The People Supporting J-1 Physicians
Rhode Island J-1 Coordinator Jill D'Errico
This is the second blog in our series highlighting the important work of J-1 program coordinators and those involved with the process throughout the country. Foreign-born physicians with J-1 Visa status are required to return to their home country for two years after their completion of residency in the States. The J-1 Visa Waiver, most commonly associated with the Conrad 30 Program, allows them to waive this requirement in return for three years of service in rural or underserved communities. For more information on the specifics of the J-1 Visa Waiver process, visit our webpage at: https://www.3rnet.org/Resources/J1-Waiver
The location of Rhode Island lends to some unique challenges when it comes to recruitment, especially with the J-1 Waiver program. We spoke with Jill D’Errico at the Primary Care Office and State Office of Rural Health to learn about the unique challenges of serving the rural and underserved of her state.
“Obviously rural Rhode Island looks very different than rural Montana,” D’Errico said, “but we do have some areas that are definitely rural. The top northwest of Rhode Island meets Connecticut and Massachusetts in what they consider rural areas, too, so If someone in one of our rural towns has to go to the hospital, they won’t go to Providence. They’ll go to Connecticut or Massachusetts because they are closer.”
When D’Errico started in her current position as Senior Public Health Promotion Specialist, her biggest challenge was institutional knowledge. Like many J-1 waiver program coordinators, she had no prior experience with the program, and had little guidance upon being handed the responsibility. “I came into the office on a Monday, and that Friday the director of the office retired,” she said.
Fortunately, the lawyer that frequently works with J-1 Waiver applicants in her state offered to help. After spending an afternoon answering her questions and explaining their individual roles in the process, she felt confident to take on the program - with dreams about increasing its reach. “We were getting about 14 [applicants] at the time, such an underutilization. I told myself that I need[ed] to start going out and talking about it, getting the word out to health centers, etc.” Since then, they’ve filled their slots almost every year, and have had to actually turn a couple of doctors away in certain years.
In Rhode Island, they prioritize primary care physicians, including psychiatry, and after an experience D’Errico had a few years ago, they prioritize husband and wife teams. “We had hired a husband and he got slot 30,” she explained. “Then when the wife applied there were no slots left. So they would have had to practice in two different states, which is fine if you can get a spot in Massachusetts or Connecticut, but those fill pretty fast, too.” Fortunately for the couple, another physician had received a waiver outside of the Conrad 30 program, and both husband and wife were able to land spots in Rhode Island together.
In years when the program has been fortunate to have an abundance of applications, some creative strategy has come in handy. D’Errico will collaborate with the facilities she serves to help decide who gets the last spots. “I’ll say, you can pick one more thing. You tell me who you want - do you want a cardiologist? Do you want an endocrinologist? I don’t know what your needs are - you know more than me.” Though she hates turning doctors away, she has found this strategy to help her communities the most when faced with overabundance. She is also in contact with nearby states, and will occasionally send doctors their way if she knows they have slots left to fill - 3RNET is a great source for this data, she mentioned.
Another important piece of her strategy is utilizing the Health and Human Services Waiver (HHS Waiver) to its full potential. The HHS waiver is usually used for primary care, but it has the added benefit of considering hospitals primary care, a distinction that is not generally granted in most states’ Conrad 30 guidelines. “See, by encouraging them last year, I only filled 25 [Conrad 30] spots, but I had 12 HHS waivers. So really, I had 37 total.”
Rhode Island doesn’t have an additional regional authority like Ann Cranford, in Tennessee mentioned. But, by utilizing the HHS waiver for primary care physicians and even hospitalists, they free up Conrad 30 spots for specialists.
Though there has been turnover in the Rhode Island Primary Care Office and State Office of Rural Health, and D’Errico has had many different roles since her start there, she refuses to give up two things: her role with 3RNET for her state, and the J-1 program. “I call the J-1 program my baby,” she said. “I worked so hard to get the program where it is now, and I work with lawyers all across the country.” Based on directorial changes, there can be some variance in the process from year to year, but D’Errico is determined to be a through line in the program for the communities she serves.
The best part of this role for her is bringing in providers that are truly helping their communities. “If you go up to anybody on the street and ask them what it is that I do, you know, 99% of people are going to say ‘no’, but I might have just hired the doctor that saved your life.” Like many who work in rural health, D’Errico sees her oftentimes hidden work as some of the most important work that she does.
Next month we will hear from Ann Cranford in Tennessee, where she oversees their J-1 program. In Tennessee, there are four pathways to obtaining a waiver, an option that both aids and sometimes confuses the process.