Retention of J-1 Visa Waiver Program Physicians in Washington State's Health Professional Shortage Areas

Purpose To determine whether the Conrad Program, which allows states to recruit 30 foreign-trained physicians per year to work in underserved settings, is meeting its goal of increasing the number of physicians in Washington State's underserved areas. Participating physicians have completed their residency training in, and want to continue residing in, the United States. Method The authors identified all J-1 visa waiver physicians assigned to employers in Washington between 1995 and 2003, tracked them (whenever possible) through public databases to their current locations, and surveyed them about their experiences in, and subsequent to, the program. Results The authors tracked 141 of 155 physicians (91%). Of those 141, 77 (55%) responded to the survey. These respondents reported that they remained with their J-1 waiver employers a median of 23 (range: 0-120) months longer than their required commitment periods and that they remained in practices serving primarily underserved populations for, on average, 34 (0-120) consecutive months after fulfilling their commitments. After leaving J-1 waiver employers, 35 of 47 physicians (74%) who served in rural areas moved toward more urban areas, and 57% (80/141) still live in the state. Whereas most expressed satisfaction with the program, 29/77 (38%) felt employers should have shown them more respect. Conclusions In Washington State, the Conrad Program has increased the number of physicians in underserved areas who frequently stay beyond their obligations. The significant movement away from rural areas for postobligation employment, however, highlights the long-term need to continue state efforts to recruit physicians to these areas. Acad Med. 2010; 85: 614-621.