Generally, J-1 physicians are required to return home and use their skills in their home country for at least two years before they can return to the U.S. This requirement is outlined in the exchange visitor visa rule and is mandatory for J-1 visa holders who have obtained medical training or education during their stay in the United States. The two-year home-country presence requirement is backed by the Immigration Nationality Act, section 212(e).
However, in some situations, this requirement can be waived for some J-1 physicians if they meet certain criteria for the waiver. If you apply for and obtain a J-1 waiver, you would be eligible to continue living and working in the U.S. immediately after your program without having to return to your home country first.
How to Get a J-1 Visa Waiver for Physicians
There are five bases under which a J-1 exchange visitor can apply for a waiver of the two-year home-country presence requirement. You will need to qualify for at least one of those bases and apply accordingly. Each of them has its own application process and requirements. They are:
- Exceptional Hardship: This means you have proof that, if you leave the U.S. to fulfill the requirement in your home country, your spouse or child who is a U.S. citizen or lawful permanent resident may face an exceptional hardship due to your absence.
- Persecution: This means you have proof that you may face persecution based on your race, religion, or political views by some individuals or organizations in your home country.
- Request by an Interested U.S. Federal Government Agency: This means there is a federal government agency that is interested in your medical skills in the U.S., and your absence from the U.S. may affect their project or research.
- Request by a Designated State Public Health Department or its Equivalent: This means there is a medically underserved area in the U.S. where your service is needed.
While a physician can qualify for a J-1 waiver under any of those bases, the last two bases are the most common ones granted to physicians.
Medical Programs For J-1 Physicians Seeking Waivers
- The Conrad-30 program: the largest program available for J-1 applicants. Each state is allotted 30 waivers a year.
- The U.S. Department of Health and Human Services (HHS) arranges the health, research, and clinical aspects of the J-1 visa program. There are two possible waivers: if research of significant interest to an agency is conducted, or if there is a demand for health care services (for the specific skills possessed by the J-1 visa holder) in a designated area.
- The Appalachian Regional Commission (ARC) is available in 13 states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia.
- Delta Regional Authority: is available in 8 states: Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee.
- Veterans Affairs (VA): granted in cases of overwhelming need when efforts to attract applications from United States (U.S.) citizens and permanent residents of the U.S. have failed to produce qualified candidates.
- Southeast Crescent Regional Commission (SCRC): Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and all of Florida
- NBRC J-1 Visa Waiver Program: requires medical licensure in ME, NH, NY, or VT
J-1 Visa Waiver Physicians Requirements:
- The J-1 physician is obligated to work full-time on an H-1B nonimmigrant status. The doctor is expected to be employed at a health care facility in an area designated by the U.S. Department of Health and Human Services. The designated field of employment shall be experiencing a need for health care professionals.
- The doctor must receive a contract from an approved health care facility. The health care facility is required to be categorized as a Professional Shortage Area, Medically Underserved Area, or Medically Underserved Population.
- The doctor is obligated to receive a “no objection” letter from the government of his/her home country. (Applicable only if the government is financially supporting the J-1 vsa holder)
- The doctor must consent to begin employment with the health care facility within 90 days of receipt of the two-year waiver. The initial day of employment cannot start on the expiration of the J-1 visa.
What is the Conrad 30 Waiver Program?
The Conrad 30 Waiver Program began in 1994 through Public Law aimed at addressing physician shortages. It is named after a former North Dakota Senator, Kent Conrad, who sponsored the bill.
The program allows each U.S. state department to seek J-1 visa waivers for up to 30 foreign exchange visitor physicians per year. To qualify for the waiver under this program as a physician, you must be willing to work in federally designated “Health Professional Shortage Areas” or “Medically Underserved Areas.”
You must also agree to provide safety-net healthcare services for the medically underserved and indigent in those areas for at least three years. Under the program, a state can assign up to 10 of its 30 waiver slots to locations outside the designated areas if the employer can prove that the J-1 physician will provide care to patients residing in shortage areas. This arrangement is known as FLEX 10 and is administered at each state’s discretion.
Where to Find J-1 Waiver Jobs for Physicians?
- 3RNET specializes in employment in underserved and rural areas.
- Find a Health Center supports physicians find FQHCs, community health centers, and HPSAs
- National Health Service Corps (NHSC)
Supporting Documents for a J-1 Physician Waiver
After submitting the main waiver application to the Department of State (DOS), other supporting documents may be submitted on your behalf by the concerned third-party organization. The specific basis under which you are applying for a waiver will determine the specific documents to submit and the third-party organization to submit them. The following are the possible bases and the organization to involve:
- Signed full-time employment contract (40 hours per week) for at least three years as a direct-care physician in the designated health care facility
- A letter of request signed by the head of the agency sponsoring you. The letter must indicate the importance of waiving the home-country presence requirement.
- Your resume
- A signed statement that includes the date serving as certification and declaration that you have the cooperation of the sponsoring agency, submitting your request, and you do not have any pending requests to another government agency
- Proof that the designated facility is in a medically underserved area. This must include a letter signed by the director of the medical facility and should indicate that its medical care is available to uninsured patients who receive Medicare and Medicaid. In addition, the statement may also include the facility’s past recruitment efforts, which necessitate the request for a foreign J-1 physician. A good example is if the facility had attempted to secure the employment of a qualified U.S. worker in the past, and proof of that can be included in the statement.
NOTE: Due to the different requirements of each state, it is important for each sponsoring employer to consult their state’s Primary Care Office (PCO) to obtain details of the exact information needed for the request.
How to Apply for The Conrad 30 Waiver Program?
- Find and secure sponsorship from a state health department. Because these waivers are competitive with only 30 available to each state, it’s important to have all paperwork prepared well in advance of the open date, which is October 1st of each federal fiscal year.
- Complete Form DS-3035 and the J-1 Visa Waiver Review Application
- The accepted state health department is required to send the waiver application to the Department of State Waiver Review Division. Submission to the division is mandatory for a recommendation.
Costs for the J-1 Waiver for Physicians
There is a US $120.00 non-refundable processing fee for a DS-3035 Application for Recommendation of a J-1 Waiver of the two-year home-country physical presence requirement.
You must submit a check or money order payable to the U.S. Department of State. It must include the following:
- Your waiver case number
- Your full name
- Your date and place of birth
J-1 Waiver for Physicians – International Medical Graduates
International Medical Graduates, also referred to as IMGs, have faced added challenges in securing many benefits deemed by the United States immigration laws and codes, despite having the fulfilled medical residencies within the country.
Since the early 90s, there has been a big push on the part of hospitals, federal/state agencies and independent groups to begin issuing temporary work visas and permanent residence to international medical graduates. What’s more, more and more programs have opted to issue temporary visas, H-1B visas, to IMGs rather than the traditional J-1 waivers for doctors (J-1 visas).
What separates J-1 visas from H-1B visas? H-1B visas allow IMGs to circumvent the law, which requires individuals on J-1 visas to fulfill the two-year physical presence requirement in their home country after finishing their medical residency and/or fellowship in the United States.
IMG Requirements – J-1 Waiver for Physicians
States around the U.S. require that International Medical Graduates successfully pass tests and fulfill a medical residency program prior to being issued a license. However, since it is required for IMGs to obtain J-1 visas to fulfill a medical residency and/or fellowship in the U.S., they are subject to the 2-year foreign residency requirement. They can, however, obtain J-1 waivers for doctors by demonstrating that they would be:
- a) Subject to persecution on the basis of race, religion or political opinion
- b) Can demonstrate that by returning to their home country it would end in “exceptional hardship” to their spouse or children who are U.S. citizens or permanent residents
- c) If they (the IMG) is sponsored by an “interested governmental agency”.
Federal Organizations that Can Recommend a J-1 Visa Waiver
Generally, a J-1 visa waiver can be recommended by any U.S. federal government agency. However, when it comes to the J-1 waiver for physicians, only a few agencies are given that responsibility. They are:
- U.S. Department of Veterans Affairs (VA)
- U.S. Department of Health and Human Services (HHS), Office of Global Affairs (OGA)
However, for some agencies, obtaining a recommendation from the HHS can be an option if they meet the Health Professional Shortage Areas (HPSA) score of seven or greater. Examples include Rural Health Clinics (RHCs), Federally Qualified Health Center (FQHCs), and American Indian/Alaskan Native tribal medical facilities as defined by the Indian Self-Determination and Education Assistance Act.
Apart from those, there are also two regional commissions that operate as federal-state partnerships that can recommend J-1 visa waivers. These two agencies only recommend waivers for physicians working within their geographic jurisdiction. They are:
- Delta Regional Authority (DRA)
- Appalachian Regional Commission (ARC)
Sponsoring Agencies for IMGS
Based on the original laws, only agencies of the federal government were permitted to sponsor IMGs for waivers from the 2-year home requirement. Due to such strong opposition, the new law was enacted in the mid-90s which allowed state departments of public health to sponsor international medical graduates on J-1 waivers.
When it comes to a J-1 waiver for physicians, the process can be quite cumbersome. Read these J-1 Visa Waiver: 50 frequently asked questions to learn more.
How to Improve Your Chances of Getting a J-1 Visa Waiver for Physicians
If you would like the home-country presence requirement waived after your medical training or education, the best thing is to start working toward it while the program is still in progress. Your performance and dedication during the program can distinguish you from other waiver applicants.
For example, the more critical role you play during the program, the higher your chances will be of getting your program sponsor’s support when applying for a waiver. For instance, if you make a major contribution to ongoing medical research, patents, publications, and other important projects, this will likely give you a better chance of getting compelling recommendation letters that may play a big role in your waiver application.
In addition, if you are significantly involved in a project and your return to your home country may affect the project, your employer may use this as proof to support your waiver application.