International medical graduates on J-1 visas have likely heard about the two-year home residency requirement, which can often feel like a hurdle to their future training. But for many physicians, the J-1 waiver is a strategic opportunity to continue practicing in the U.S. while serving in areas that need doctors the most.
In this post, we'll break down exactly what the J-1 waiver is, who it's for, what agencies are involved, and how physicians can use it to bypass the home residency requirement.
What is the J-1 waiver?
A J-1 visa permits noncitizens to come to the United States in an exchange program designated by the Department of State (DOS). TheJ-1 exchange visitor must enter the United States for the purpose of teaching, instructing, lecturing, studying, observing, conducting research, consulting, demonstrating special skills or receiving training.
Certain J-1 exchange visitors, including international medical graduates (IMGs), are required to return to their home country for two years after the completion of their exchange visitor program before they can apply for certain nonimmigrant visas (including the H-1B and B-1) or green card. That rule has the potential to create obstacles for physicians who want to continue living and working in the U.S.
However, certain exchange visitors are eligible to "waive" that requirement, and there are limited pathways to do so. For physicians, the J-1 waiver pursuant to Section 220 of Public Law 103-416 was created for the possibility of obtaining a physician-specific waiver, as well as address the shortage of medical professionals in rural and underserved areas.
This law specifically amended the two-year home residency requirement for international medical graduates, contingent upon the physician's agreement to work for at least three years in a medically underserved area. By working for at least three years in a qualifying health care facility, a J-1 physician can waive the two-year home residency requirement and continue their employment in the United States without having to return to their home country.
Most common paths to a J-1 waiver for physicians
The two physician-specific paths to a J-1 waiver are the Conrad 30 and Interested Government Agency (IGA) programs. To qualify for both the Conrad 30 and Interested Government Agency (IGA) Waiver programs, the physician must agree to work in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA).
To receive a waiver, physicians must first receive recommendation from the applicable state's health department or Interested Government Agency, as well as from the Department of State. Once both agencies forward their recommendations to U.S. Citizenship and Immigration Services (USCIS), the waiver can ultimately be approved (I-612 Approval) and the physician is then eligible to change nonimmigrant status.
The Conrad 30 Waiver Program
Each U.S. state receives 30 waiver slots per year for J-1 physicians willing to work in medically underserved areas, known as the "Conrad 30 Waiver." Some states also allocate up to 10 "flex spots" for physicians who will not be working in a medically underserved area.
Each state determines its own rules, procedures, and timelines for granting Conrad 30 Waivers.
Some states regularly distribute all of their 30 Conrad waivers per year, oftentimes with a waiting list, while other states have spots available throughout the fiscal year.
Some states prioritize primary care physicians for Conrad 30 waivers, but specialists can qualify, as well, especially in areas with unfilled slots. Some states review applications on a rolling basis, while others have a specific application period.
Interested Government Agency (IGA) Waivers
Interested Government Agency (IGA) Waivers require a U.S. government agency to recommend a waiver for a physician if they are actively and substantially involved in a program or activity sponsored by or of interest to such agency.
Some of the agencies included in the Federal program that sponsor IGA waivers for physicians are the:
- Appalachian Regional Commission
- Delta Regional Authority
- Department of Veterans Affairs
- DHHS
- Southeast Crescent Regional Commission
Each agency has its own guidelines for recommending an IGA waiver.
What positions are eligible for J-1 waivers?
In general, physician positions eligible for a J-1 waiver must:
- Be full-time clinical work, providing direct patient care
- Be physically serving patients in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA)
- Agree to a contract for at least three years
- Include support from the employer in the waiver application process
As mentioned above, each state and/or agency has its own requirements for positions to receive a J-1 waiver.
Common issues when applying
Even the most qualified J-1 physicians can see their waiver applications delayed or denied because of avoidable issues. Some missteps that could affect the J-1 waiver process include:
- Choosing a job without verifying it qualifies for a waiver: All hospitals are not designated under the Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) criteria, and the shortage designation may only apply to certain specialties. Additionally, some agencies will only accept HPSA designated worksites, whereas others will accept either HPSA or MUA.
- Waiting too long to start the process: Conrad 30 Waivers are usually capped at 30 per state per year, and some states fill up very quickly. Additionally, since several agencies are involved in the recommendation process before USCIS can ultimately approve the waiver, the waiver is subject to processing times at multiple agencies. With most physicians' residency programs (and thus J-1 programs) ending in June each year, the agencies tend to experience a higher volume of waiver applications in the spring, which may contribute to lengthier processing times and thus risk a timely start date. Initiating the waiver process before the end of the year (for those agencies that accept applications on a rolling basis) can help avoid or minimize such delays and risks.
- Employment Agreements: Each agency has its own requirements for provisions that must be included in the employment agreement, such as liquidated damages, no non-compete clauses, etc. It is important to ensure the employment agreement meets the applicable agency's requirements.
- Overlooking the H-1B transition: Even after a waiver is approved, physicians must change to H-1B status before their J-1 program (+30-day grace period) expires in order to have status and work beyond the end of the physician's J-1 program.
The J-1 waiver is a powerful tool to help physicians continue to live and work in the United States while serving Health Professional Shortage or Medically Underserved Areas.
Physicians who are interested in a J-1 waiver should contact immigration counsel to learn more about the process. An immigration attorney experienced in physician waivers can help:
- Select the right waiver path
- Review a job offer for compliance
- Prepare necessary documentation and petitions
- Guide employers through sponsorship, if needed
- Monitor status and develop a green card strategy
Further Reading
4 things to know about navigating visa sponsorship for hospitals, healthcare providers
ICE visits Q&A for healthcare employers, hospitals, and clinics
EB-2 physician green card pathways: PERM vs. the Physician National Interest Waiver (PNIW)
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
