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Shortage areas: Key to recruiting international physicians – Spring 2014
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By Carl Shusterman, Principal, Law Offices of Carl Shusterman

About one-quarter of all practicing physicians in the United States, and about one-quarter of those currently in training, are international medical graduates (IMGs). In an era of widespread physician shortages, IMGs are a critical resource for physician recruitment professionals, particularly those working in traditionally underserved, rural and inner city areas.

The good news for recruiters in underserved regions of the country is that many IMGs completing their training actively seek out employment in federally designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs) in order to fulfill immigration requirements. For example, IMGs on J-1 visas generally need to serve in physician shortage areas in order to obtain J-1 waivers and avoid returning to their countries of origin for their two-year home residency requirement. Similarly, most international doctors wishing to obtain green cards using National Interest Waivers must practice in physician shortage areas for five years before being granted permanent residence.

Therefore, it is valuable for in-house physician recruiters to have a working knowledge of physician shortage area designations and be able to determine if their health care facility is located in a shortage area.

HPSAs are designated by the Health Resources and Services Administration (HRSA) as having shortages of primary care physicians, dental or mental health providers. A HPSA can be a geographic area (a county or hospital service area), a demographic group (a low income population), or an institution (a hospital, community health center or other public facility). MUAs are areas or populations designated by HRSA as having too few primary care providers, high infant mortality, a high poverty rate, and/or a high elderly population. MUAs generally include groups of people who face economic, cultural or linguistic barriers to health care.

There are currently 5,800 designated Primary Care HPSAs nationwide. Primary Care HPSAs are based on a physician to population ratio of 1 physician to every 3,500 in population. When there are more than 3,500 people per one primary care physician, an area is eligible for HPSA designation. Applying this formula, it would take about 7,500 additional primary care physicians to eliminate the current Primary Care HPSA designations.

There are currently 3,700 Mental Health HPSAs nationwide. Mental Health HPSAs are based on a psychiatrist to population ratio of 1 psychiatrist to every 30,000 in population. Applying this ratio, it would take approximately 2,400 additional psychiatrists to eliminate the current Mental Health HPSA designations.

Shortage designations do not apply only to physicians. There are currently about 4,600 Dental HPSAs nationwide, which are based on a dentist to population ratio of 1 dentist to every 5,000 in population. Applying this ratio, it would take 6,600 additional dentists to eliminate the current Dental HPSA designations.

The standards for obtaining MUA designation are a little more nuanced and can be researched on the HRSA website at: Obtaining a shortage designation is an important first step to recruiting IMGs, who can be an indispensable resource for in-house physician recruitment professionals working in areas in which recruiting doctors remains a challenge.
Carl Shusterman served as Trial Attorney for the U.S. Immigration and Naturalization Service (1976-1983) and is principal of the Los Angeles-based Law Offices of Carl Shusterman. Recruiters can check Shusterman’s website to see if their hospital, medical group, community health center or facility is located in a HPSA or MUA (

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