The Northern Border Regional Commission has a new program to sponsor waivers for international physicians who got their degrees by studying in the U.S. on a J-1 visa. The waivers would allow these new physicians to skip a required two-year stint in their home country and begin working immediately in rural areas with physician shortages, including the Tri-Lakes.

The goal is to get more physicians in the North Country, which Adirondack Health officials say has been challenging for years now.

“Recruiting and retaining physicians in rural communities — amid a protracted national shortage — is challenging, but essential for sustainability and equitable access to care,” Adirondack Health President and CEO Aaron Kramer said in a statement.

Adirondack Health, which manages Adirondack Medical Center in Saranac Lake, the Lake Placid Health and Medical Fitness Center and health centers around the region, has 154 physicians on its medical staff, according to spokesman Matt Scollin. He said there are approximately 85 full-time, on-site physicians in Saranac Lake, between Adirondack Medical Center and the health organization’s primary care practices.

This program is similar to ones in the Mississippi Delta and Appalachia and is modeled, in part, after the Appalachian Regional Commission’s J-1 visa waiver program.

North Country Rep. Elise Stefanik, R-Schuylerville, advocated for this program, which Kramer applauded her for.

“These physicians will provide critical medical services in rural areas of our states currently suffering from physician staffing shortages,” Stefanik said in a statement.

These waivers ease the visa requirements for nondomestic physicians who trained in the U.S. if they agree to practice in federally recognized Health Professional Shortage Areas and Medically Underserved Areas. Scollin said Adirondack Medical Center is in Franklin County, which the federal government has designated as a Health Professional Shortage Area.

NBRC will recommend the U.S. Department of Homeland Security waive what it calls the “two-year home-country physical presence requirement” for physicians seeking to work within the NBRC territory, covering portions of New York, Vermont, New Hampshire and Maine.

This rule requires that J-1 visa holders return to their home country for at least two years after their exchange visitor program before they can apply for H-1B visas to work in the states.

This requirement can be waived by the DHS, but only for a limited number of reasons — their home country agrees to the waiver, they are set to work with the U.S. federal government, they will be persecuted if they return to their home country, they have a spouse or child who is a U.S. citizen or they have been requested by a state public health department.

There is an existing program through the state, called Conrad 30, which allows for similar waivers, but it is very limited. The Conrad 30 program only allots up to 30 waiver sponsorships per state, per year.

Since the program’s inception in 1994, it has sponsored approximately 23,000 physicians, but NBRC Rural Healthcare Coordinator Liz Cross said Conrad 30 has not been enough.

“States in our region have expressed that the need and the requests by physicians is way beyond 30 slots,” Cross said.

Scollin said he does not believe Adirondack Health has ever had physicians working there through the Conrad 30 program.

This NBRC program expands the capacity of states to get J-1 visa physicians into rural hospitals and does not have a cap.

The J-1 visa is the most common visa for international medical graduates studying in the U.S., according to the American Medical Association.

This program was just announced on Dec. 5, Cross said, so it is just getting off the ground now.

Physicians in this program will be required work in primary or mental health care for 40 hours per week for at least three years, according to the NBRC. The physicians seeking a waiver must first be sponsored by a state. Then the NBRC will sponsor the waiver requests to Homeland Security. Homeland Security rules on each applicant individually.

“It is challenging to be a physician — there are endless responsibilities and so much at stake,” Scollin wrote in an email.

He said Adirondack Health has found the most success in recruiting physicians who are looking for “everything the Adirondacks have to offer,” as the rural nature of Adirondack Health is a draw for some and a deterrent for others.

“They have mostly completed their medical training at academic teaching hospitals in urban or suburban places, so it’s an adjustment to come up here,” Scollin wrote. “They seem to either fall in love with the place and opt to build a career here, or spend a couple of years with us, then move on. This is a great place to live, but it’s not for everyone.”

In July 2022, Stefanik took the lead on a letter co-signed by several bipartisan House colleagues asking the NBRC to implement this J-1 visa waiver program.

The letter points to similar programs administered by the Delta Regional Authority in the Mississippi Delta and the Appalachian Regional Commission in Appalachia.

“In 2019 alone, the Delta Regional Authority processed 160 physician applications through their Delta Doctors program,” Stefanik wrote in this letter.

According to the DRA, it sponsored 440 physicians from 2019 to 2021.

In August 2022, the NBRC agreed to begin implementing a J-1 visa program in the 2023 fiscal year.

“Any chance to get more physicians practicing up here is a good thing,” Scollin said.

“With her support, physicians trained in our country will find it easier to stay here and practice, and that’s great news as we continue to struggle with a chronic physician shortage,” Alice Hyde Medical Center and Champlain Valley Physicians Hospital President Michelle LeBeau said in a statement.

LeBeau thanked Stefanik for her advocacy.

“As part of the Biden Administration’s commitment to rural communities, it is with great excitement that the Commission undertakes this effort to address the region’s healthcare workforce shortages and bolster one of the underlying elements that make economic development possible,” NBRC Federal Co-Chair Chris Saunders said in a statement.

Community Health Center of the North Country Director of Communications and Strategic Partnerships Ray Babowicz said he has spoken to Stefanik about the physician shortage “many times” over the past couple years.

“(I) truly appreciate the follow through on making this not just a hope, but a reality,” Babowicz said in a statement. “This may not fix the problem overnight, but it will give healthcare systems more flexibility when bringing on additional providers for primary and behavioral healthcare services.”