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derserved areas in Texas. She also over- sees the state’s J-1 visa waiver program, known as Conrad 30, through which physicians have had success finding placement and good experiences with the communities and employers they work with.
Those factors, Ms. Berry says, contrib- ute to the continual interest in the J-1 waiver program and physician retention in Texas, and could translate to similar success under the new H-1B visa licen- sure requirement.
Not what they intended? Physicians and TMA staff say some of the TMB provisions, such as the defini- tion of full-time practice, may help miti- gate potential problems with the new law. Credit for residency in an under- served area also may help keep doctors in those communities and throughout Texas.
But the law may invite other unin- tended consequences, some physicians and licensure experts warn. Dr. Sarino-Roy says the law overlooks
some potential limitations on specialty practice in the designated underserved areas.
The federal government designates
HPSAs and MUAs largely based on pri- mary care and mental health shortages, among other factors. That means an IMG who has trained two or more years in a specialty field could be required to spend three years practicing primary care before obtaining full licensure in Texas, Dr. Sarino-Roy says.
“This brings up concerns about the safety of medical practice for doctors who are not specifically trained for pri- mary care or mental health,” she said. The number of residency program slots available continues to dwindle, as does the pool of noncitizen physicians applying for Texas licensure, she says. So the requirement might better serve its purpose and physicians if it applied instead to licensure applicants trained in a primary care specialty, regardless of their citizenship status. According to American Medical As- sociation data, the top specialties repre- sented by the IMG population are inter- nal medicine, anesthesiology, psychiatry,
pediatrics, family medicine, obstetrics and gynecology, radiology, and general surgery.
But even specialists who are able to fill a void in an underserved area may not have access there to the facilities they need to keep up their skills, says Denise Meyer, a former team leader in licensure at TMB and a physician licen- sure consultant.
The law could be a boon to many
rural areas that have difficulty recruit- ing medical professionals, she says. But some regions and facilities could be left out.
“There are plenty of midsized hospi- tals out there in the middle of Texas that rely on IMG recruitment. But they are in areas not designated as MUAs or HP- SAs and do not have a GME institution around them, and they could be poten- tially harmed,” Ms. Meyer said. And with more than 4,000 license re- quests a year, the board could have its hands full with additional documenta- tion checks “that could affect the time it takes to process an application,” she added. Legal implications may lurk, too. The 2nd U.S. Circuit Court of Appeals
in July struck down as unconstitutional a similar New York measure that barred noncitizen physicians and other health professionals from obtaining full licen- sure unless they secured a three-year waiver to practice in a medically under- served area. The court in Dandamudi v. Tisch said the rule was discriminatory. Texas and New York are the only states known to have such requirements, according to data from the Federation of State Medical Boards. The TMB’s Ms. Robinson said it’s too early to know the new law’s full impact. Because the requirement just took effect, however, most current noncitizen physi- cian applicants are likely exempt. “This is a new requirement for the
board, too. Hopefully it will not be prob- lematic, but we’ll know better in a few months,” she said.
Altex Business Solutions ........................38 American Physicians Insurance Company .................................................40 Arms of Hope .............................................37 Athenahealth ................................................9 Capital Farm Credit ..................................29 Centers for Medicare and Medicaid .....6 Cooper Aerobics Center ..........................15 Covenant Medical Group .......................... 7 Humana .......................................................IBC Kindred .......................................................... 10 Leichter Law..................................................8 Looper Reed & McGraw .........................40 nAbleMD .......................................................36 Seton Healthcare .......................................45 Sharp & Cobos, P.C. Attorneys at Law .........................................................31
Texas Cardiac Center ................................14 Texas Department of State Health Services (HIV) .........................................24
Texas Medical Association Classifieds .................................................22 Communication ......................................52 Facebook ................................................. 46 First Tuesdays at the Capitol ........... 64 Gulf Coast REC .......................................39 Hard Hats for Little Heads ..................51 Home Study Course ..............................14 Medical Education Dept. .....................51 Physician Oncology Education Program ............................................. Insert Physicians Benevolent Fund ............... 3 Practice Consulting ...............................32 TEXPAC ......................................................31
Texas Medical Association Insurance Trust ......................................................5, BC
Texas Medical Liability Trust ............... IFC Texas Mutual Insurance Company ......23 Transwestern ...............................................24 West, Webb, Allbritton and Gentry, PC ................................................38
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December 2012 TEXAS MEDICINE 55
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