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.