WHITEFIELD, N.H. – Tears are flowing at the Ammonoosuc Community Health Center, but they have nothing to do with injections or ingesting vile tasting medicines.

Instead, patients are struggling with the departure of their beloved doctor, who is leaving next month to pursue a research fellowship in Boston.

“We have crying sessions every day,” says Dr. Shadan Mansoor, a Pakistani-born oncologist and hematologist who has spent the last three years shuttling among four rural health clinics where patients have little or no health insurance.

“I never felt any form of discrimination,” Mansoor said. “The warmth and love of the people in northern New Hampshire is something I’ll never forget.”

But while Mansoor’s patients gave her a warm welcome, the federal government is giving the cold shoulder to other doctors like her who work in northern New England, including Maine.

The U.S. Department of Agriculture is deciding whether to stop recommending foreign doctors for extended stays in the United States if they work in hospitals and clinics where doctors are in short supply.

Most, if not all, of the two dozen foreign doctors working in northern New England were recommended by state governments rather than the Agriculture Department. But many worry that security concerns about the federal program will undercut support from the states, too.

Officials in Maine, Vermont and New Hampshire insist they are committed to the program.

“We consider it to be very important,” said Bryan Ayars of the New Hampshire Office of Health Management. “It’s one more way to provide better access to health care.”

In most cases, foreigners who study medicine in the United States must return home for two years when they complete their training. However, the U.S. Immigration and Naturalization Service can waive the requirement if another government agency recommends the doctor for a position in a needy area.

The Agriculture Department was the lead player, but said after the Sept. 11 terrorist attacks that it was returning all pending applications. Some of the physicians it had recommended turned up on government watch lists, and the department had concerns about screening future applicants.

Protests prompted the department to say it will reconsider, but Mansoor and the region’s other foreign doctors already were alarmed.

“I think they overreacted,” Mansoor said. “To be treated like a possible criminal or terrorist hurts me.”

A foreign doctor in Eastport, Maine, agrees.

Dr. Shahid Mansoor, who is not related to Shadan Mansoor, calls the department’s initial decision extreme. He questioned whether a would-be terrorist would go through the trouble of a medical residency just to stay in the United States.

“You work 120 hours a week, you don’t eat, you don’t sleep. I don’t think a terrorist would take that,” he said. “It’s a real stretch.”

Shahid Mansoor, a nephrologist from Pakistan, has worked at Eastport Health Care for four years. If plans to open a kidney dialysis center succeed, he intends to make Maine his permanent home.

Without the waiver program, rural communities such as Eastport tend to attract young doctors who stay just long enough to pay off their medical school loans, he said.

“They are set on moving out, and these rural populations suffer,” he said.

Charles Wellman, director of the Maine clinic, says some of his patients travel more than 100 miles for treatment.

“It’s very difficult, where I am, to recruit doctors,” Wellman said. “We’ve had physicians shortages as long as I’ve been here – eight years – and before that, and just continuous turnover.”

When he heard about the department’s decision, Wellman immediately called his regional contact with the waiver program.

“I understand we have a terrorist problem, and I understand if the INS has to be a little more conservative or careful in how to screen people, but if they close that program down, we’re really going to feel it,” he said.

States can recommend 20 physicians a year for waivers. Because none of the northern New England states ever fills its 20 slots, there has been no need to ask the Agriculture Department for more.

New Hampshire typically hires eight or nine foreign doctors each year, said Stephanie Pagliuca, a program manager at the Bi-State Primary Care Association, a nonprofit that recruits doctors for New Hampshire and Vermont.

Some applicants are put off by how rural the state is, said Ayars, who coordinates New Hampshire’s program. “More urban states go through their 20 positions within six weeks,” he said.

Shadan Mansoor’s positive experience notwithstanding, the state’s lack of ethnic diversity also is a drawback, he said.

“Communities tend to be very welcoming, but it tends to be difficult because there’s no support system,” he said.

Maine hospitals and clinics hire about 10 foreign doctors a year, all of whom have expressed interest in the state.

“We process the applications that come to us, but we don’t go out and promote the program,” said Sophie Glidden, director of the state Office of Primary Care. “We don’t go out and do the work of headhunters.”

Vermont never has hired more than three doctors a year through the program. Craig Stevens at the Vermont Recruitment Center said one reason is that few areas of the state are designated as underserved.

He also said the state has made rural health care such a priority that it doesn’t need many foreign physicians.

“We’re not a wealthy state, but we put a lot of resources into health care,” he said.

Despite the concerns raised by the Agriculture Department, neither Stevens nor his counterparts in the other two states has heard any talk of dropping the program at the state level.

Glidden is confident the voluminous paperwork in Maine’s application process would expose frauds.

“Obviously, it’s something that a very intelligent person could come up with, but I think we have a pretty standard process of making sure they are who they say they are,” she said.

But Stevens said he wouldn’t be surprised if states eventually reevaluate the program in light of security issues.

Given the federal debate, “it’s only a matter of time before it’s a discussion at the state level,” he said.

Sid Tole, president of Vermont’s most rural hospital, hopes if that discussion happens, his voice will be heard.

North Country Hospital, eight miles from the Canadian border in Newport, employs two doctors through the waiver program: a neurologist from Pakistan and an internist from Hungary.

“I’ve never seen a more complicated process, but it does work, and it does allow us to get the physicians we need,” he said.

As passionate as she is about her patients, Shadan Mansoor believes more is at stake than their care.

“America is a land of foreigners, of immigrants. That’s its strength,” she said. “If we start closing up our borders, then we will not be the great America we are.”