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The J-1 visa waiver program allows international medical graduates who agree to spend three years working in medically underserved areas to stay in the United States after their residency training. However, many communities struggle to retain these physicians after their term expires.

Byron J. Crouse, M.D.
Associate Dean for Rural and Community Health
University of Wisconsin School of Medicine and Public Health
Madison, Wis.


The quality of healthcare provided by J-1 visa waiver physicians in underserved communities is good and definitely needed today. Retention of these providers is a problem. The professional goals of these physicians often cannot be met in the underserved community, as some aspire to subspecialty work. The physician and family with an international background may not find the community support for their cultural or religious practices. These aspects need to be addressed during recruitment. The physician and family should meet with individuals from the community to determine the professional and social fit. Situations in which physicians revolve through the community every three years result in a lack of continuity in healthcare. The community will come to perceive local healthcare as lacking, and the future recruitment of physicians becomes even more difficult.

Andrew Craigie
Chief Executive Officer
Garfield County Memorial Hospital
Pomeroy, Wash.


The biggest obstacle to retaining J-1 physicians is having access to a social and cultural network that is consistent with the background of the provider. We successfully retained our J-1 physician for seven years because our community has really embraced our physician. For example, we had an open house at the school for people to drop in and meet him, and the chair of our board assembled a gift basket with items from local businesses to welcome him. He and his family have really made a home in our small town, but the distance from family and friends of the same culture has made it more difficult. Now he is preparing to leave to be closer to family in Atlanta. The community has a genuine sense of loss over his anticipated departure. This level of sincere appreciation is probably the biggest reason he has stayed so long.

—Carrie Vaughan