ImLaw Answers FAQs about the Most Common Interested Government Agency (IGA) Waivers for Physicians
The J-1 exchange visitor visa may be used to study, train, and work in the U.S. Certain J-1 exchange visitors are subject to a two-year home country residence requirement, which requires the J-1 visa holder and their J-2 dependents to return to their home country for an aggregate of two years following the J-1 program.
Notably, certain foreign physicians (also known as international medical graduates or IMGs) receiving graduate medical training in the U.S. are automatically subject to the two-year home residence requirement. Interested Government Agency (IGA) waivers of the two-year requirement may be available when a U.S. government agency finds the J-1’s departure from the U.S. would be harmful to the agency’s program.
For physicians, the most common IGA waiver is the J-1 Conrad 30 Waiver, which starts with an application to a state health department. A Conrad 30 waiver effectively waives the two-year home residence requirement if the IMGs agree to work full-time in a medically underserved area for a minimum three-year period. After receiving a J-1 Conrad 30 waiver, the IMG can apply for H-1B work visa status to work for the designated facility. Notably, physicians in this scenario are exempt from the H-1B cap, meaning they avoid the annual H-1B lottery altogether.
What is a J-1 Conrad 30 Waiver?
The J-1 Conrad 30 Waiver Program allows IMGs to apply for a waiver of the two-year home residence requirement. Under the Conrad 30 Program, each state may grant J-1 waivers to 30 physicians per year to work in medically underserved areas. In addition, most states are able to issue 10 of the 30 slots to physicians who will serve patients that reside in medically underserved areas.
What does it do?
The purpose of the Conrad 30 Waiver Program is to address the shortage of qualified doctors in medically underserved areas throughout the U.S. Obtaining a J-1 waiver approval allows employers to file for H-1B work visa status on behalf of the physicians, sparing them from having to return to their home country for the mandatory two-year period.
Who is eligible for what?
Most states reserve the majority of their 30 waiver slots for primary care physicians or psychiatrists. However, they may consider granting waiver slots to specialists as well. In most states, both primary care physicians and specialists are eligible for the two types of waivers: regular and FLEX Conrad 30 Waivers.
For a regular Conrad 30 Waiver, the physician must:
Serve in a Health Professional Shortage Area (HPSA) or, in some states, serve at a site located in a Medically Underserved Area (MUA) or Medically Underserved Population (MUP). Click here for more information about these designations in Michigan and at the federal level.
For a FLEX 10 Conrad Waiver, the physician must:
Serve populations residing in medically underserved areas, with the practice site not geographically located in a federally designated underserved area. States may have additional requirements to be eligible for this waiver, such as specifying the percentage of patients served who are from federally designated underserved areas.
Are there additional requirements?
The physician must:
Provide a signed contract of employment with the designated facility.
Commit to a minimum 3-year term of service.
Agree to begin employment within 90 days of receiving approval of the waiver and H-1B status by USCIS.
Agree to work for a minimum of 40 hours per week at the designated facility.
Provide proof of or eligibility for the required state licensure; proof of passage of USMLE (U.S. Medical Licensure Exam) steps 1, 2, and 3; and an updated resume
The employer must:
Provide documentation that the facility is located in an HPSA or MUA/MUP.
Offer and pay a base salary to the physician that is the higher of the U.S. Department of Labor’s prevailing wage or the actual wage paid to similarly situated physicians at the proposed place of employment.
Provide a summary of efforts to find and recruit U.S. physicians and/or evidence of same.
In certain states, the employer must demonstrate a shortage of physicians providing services in the specified underserved area.
How many waivers are available?
There are a total of 30 available Conrad Waivers per state, with up to 10 of these available for FLEX 10 Waivers. The available number of waivers per state is refreshed at the start of each fiscal year (October 1).
What does the process look like?
Conrad 30 Waivers: Click here to see our overview of the Conrad 30 Waiver process.
Other Interested Government Agency (IGA) Waivers: There are additional U.S. government agencies that routinely support requests for IGA J-1 waivers for physicians including, but not limited to, the U.S. Department of Health and Human Services (HHS). Like state Conrad 30 waivers, federal HHS (Health and Human Services) waivers are available to J-1 physicians who have agreed to provide health care services for a minimum 3-year period in a primary care- or mental health-designated Health Professional Shortage Area (HPSA). A key difference between the two waivers is that federal HHS waivers are not capped per year, unlike Conrad 30 state waivers, which are capped at a maximum of 30 per fiscal year. Additionally, while some healthcare organizations are eligible to file for either a state Conrad 30 waiver or a federal HHS waiver, Federally Qualified Health Centers (FQHCs) generally must apply for a federal waiver with HHS, as was the case for our client. More information on HHS J-1 waivers is available here.
The ImLaw team is able to assist physicians with J-1 Conrad 30 Waivers and other IGA Waivers. Get started by submitting our online inquiry form here.