meyerhoeffer, director of immigration services at East Carolina University, which operates the Brody School of Medicine in conjunction with Vidant, suggested lifting the cap on specialists.

“We use a significant number of those specialists, and we are constantly at a shortage from a specialist perspective” in their 29-county service area, Meyerhoeffer said.

Meyerhoeffer said it takes five months to get federal approval of a J-1 visa waiver, and up to another year to get a federal H1B visa to let the foreign doctor work. Ending the first-come, first-served approvals would extend the wait time even longer.

“These international physicians are just not going to wait that long,” Meyerhoeffer said. “They’re going to be going somewhere else.”

The H1B visa process can be expedited, but that costs $1,410 in addition to the regular $960 fee.

But the move to expand the use of specialists has its critics. Greg Griggs, executive vice president of the N.C. Academy of Family Physicians, said the Office of Rural Health should maintain a focus on primary care and behavioral health physicians rather than expanding specialist incentives. He recommended lobbying the General Assembly for more money so “we can increase the pie for everyone.”

Stephanie Nantz, assistant director of operations, said other Office of Rural Health offerings include a community health grant program with almost $15 million to support access to primary care in rural areas; a farm worker health program to ensure seasonal workers have access to medical, dental, and behavioral health services; a program to support rural hospitals; a telepsychiatry program expanding from emergency rooms into the community; and information technology support.

Franklin Walker, vice president of the N.C. Medical Society, said its Community Practitioner Program is a loan repayment alternative of last resort. The program pays 50 percent of a doctor’s medical loans up to $70,000, and has awarded $14.5 million to 408 participants over 28 years. Doctors have been placed in 84 counties.

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