J-1 Waiver Options for Physicians

The J-1 visa category for Alien Physicians allows foreign medical graduates to obtain residency training within the United States under the auspices of the Educational Commission on Foreign Medical Graduates, the sole J-1 program authorized by the U.S. Department of State to sponsor physicians engaged in clinical training programs in the United States.

The majority of international medical graduate (IMG) physicians who come to the United States for graduate medical education (GME) enter the US on a J-1 visa. Upon GME completion, J-1 medical residents must either return to their home countries for at least two years, or apply for and receive a waiver of that home residency requirement. This process is referred to as obtaining a “J-1 waiver.”

The Conrad 30 Program

The most common route to a J-1 waiver for IMG physicians is through the Conrad 30 program. Conrad 30 waivers are available to physicians who agree to work full-time for at least three years in a federally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA). The Department of Health in every state has the ability to grant 30 waiver slots each fiscal year to qualifying facilities. Each state has its own application process and eligibility criteria for the Conrad 30 program, but all states require at least a three-year commitment from the physician, and require the facility to be located in a HPSA or MUA.

For information about Conrad 30 J-1 visa requirements, see the Conrad 30 Map and click on a state for information about that state's Conrad 30 program.

Many Conrad 30 programs will accept up to 10 J-1 waiver applications from facilities that are outside geographic HPSA / MUAs in addition to J-1 waivers available to facilities in underserved areas. These are referred to as “FLEX” slots. The exact criteria for FLEX slots and their availability are state-specific, but non-HPSA / MUA facilities may be able to sponsor a J-1 candidate for a waiver by using a FLEX slot if the facility qualifies.

J-1 Waivers through Federal Agencies

In addition to the Conrad 30 program, there are also federal agencies that sponsor J-1 waivers. For example, the U.S. Department of Health and Human Services can sponsor J-1 waivers for physicians practicing primary care or general psychiatry in a HPSA or mental health HPSA. This program is a common default for facilities located in states that use up their Conrad 30 waiver slots within the first few weeks or months of the fiscal year. In addition, the Delta Regional Authority and Appalachian Regional Commission are two separate programs that cover many states in the southeast. Finally, there is a limited waiver category available to physicians who can demonstrate that a U.S. citizen or permanent resident spouse or child would suffer “extreme hardship” if the physician were required to fulfill the home residency requirement.

J-1 Waiver Applications

Once the determination has been made that the facility qualifies for a waiver program, the employer submits a request to the state health department or federal government agency on behalf of the physician. The physician cannot file on his or her own behalf. If the state health department or government agency agrees to recommend a waiver, it will forward its recommendation to the U.S. Department of State’s J-1 Waiver Review Office. Within approximately one to two months of receiving the interested government agency recommendation, the Department of State will send its recommendation to the U.S. Citizenship and Immigration Services (USCIS). The USCIS has the final authority to grant the J-1 waiver. At this point the physician is eligible to apply to change status to H-1B.

U.S. Immigration Assistance for International Medical Graduate Physicians

Read more here about immigration options for physicians. If you are an IMG physician or employer in need of assistance with immigration issues, we welcome you to contact an immigration attorney at Sivaraman Immigration Law to request a consultation.