ment, says TMB Executive Director Mari Robinson.
“The rules were meant to make sure that the basic requirements of the law were enacted. So if it was not required, we were not going to be adding to it,” Ms. Robinson said. The three-year clock generally starts
ticking from the time TMB approves an application, she says. Residency train- ing in an underserved area counts to- ward the service requirement. And those who are employed at an institution that maintains a graduate medical education (GME) program, for example as a pro- fessor, are excused from the three-year service obligation.
But the new rule also comes with doc- umentation requirements that apply to all physician licensure applicants. Those physicians who are U.S. citi- zens, permanent residents, or condi- tional permanent residents must present acceptable proof of their status when applying for Texas licensure. Applicants subject to the mandatory service require- ment must submit an affidavit of their intent to practice full time in an under- served area, such as an employment agreement, and they must eventually prove that they completed the three-year service.
TMB details these documentation re- quirements at
www.tmb.state.tx.us/pro
fessionals/physicians/applicants/manda
toryServiceRequirement.php.
Wanted: Physician in underserved area
Noncitizen physicians subject to a new three-year service re- quirement in an underserved area before getting full licensure in Texas are not on their own to find a job. The Texas Department of State Health Services Primary Care
Office (TPCO) is available to help. Physicians can contact TPCO by email at
TexasPCO@dshs.state.tx.us or by phone at (512) 776-7518. Search federally designated medically underserved areas and health professional shortage areas in Texas at www.dshs
.state.tx.us/chs/hprc/hpsa.shtm, which includes links to maps from the U.S. Department of Health and Human Services Health Resources and Services Administration. Doctors also can browse for Texas jobs at:
• National Health Service Corps Job Center: http://nhscjobs
.hrsa.gov;
• Texas Association of Community Health Centers: www.tachc .org;
• TPCO, East Texas Area Health Education Center, State Office of Rural Health partnership:
www.txhealthmatch.com; and
• National Rural Recruiting and Retention Network: www.3rnet .org.
54 TEXAS MEDICINE December 2012
Noble beginnings State Rep. John M. Zerwas, MD (R- Simonton), who cosponsored the law along with Sen. Jane Nelson (R-Flower Mound), says it was an opportunity to drive some physician presence into un- derserved counties. “Clearly, there is a deficiency in phy- sician supply across the state, more in certain areas than others,” he said. “The focus tends to be on primary care, but all physician specialty groups are in demand.” Rural areas like West Texas, as well as the Rio Grande Valley and border re- gions, for example, remain challenged to recruit physicians, Dr. Zerwas says. But even Waller County, part of the Houston metropolitan area he represents, is a des- ignated MUA. Because Texas has a friendly practice
environment, the requirement is unlikely to deter many IMGs from applying for licensure, Dr. Zerwas says, though law- makers weighed such concerns when they considered the legislation. “There is no one-size-fits-all solution to the physi- cian shortage, but this is one of the ways we can address some of that problem and get a little bit more mileage out of our H-1B visas.” Proponents say the law also creates parity with the federal J-1 visa waiver program. That program allows foreign medical graduates who complete their residencies in the United States to stay and work by committing to practice in an underserved area for three years, in lieu of returning to their home coun- try for two years as their student visas require. Because federal law caps phy- sician J-1 visa waivers at 30 per state, however, a disproportionate number of IMGs began seeking H-1B work visas in- stead, which previously had no service obligation.
Connie Berry, manager of the Texas Department of State Health Services Pri- mary Care Office, said the law “levels the playing field between the two visa types and gives us one more tool for address- ing the maldistribution of physicians.” Her office monitors the need in un-
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