Hartford Business Journal

www.HartfordBusiness.com • February 12, 2018 • Hartford Business Journal 15 permanent residency. "Places say 'yes we can do J-1 waiv- ers,' but the paperwork that goes into that and the knowledge required in getting that to actually happen are two very different things," Menon said. The so-called "Conrad 30" waiv- ers — named for a former Congress- man who pushed to create them in 1994 — allow foreign doctors to skip a requirement that they leave the U.S. for two years when their J-1 expires. In exchange, they agree to work for three years in a federally designated provider shortage area, after which point they can pursue a green card. Foreign docs J-1 waivers have helped fuel Con- necticut's relatively high number of foreign doctors. The state has the seventh-highest percentage of inter- national medical school graduates (28.1 percent), according to 2014 data from the Association of American Medical Colleges. That's compared to a national median of 18.6 percent. Barwis said trust plays a big role in the process, and the more experience a hospital has, the better chance it can land a recruit. J-1 visas are com- plicated and plenty can go wrong, so if a physician accepts a job offer from a hospital inexperienced with the program, their ability to remain in the United States is at stake, he said. He also said he's been impressed with the caliber of foreign recruits. Dr. Vanessa Malit, a surgeon who joined Bristol Multispecialty Group in 2014, agrees. She works closely with two Lebanese doctors at Bristol who took the J-1 immigration route. She said they have "extremely good skill sets." "Honestly I think the J-1 opportuni- ties here have expanded our ability to recruit higher-quality physicians," Malit said. Supply and demand The problem for hospitals trying to recruit foreign doctors is that Conrad 30, as its name implies, only allows 30 applications per year for the state. The Department of Public Health, which facilitates the program for Connecticut, accepts applications on a first-come, first-serve basis, and like a rabid music fan sleeping outside to get concert tickets the next morning, Bristol Hospital has learned to have someone at or near the front of that line often. Its legal team has also become well- versed with the intricacies of im- migration rules, paperwork and deadlines. Their strategy, however, may be in jeopardy. According to DPH, waiver ap- plications have recently begun to exceed the cap for the first time since the state joined the Conrad 30 pro- gram in 2002. It happened in 2015, when there were 34 appli- cants. In 2016, there were 36. And last year, 45 applied. DPH says it's weighing wheth- er to switch to a lottery system. "The depart- ment recognizes the important role that all J-1 waiver visa hold- ers play since they are required to provide services in medically under- served areas," DPH spokeswoman Maura Downes said. "Unfortunately, there are only 30 slots allocated to Connecticut for this program." Changes possible? Karen Buckley, vice president of ad- vocacy for the Connecticut Hospital Association, said the association has taken an interest in the topic. "We are currently investigating how other states handle the J-1 visa issue and exploring options with staff from the Department of Public Health to potentially modify the system so that we can continue to recruit high-qual- ity physicians for positions in Con- necticut hospitals," she said. Barwis said he hopes the situation leads to Connecticut finding a way to get more foreign doctors hired in the state. Doing so may take an act of Con- gress, according to DPH. The timing is a bit precarious, given the political gridlock in Wash- ington, D.C. on immigration reform. It's unclear how the Trump admin- istration might respond to a state wanting to import more physicians from other countries. While Trump's "travel ban" last year (which appears headed to the Supreme Court) caused uncertainty for foreign doctors from Muslim-ma- jority countries — and even stranded some overseas — Bristol Hospital did not see any major impacts, said Ed Henry, executive director of the Multispeciality Group. Connecticut may need to convince a federal agency to sponsor additional spots, Barwis said. Some other states have found creative ways to bring in more foreign medical talent, such as Tennessee, he added. Henry said the future growth of the group depends in part on the immi- gration situation. "Certainly, being in an underserved area, the ability to recruit J-1 visa candidates is a help for us and a criti- cal need and that should continue moving forward," Henry said. J-1 Physicians by State, 2016 State Physicians NY 479 MI 204 FL 177 TX 173 OH 161 MA 157 PA 143 IL 131 NJ 113 MD 100 CT 69 DC 62 U.S. Total 2,624 Source: U.S. Dept of State Ed Henry, executive director of Bristol Multispeciality Group, with Dr. Nandini Menon (middle) and Dr. Vanessa Malit. Tesla to mount attempt No. 4 at the Capitol By Matt Pilon mpilon@HartfordBusiness.com I n Connecticut, Tesla could be a synonym for "persistent." The electric-vehicle manufactur- er (which also owns solar installer SolarCity), has tried but failed for the past three years to get its direct-sales business model legalized in Connecticut. Tesla representatives made the rounds at the state Capitol recently in advance of the legislative session. The company has secured a pledge to get a bill introduced again this year, said Will Nicholas, Tesla's government relations manager. Nicholas said Tesla sees Connecticut as one of the biggest potential markets it has not yet been able to fully tap. The company has faced steep oppo- sition from car dealerships, headed by the Connecticut Automotive Retailers Association (CARA), which says no company should be allowed to avoid the state's longstanding laws requir- ing car makers to sell through third- party franchisees. Dealers say that model protects consumers and that auto dealers have a greater economic impact than a direct-sales store would. Tesla argues the direct model protects dealerships from competition and that dealers are not doing a good enough job putting electric cars on the road. Meanwhile, Tesla remains embroiled in a lawsuit against the state Depart- ment of Motor Vehicles, which agreed with CARA last year that the car-mak- er's Greenwich gallery requires a sales license, though Tesla says it's not sell- ing cars from that location. The facility remains open, pending Tesla's appeal. CARA, which speaks for more than 270 dealers that together employ 14,000 workers, had previously challenged the Greenwich gallery on zoning grounds, but the effort was unsuccessful. Jim Fleming, CARA's president, said he hopes a committee won't raise a Tesla bill this year. "My hope is the committee recon- siders raising the bill while we are in litigation," Fleming said, referring to Tesla's DMV appeal. If a bill is filed, Fleming said CARA will oppose it, as it has in the past. The legislature thus far has favored dealerships, with a Tesla bill reaching a vote in the House just once, in 2015, and never reaching a Senate vote. Most Connecticut residents must travel to New York to purchase a Tesla. Despite the extra steps needed, more than 1,600 Connecticut resi- dents own a Tesla. Nicholas said more than three times that number have paid a deposit to reserve the company's relatively lower-priced Model 3, which is now in production (though at a slower pace than originally hoped).

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