Senator Kent Conrad from North Dakota introduced this valuable legislation back in 1994, and it has been amended and reauthorized several times. Most recently, in 2004, the so-called FLEX-5 provision was added to be superseded in 2008 with FLEX-10. More on this later.
The current framework provides that each of the 50 states plus DC, Guam, and Puerto Rico can bring in 30 foreign physicians to serve in federally-designated underserved areas. Although each program has unique characteristics, each program must meet the following mandates:
1. Within 90 days of waiver receipt, physician must begin employment.
2. Term of employment must not be less than three years.
3. Patients served must be in federally-designated underserved areas.
4. Employment must be full-time.
Shortage of the specialty must be documented if non-PCP. See INA Sec. 214(l)(l). Having met these statutory mandates, states are free to set their own requirements, an illustration of federalism at work. In actuality, there is a great deal of variation between programs. It is at this level that policy decisions can help or worsen physician shortages by state.