Neha Kansara is from a family of medical professionals. Her father and husband both graduated from Indian medical schools and her mom was a nurse. But when Kansara chose psychiatry as her field, she knew her native country wasn’t the best place to practice. “Psychiatry continues to carry some social taboo back in India,” she says. “It’s getting better, but in the U.S., awareness about mental health has been widespread for quite some time. I wanted to give it a shot here, because I believed I could have more impact, given my training and education.”
After completing medical school and training in Mumbai, Kansara worked in underserved villages before coming to the United States to continue her education. She completed her residency in adult psychiatry at the University of Mississippi Medical Center, and did a fellowship in infant, child, and adolescent psychiatry at Louisiana State University. Now Kansara treats patients at a New Orleans psychiatric center and provides in-home treatment to Louisianans with mental illness and developmental delays. “These are patients who are underprivileged and have no means of transportation to get to a doctor’s office,” she says. “It’s hard to find professionals who offer similar door-to-door treatment. But helping people and giving back to the community is the whole reason I got into medicine in the first place. A humanitarian approach is what I feel is necessary for the community.”
Without foreign-born doctors like Kansara, these patients — and many others across the country — might be left without any care at all. In any given year, an estimated one in five Americans experiences a mental health issue, yet millions go without care.
There’s no one even existing in their area who’s as closely trained as I am to do what I’m doing.
The reasons why patients may not receive treatment are multifold, but there’s no doubt that without doctors, no one would get the care they need. And, as it stands today, the United States is not producing enough doctors. Sadly, this is the case in many fields of healthcare, including mental health. Currently more than half of U.S. counties lack even a single practicing psychiatrist, and, given that one-quarter of psychiatrists practicing in the United States are already over the age of 65 and facing retirement, the number of Americans who don’t have ready access to mental healthcare is only expected to grow. If the country wants to meet the minimum federal standards of care, it will have to add some 4,870 psychiatrists by the year 2020.
This shortage of care carries both a human and an economic cost. Suicide is the second-leading cause of death for young Americans between the ages of 15 and 24, and more than 90 percent of children who die by suicide have a mental health condition. In the workplace, mental health disorders are considered the leading cause of disability, defined as the inability to work at full capacity. As a result, the National Alliance on Mental Illness estimates that when left untreated mental illness costs the United States more than $100 billion a year in lost productivity.
“New Orleans is a big city, urban population,” says Kansara. “But you’d be surprised: The area that I am in, New Orleans East, is designated as a health provider shortage area for the country. A lot of patients that come to our practice from around the suburbs, like Hammond, there’s no one even existing in their area who’s as closely trained as I am to do what I’m doing.”
In 1994, U.S. Sen. Kent Conrad introduced a program to help alleviate the dangerous shortage of physicians in the United States. The Conrad State 30 Waiver allows foreign-born doctors who complete a U.S. medical residency program under the J-1 visa, which most international doctors use, to waive the requirement that they return home for two years after residency as long as they agree to practice medicine in an underserved area of the United States for three years.
The Conrad 30 waiver has brought medical care to tens of millions of Americans in medically underserved areas. But it still falls short. Under the terms of the program, each state is only allowed 30 physician waivers per year. So sometimes, even though qualified international doctors are willing to work in these areas, they are denied a position. This recently happened to one of Kansara’s colleagues, an internal medicine doctor, because the state where she wanted to work had already awarded its 30 spots. “If your state is underserved, why do you want to cap it?” she says.
Kansara would like to see immigration reform to allow more qualified, foreign-born doctors to work with these underserved populations. “I’m hoping they can make the whole process easier, faster, and less expensive,” she says. Without such changes, the constraints of existing policy “could put pressure on international medical school graduates and make them reconsider whether they want to serve the patient population in the U.S. We’d miss out on this population of professionals who care about giving back to the patients and, in turn, to the community.”