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Primary Care Office
Primary Care Office
Mom and Child  
Because of a common interest in improving access to care and reducing health disparities the U.S. Health Resources and Services Administration (HRSA) and the State of Oregon entered into a continuing cooperative agreement to help improve primary care access and reduce health disparities for low income and vulnerable Oregonians.

HRSA asks OHPR, through the Primary Care Office (PCO) agreement, to help determine where shortages of health professionals exist in the state and to identify underserved populations and areas of the state. HRSA takes data provided by OHPR and designates Health Professional Shortage Areas (HPSA), and Medically Underserved Areas/Populations (MUA/MUP). Certain designations enable communities to apply for funds to start, expand, and maintain clinics and services or to apply for National Health Service Corps placements. Some designations allow physicians and/or nurse practitioners to form Rural Health Centers and to receive prospective payment.

HRSA asks OHPR to assist with the support and monitoring of National Health Service Corps (NHSC) loan and scholarship sites and placements located in underserved areas of Oregon. Additionally the two organizations agree to coordinate activities as they relate to placement of foreign physicians in underserved areas of the state through the Physician Visa Waiver Program.
The PCO Cooperative Agreement provides an opportunity through the work of the Migrant Health Coordinator to focus on the health needs of migrant and seasonal farm workers who historically face barriers to care and whose health is at risk because of the nature of their work. The Office of Multicultural Health and Services shares in this responsibility.
A core expectation is that OHPR leverage other state and federal resources and thus expand the impact of the Agreement. PCOs are expected to build partnerships that contribute to improved access, greater health equity, and improved health status. As an example, OHPR works to nurture and provide technical assistance to community groups, collaboratives,and local organizations that have identified access or health related issues in conjunction with foundations, health departments, ORH, OPCA, and other partners.
The Office of Rural Health (ORH) represents another important counterpart to the OHPR but with a strong rural emphasis. Oregon’s Public Health Division School-Based Health Centers Program represents another allied focus of the Oregon Health Authority. HRSA has also established a cooperative agreement with the Oregon Primary Care Association (OPCA). OPCA receives funds to provide support, technical assistance, and community health center expansion activities in Oregon.

OHPR, through the PCO agreement, applies for three types of federal designations from the Bureau of Health Professions, Shortage Designation Branch: 1) Health Professional Shortage Areas (HPSA); 2) Medically Underserved Areas (MUA), and 3) Medically Underserved Populations (MUP). These designations target millions of dollars of federal resources to improve health care in underserved areas of the state. We estimate these designations bring in over $20M per year in unmatched federal resources. View maps of Oregon's three health professional shortage areas and MUA/MUP areas.
All subgroups of HPSA can cover a geographic area or a special population. Special populations include migrant and/or seasonal farm workers, and/or homeless and/or low income populations (below 200% of the Federal Poverty Level (FPL)). About 48 federal programs and some state programs are tied to these designations.

Historically, MUA/MUP designations were created for funding eligibility of Community Health Center programs and HPSA designations were created for distribution National Health Service Corps (NHSC) resources. HPSA designations are updated every four years.
A sample of programs currently related to these designations is listed below:
  • Community Health Center funding - MUA/MUP
  • National Health Service Corps - HPSC
  • Rural Health Clinic Certification - Primary Care HPSA, MUA, not MUP (this information is date sensitive)
  • Oregon Conrad Program - Primary Care HPSA, MUA, MUP and Mental Health HPSA (for psychiatrists)
  • Remote Supervision of Oregon physician assistants - HPSA, MUA or MUP
HPSA designation criteria includes provider-to-population ratio and distance to the next source of care. Indicators included in MUA/P designations are percent of population under 100% FPL, percent of population over 65 years of age, the infant mortality rate and provider-to-population ratio.

Physician Visa Waiver Program
Many Oregonians do not have access to a primary care doctor in their community. This is true in the majority of rural areas, as well as in some urban and suburban communities.  In order to address this problem, Oregon started its Physician Visa Waiver Program (also known as the "Conrad Program" or "J-1 Visa Waiver Program ") in August 2002.
International medical graduates who study in the United States are required to return to their home countries for two years upon completion of residencies or fellowships. The Physician Visa Waiver Program allows these doctors to remain in the United States, if they accept employment in a federally designated shortage area.
The 2003 State Legislature enacted House Bill 2151 enabling creation of Administrative Rules and collection of a $2,000 application fee needed in order to implement and fund the program.

Filling a Critical Medical Care Gap
A profile:
This physician literally brings a world of experience to her work as an Obstetrician and Gynecologist at the Providence Medical Center where she’s helping fill a critical medical care gap in the community.
Born in Mozambique, she’s lived in Portugal, South Africa, Canada and the United States. She speaks four languages and has degrees in medicine, architecture and biochemistry.
She completed Obstetrics and Gynecology training at Tufts New England Medical Center under a J-1 visa. It allows physicians to obtain residency training in the United States with the understanding that once the training is complete, the physician must return to his/her home country for two years.
But she sought and received a J-1 visa waiver, which allowed her to stay in the United States and work in a pre-designated rural or medically underserved area. After interviewing around the country, the family chose Oregon because of the diverse outdoor and cultural activities it offers.
This doctor is one of 58 currently working in 14 Oregon counties under the J-1 waiver program. Without them, many of the local residents would not have access to the medical expertise they bring.
How Oregon's Physician Visa Waiver
Program works . . .

The Physician Visa Waiver Program allows Oregon to sponsor 30 (thirty) J-1 Waiver applications per federal fiscal year, i.e., October 1-September 30.
The new fiscal year started on October 1, 2011.  The program will accept applications on a first-come, first-serve basis, with no deadline.  At this time ample slots remain.  Last year 29 physicians received waivers.
Read program summary  (pdf) 

Please contact Dia Shuhart, Program Coordinator, prior to starting the application process. 
Application Forms

Please visit the Department of State and obtain your tracking number in advance. The employer and the J1 physician need to work together to complete the application. The Administrative Rules PDF give a general explanation of program requirements and the steps to complete the application process. The forms you will need are listed below (in pdf):

Migrant Health Coordination
Migrant Health
National Health Services Corps
Oregon participates in the National Health Service Corps program to address the needs of underserved populations. Through this program, certain health care providers are offered scholarships or loan repayments for providing service in federally designated Health Professional Shortage Areas (HPSA).
National Health Service Corps placements in Oregon (pdf map)  
Learn more about the National Health Service Corps 
NHSC and Federal Designations Fact Sheet
Safety Net Clinics
Oregon's health care safety net is comprised of a broad range of local non-profit organizations, government agencies, and individual providers who share the common mission of delivering health care to persons who experience barriers to accessing the health care services they need.

Health care safety net clinics in Oregon are staffed by physicians, nurse practitioners, physician assistants, nurses, dentists, social workers, community health workers, other health care providers, and volunteers.
Lists of Safety Net providers in Oregon (pdf):
These clinics vary in terms of size, number and types of professionals employed, client characteristics, service area population density and demographics, diversity and stability of revenue sources, as well as sophistication in practice and business management practices.

Health care safety net clinics are community-based providers who offer health services to low-income people, including those without insurance. Most safety net patients are OHP enrollees, the uninsured, and other vulnerable Oregonians who pay a sliding discounted fee for primary care services. Primary care services provided by the safety net include, but are not limited to:
  • Urgent care
  • Acute and chronic disease treatment
  • Services based on local community need (mental health, dental, and vision)
  • Preventive care
  • Well childcare
  • Enabling services (translation/interpretation, case management, transportation and outreach)
OHPR supports health care safety net providers in Oregon in a variety of areas:
  • Assists local communities and clinics to improve access to needed health services
  • Designates areas of the state that are health professional shortage areas or are underserved
  • Processes waiver applications for up to 30 foreign physicians per year to practice in underserved areas of the state as primary care physicians, specialists, or psychiatrists
  • Links Oregon communities with National Health Service Corps practitioners

Workforce Partner Resources
The PCO is proud to partner with other organizations which share a commitment to health equity and access in its workforce development efforts:
  • Oregon Office of Rural Health
  • Oregon Primary Care Association
  • Oregon Healthcare Workforce Institute
  • Oregon Area Health Education Centers
  • US Human Resources & Services Administration
Oregon Healthcare Workforce Partner Resources
For more information please contact:
Office for Oregon Health Policy and Research
Primary Care Office
1225 Ferry Street SE, 1st Floor
Salem, OR  97301
Phone:  503-373-1779
Fax:      503-378-5511