Migration Policy and the Supply of Foreign Physicians: Evidence from the Conrad 30 Waiver Program

In the United States, rural and low-income communities have difficulty attracting and retaining physicians, potentially adversely impacting health outcomes. With a limited supply of physicians completing medical school at US universities, foreign-born and educated physicians provide a potential source of supply in underserved areas. For international medical school graduates (IMGs) the terms of the commonly used J-1 visa require a return to the home country for two years following employment in medical residency. Our analysis examines the extent to which the Conrad 30 Visa Waiver impacts the supply of physicians at state and local levels, particularly in areas designated as medically underserved. Changes in the federal limit on the number of waivers per state, combined with variation in the state-level restrictions on eligible specialties, and geographies in which physicians can work, provide evidence on the role of visa restrictions in limiting the supply of doctors. Expansion of the cap on visa waivers increased the supply of IMGs, particularly in states that did not limit waiver recipients to primary care physicians or particular places of employment. There is little evidence of reductions in US-trained doctors in states where IMG increases were the largest, suggesting little evidence for crowding out.