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This one physician program can help heal America—but only if Congress acts

February 22, 2024

With more Americans reaching retirement age, our country faces a shortage of over 139,000 physicians by 2030. And given that about half of U.S. physicians report that they’re contemplating early retirement or a career change due to being overworked, that shortfall is likely to be even higher.  

Rural Americans, 4 million of whom are Latino, are living on the front lines of this health care crisis—with many of them having to travel over 20 miles to receive inpatient care. In some circumstances, rural residents are driving over 70 miles to visit their nearest medical specialist. At these distances, high gas prices and missed time from work can deter people from receiving needed care.  

Many of the physicians delivering care to these Americans are enrolled in the Conrad 30 program, America’s main pathway for retaining foreign doctors who completed their medical training in the United States. Typically, immigration law requires foreign physicians to leave the U.S. after finishing their training and wait at least two years before returning. Under the Conrad 30 program, however, each state may select up to 30 physicians annually to be exempted from this requirement if they agree to practice in a medically underserved area for at least three years.  

Since the program’s creation in 1994, physicians practicing under the Conrad 30 program have treated over 40 million U.S. patients in medically underserved areas. It’s not unheard of for a single Conrad 30 physician to oversee care for nearly 3,000 people and make monthly air flights to treat patients throughout the country. In some cases, a Conrad 30 physician may be one of just a few specialists in 150,000 square miles. In large states like Texas, dozens of counties still have no physician at all. 

The last time Congress updated the Conrad 30 program was 2003, where lawmakers agreed to expand the number of slots per state from 20 to 30. Since then, the program hasn’t been reformed to keep pace with the nation’s surging demand for more in-patient services.  

Lawmakers must pass the following bills to ensure that the Conrad 30 program is responsive to America’s growing health care needs:  

  • Conrad 30 and Physician Access Reauthorization Act (H.R.4942/S.665): The Conrad 30 program requires authorization every three years. Despite being set to expire, Congress has briefly extended the program for several additional months with continuing resolutions and is now set to expire this March. Congress should pass the Conrad 30 Reauthorization Act to ensure the program lasts 3 more years. The bill would also increase the number of physician slots by 5 every year when specific demand thresholds are met.  
  • Pass the DOCTORS Act (H.R.6980/S.2719): Even for small states like Connecticut, demand for additional physician slots has far outpaced the 30 available every year. Meanwhile, other states fail to use all of their available physician slots. In 2021, for example, only 24 states utilized all 30 slots, leaving 376 to go unused. While state governments should eventually reverse onerous restrictions (such as banning most medical specialties from being eligible) that prevent all of their slots from being used, allowing other states to recapture these unused slots is a critical federal reform.  
  • Pass the Doctors Within our Borders Act (H.R.4875): If enacted, this bill enables states to attract a maximum of 100 physicians per year to work in medically underserved communities.  

The longer Congress waits to address the health care shortage, the worse the crisis will become. Lawmakers should immediately enact the above reforms to the Conrad 30 program. Doing so is a much-needed component for any comprehensive solution to addressing our nation’s medical needs.  

Sam Peak – Senior Policy Analyst

Americans for Prosperity