SUN FOLLOW-UP:

Protect foreign doctors who work in Nevada, colleagues urge

Win-win sought to protect doctors

Wed, Jan 16, 2008 (2 a.m.)

Across the United States, foreign doctors are being worked to exhaustion, cheated out of wages, coerced into unfair contracts and diverted away from the medically needy patients they're supposed to serve. Their bosses can bully them because they sponsor their visas.

This series takes a look at these physicians

An association of about 1,400 Nevada physicians is calling for whistleblower protection for foreign doctors who complain of being exploited by their bosses, and for the government to more aggressively monitor the program that allows them to work in the state.

The Nevada State Medical Association’s recommendations for reform came in a letter to the Nevada State Health Division, in response to a Sun investigation of the “J-1” visa waiver program, which is designed to bring foreign doctors to medically needy communities, but in some cases has been abused by employers.

The Sun found foreign doctors being forced by their bosses to work up to 100 hours a week, which is dangerous for patients, cheated out of their salaries and diverted from the -- patients in underserved areas they’re supposed to help. The abuses are possible because the foreign doctors are reluctant to complain about their employers, who sponsor the visas allowing them to stay in the United States.

Larry Matheis, executive director of the association, made four recommendations in the letter. The first is to adopt the guidelines that govern the J-1 visa waiver program as regulations, which carry the weight of state law. He says the step would not require legislative action and would allow for clear action and investigation when there are violations.

Matheis also said an advisory group that makes recommendations about the program should be expanded to include anyone who is interested and the meetings should be made public.

“There’s a sense that things may have gotten out of hand because neither the public -- nor the regulators could monitor what was going on,” Matheis said. “It was a problem that had been developing for some time and it really was time to resolve it.”

A third suggestion is to remove noncompete clauses -- which restrict where a foreign doctor can work after he leaves his employer’s practice -- from current contracts between employers and foreign doctors so they’re in line with federal guidelines.

Finally, Matheis said Nevada’s current whistleblower protection laws should be expanded to protect physicians, their families and others who might report violations in the program. This may require legislative action in 2009, Matheis said.

Drs. Ikram Khan and Amir Qureshi, who are on the J-1 advisory committee, said they were pleased to hear about Matheis’ letter and that the process of implementing changes needs to continue.

“They’re still in the process of evolution,” Khan said of the reforms. “They should continue to the point where it’s absolutely foolproof.”

Khan and Qureshi said they’re in favor of eliminating existing noncompete clauses in contracts and expanding the whistleblower legislation to include doctors. But they said they need to hear more details before they can form opinions on the other recommendations.

Qureshi said his primary concern with turning guidelines into regulations is for the foreign doctors, who may be forced by their employers to violate the rules of the program. The foreign doctors must be protected, Qureshi said.

Lynn O’Mara, health planning program manager for the state health division, said all of Matheis’ recommendations are being discussed. The goal is to move forward with improvement as soon as possible so the program “is a win-win all around,” she said.

The Sun’s findings that some U.S. doctors bully their foreign employees were cited by Senate Majority Leader Harry Reid in calling for an investigation by the Homeland Security Department.

Discussion: 2 comments so far…

By gene

1/16/08 at 4:37 a.m.

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I speak from firsthand experience of the J1 program in another state. This blog provides the anonymity that allows me to state the issues on this topic as I see them.
1) This program was created to disperse care to under-served/inner city/rural areas of the country. A noble ideal no doubt since Physician distribution is definitely a problem in the USA. It took no account of possible abuses of the physician by his/her employer.
2) The problem is that most doctors in the USA, either set up their practice or are partners in one, even when employed they have enough leverage, since they can always walk if there are abuses.
A J1 doctor is committed to 3 yrs, in that location, to that employer for his visa, with virtually no exceptions. The employer controls that visa, and makes money off that doctors earnings generated. It does not take much imagination to understand where that can lead with a wink and a nod from state officials ill equipped and less concerned about the welfare of these professionals. Abuses can and do happen, not just in Nevada but all over the country. Any abuse you can think of in this scenario does happen. The secondary victims are the patients, treated by frustrated, tired, unhappy, themselves captive doctors.
3) All of the solutions proposed are like putting lipstick on a pig. The only way to rectify this is to alter the program so that, the only requirement placed on the J1 doctor is to provide the service in the Underserved area/population. The mandate that he/she be employed is inappropriate and serves no purpose than to fatten the wallets of other doctors/exploitative employers which presumably is not the intent of the program. Unless this change can be brought about, these proposals are a waste of time.
4) Organized medicine is ambivalent on this issue. Caught between the interests of some of the exploiting American physicians/hospitals and their foreign graduate colleagues. Also unable to decide with certainty whether they should support the immigration ambitions of these colleagues.
5) The US is facing a massive shortage of physicians. American trained physicians(Post graduate training in the US) will be very hard to come by in short order. We are already seeing shortages in many specialties, and especially acute in already sparsely doctored areas.
This program should be fixed properly for the benefit of all.
By Michael

1/16/08 at 8 a.m.

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If you think there is a shortage of doctors now then wait till Hillary Clinton becomes the President....all hell will break lose then. I have several of my friends from university days who are in medical practice right now and most of them are planning on retiring if Hillary becomes the President. She wants to move to a socialized medicine concept which has many flaws also. In other OECD countries where this system exists, people actually die on waiting lists unlike in America. Their taxes are through the roof because how can the government pay for socialized medicine without collecting tax? Hillary wants to go even further and restrict doctors income in different ways.

In America you CANNOT have a 2-tier system i.e. capitalism and socialism at the same time....one or both the elements involved will fall apart and in this case it will be the doctors who will be retiring in droves or opting to just work limited hours in a hospital setting rather than private practice because there will be no financial gain for them if Hillary gets her way. This also means that those employed in private practice by those doctors will lose their jobs...it will be ripple effect and then people will be in a deeper mess than before. Right now the system is quite balanced and all that needs to be done is to make insurance affordable rather than totally embracing the socialized medicine concept.