Sunday, Dec. 23, 2007 | 6 a.m.
The desperate plea from the foreign doctor in Florida stands in stark contrast to the bureaucratic reply.
"I am an international medical graduate working as a J-1 visa waiver in an underserved area," the doctor wrote in an anonymous complaint to federal regulators. "My employer initially told me that I would work five days a week and see 20 patients a day and have (hospital) call one in four weekends. But it is a nightmare now. I work from 6 a.m. to 11 p.m. and see 25-30 outpatients and 20 inpatients, and worst of all have one weekend (off duty) in the past two months. This is clearly exploitation. I was threatened when I raised this question. Please help me. I am granted a waiver to serve poor people but my employer is using me to increase his profit margins."
The U.S. Labor Department replied that the Fair Labor Standards Act does not limit the number of days an adult employee can work, and employers may freely change work hours. The answer came in a form letter.
Unlike most people, the Florida doctor can't simply find another employer. He is one of thousands of international medical school graduates practicing in the United States under what is known as the J-1 visa waiver program. He committed to spend 40 hours a week serving medically needy patients for at least three years in exchange for a ticket to U.S. residency. But along the way, his employer - who sponsors his visa - has leaned on him in ways he never expected. The foreign doctor is in little position to complain, for fear of losing his job, jeopardizing his visa and giving up any hope of becoming an American citizen.
Throughout the United States the J-1 waiver system enables foreign doctors to care for some of America's neediest patients. But a Las Vegas Sun investigation found employers who leverage the vulnerability of J-1 doctors to overwork them, underpay them and divert them from needy patients in favor of affluent patients who can bring in more money for the employer.
Despite violations of the J-1 federal guidelines approved by Congress, no single government agency has clear oversight of the program, and complaints have generally fallen on uncaring or unresponsive bureaucratic ears. The foreign doctors have no advocates.
In its initial investigation, the Sun found systematic abuse by employers in Nevada who have hired about 70 J-1 doctors over the past decade, as well in Arizona, Tennessee and Utah. A subsequent look at the program nationally found additional abuses in Arizona, Florida, Georgia and Michigan. All appear to have escaped government sanctions.
Like other J-1 doctors, the Florida doctor would speak to the Sun only on the promise of anonymity, for fear he would be fired.
He said that in November he worked at least 90 hours a week doing hospital rounds and practicing in a clinic - one week he worked 119 hours - plus an additional 17 overnight on-call shifts for hospital emergency rooms.
"My main concern is patient safety," he wrote in an anonymous online complaint to the American Medical Association. The AMA suggested he complain to his local medical board or medical society.
The J-1 waiver program exists to make employers wealthy, the Florida doctor said, by giving them "cheap labor that cannot complain or even leave."
It's ironic, he said, that his employer is also an immigrant - a prevalent characteristic among exploitative J-1 bosses, the Sun found. The foreign J-1 physicians say their foreign-born bosses are familiar with - and are taking advantage of - their tenuous immigration status.
J-1 doctors say abuses happen throughout the United States. Indeed, a 2003 survey of state officials who administer the program in 41 states, published in the journal Health Affairs, found signs in many states of employers abusing the system.
- Three-fourths of respondents said there were problems with employers changing work practices after the employment agreement was signed.
- Half said employers were requiring J-1 doctors to work in poor or unfair conditions.
- More than half reported compensation disputes.
- Sixty percent of respondents said foreign physicians were violating various requirements, often related to not working in the approved location - a complaint other doctors blamed on their bosses' diverting them to more affluent areas.
University of Washington professor Amy Hagopian, one of the authors of the study, said she is unaware of any follow-up to the report - but said she would examine the problem.
A former J-1 doctor from Syria who was assigned to work in an underserved town in Michigan said he was paid $72,000 a year when he started in 2001, even though federal law mandated that he be paid 95 percent of the prevailing wage - the amount a similarly skilled American physician would earn - which was more than $100,000 a year. A separate contract reflecting the prevailing wage was sent to the Labor Department so the deal could be approved, said the doctor, who now works in a different state.
He said he worked more than 80 hours a week and was on call every weekend at a nursing home - and spent almost no time in an underserved area. He said his boss asked him to fraudulently bill Medicare by performing unnecessary examinations on healthy patients - which he refused to do - and cover shifts for pulmonary critical care specialists when he was an internist, unqualified to do such work.
In Arizona, three J-1 doctors left a Phoenix-area practice this year, claiming they were overworked and assigned to work full time in hospitals that are not in underserved communities.
One of the physicians said he had to work an 84-hour weekend shift - days doing rounds and nights on call for the emergency room - in addition to 12-hour shifts on weekdays.
The J-1 doctor spent about $15,000 in lawyer fees and other costs to appeal extreme hardship to U.S. Citizenship and Immigration Services, which approved his transfer to another employer.
The other two J-1 doctors made similar complaints to the Sun after they, too, were allowed to transfer to other employers. The office manager where the three doctors worked shrugged off the complaints about long hours: "Being a doctor, you really have to sacrifice to take care of patients."
The office no longer employs J-1 doctors, the manager said, because they cause too many headaches.
The three J-1 doctors said that when they complained about the mistreatment to hospital officials and the Arizona Health Department, which administers the program on behalf of the federal government, they were told to find a new boss. Their transfers were approved after the doctors showed that they were bullied and not assigned to an underserved area, but no one spoke of holding their boss accountable.
"I came to the United States because I believed it's a land of law and freedom," one of the doctors said. "Where's the law? Everyone knows this is happening - so where's the law?"