The Conrad-30 waiver program is a vital bipartisan initiative that expands healthcare access for Americans in rural and underserved areas across the United States. Despite its effectiveness, this crucial program remains underutilized in many states, leaving hundreds of waivers unused each year. The bicameral DOCTORS Act, introduced by Senators Joni Ernst (R-IA) and Amy Klobuchar (D-MN) alongside Representatives Troy Nehls (R-TX-22) and Brad Schneider (D-IL-10), aims to change that by reforming the Conrad-30 program so that it allows states to use waivers that would otherwise go unused.
According to Niskanen Center data analysis, this minor but meaningful reform would allow states to retain over 100 U.S.-trained physicians in rural areas without increasing the total number of waivers currently authorized by law. By placing these doctors where they are needed most, the DOCTORS Act has the potential to improve primary care access for nearly half a million Americans.
Currently, the Conrad-30 program allows each state to retain up to 30 foreign-trained physicians to work in underserved areas, bypassing the requirement that they return to their home country for two years before reapplying to work in the U.S. In exchange, these doctors commit to serving three years in medically underserved or rural communities that struggle to attract and retain healthcare professionals.
While 21 states used all 30 of their waiver slots in Fiscal Year 2023, Niskanen’s analysis of available data shows that others left over 350 waivers unused.1 This inconsistency underscores that the original Conrad-30 legislation failed to account for states’ varying needs year-to-year.
The DOCTORS Act would fix this by taking one-third of the prior fiscal year’s unused waivers and distributing them equally amongst the states that used all 30 slots that year. Based on Niskanen’s analysis, states that fully utilized their waivers in 2023 would have retained approximately six additional U.S.-trained doctors in rural and underserved areas in fiscal year 2024.2
The DOCTORS Act would allow states to use and distribute the additional waivers according to local needs and priorities. For example, in states that used all their waivers in 2023, 585 geographic areas are still classified as Health Professional Shortage Areas (HPSAs), meaning that the number of primary care doctors falls below the minimum standard of one physician per 3,500 residents. Niskanen’s research indicates that placing the estimated 119 physicians retained through the DOCTORS Act into geographic HPSAs in full-usage states could offer primary care access to nearly half a million Americans and effectively eliminate primary care shortages in states like Pennsylvania, Connecticut, and Rhode Island, and bring New York close to achieving full coverage.
While it remains difficult to attract and retain physicians to rural and underserved areas, the Conrad-30 program has a proven track record of success. A 2018 report from the Trump administration highlighted its effectiveness in boosting healthcare access to underserved areas, and an Iowa-based study found that 92% of Conrad-30 physicians in the state met their initial three-year obligation, with 68% choosing to stay beyond their required term. This program is not only attracting doctors to underserved areas–it’s keeping them there.
Public support for this initiative–unsurprisingly– is strong and transcends party lines. A recent poll conducted by Americans For Prosperity found that 90% of registered voters agree that “the U.S. should make it easier for foreign doctors to remain in the U.S. if they practice in a part of the country where there are not enough doctors.”
As Rep. Nehls, the lead House sponsor of the bill, noted:
Since 2009, over 50 waivers have been given to foreign-born medical school graduates to practice in counties in my district. That’s 50 more doctors, who specialize in areas including anesthesiology, cardiology, infectious disease, internal medicine, neurology, pediatrics, psychiatry, radiology, transplants, urology, and more. Reclaiming unused waivers from the previous fiscal year is a simple, common-sense approach to address the critical nationwide physician shortages, without increasing the number of visas.
In today’s polarized political environment, it is rare to find a policy addressing a pressing need that garners support from both parties. The DOCTORS Act is exactly that–a narrow, bipartisan solution that uses existing immigration policy to directly improve the lives of Americans.
Congress should seize this opportunity to pass the DOCTORS Act and ensure that every available physician waiver is put to its best use. For rural communities and underserved neighborhoods struggling to access basic healthcare, this simple fix could make all the difference.
Footnotes
- Niskanen’s analysis relies on data from 3RNET in addition to data obtained directly from the state-level offices managing Conrad-30 programs in Texas and Montana. As of the date of publication, FY2023 waiver usage data remains unavailable from California, Guam, and Vermont. ↩︎
- Currently available data suggests that each full-usage state would be eligible for 5.7 additional waivers, but the proposed legislative text does not clarify how partial waivers would be handled. Also, collecting the remaining unavailable data from states and territories will impact the number of unused waivers and the number of full-usage states, and therefore the number of waivers available under this bill. ↩︎