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  Most recently, in 2004, the so-called FLEX-5 provision was added to be superseded in 2008 with FLEX-10.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.