The Conrad 30 J-1 Visa Waiver Program

Why is a J-1 Waiver Needed?

  • J-1 visa status authorizes an International Medical Graduate (IMG) to do Graduate Medical Education (GME) in the United States.
  • All J-1 clinical physicians – no exceptions – need to return for two years to their home countries following conclusion of GME.
  • Unless the two-year home residence obligation is waived, a J-1 physician is ineligible for an H-1B visa and/or permanent residence
  • Therefore, it is necessary to get a waiver of the two-year home residence obligation in order to get H-1B eligibility which, in turn, is the visa status that will enable an IMG to work as a physician in the United States.

The Conrad 30 Program

  • States can sponsor waivers in order to get physicians into hard-to-fill placements where they will be serving the medically undeserved. There has to be an element of expanding the safety net.
  • There are 30 waivers per year for each state. The waivers become available October 1. Some states fill all 30 slots very quickly (a few hours); others never fill all 30 slots. See how many waivers states have used in the past here.
    • If states fill quickly – you need to start this process with the goal of filing waiver early in waiver cycle (i.e., in or shortly after October)
    • Consult with the Primary Care Office (PCO) to determine the likely drawdown of J-1 waiver numbers– how many states fill their slots in 2014. 
    • Consult with PCO to determine how the state processes J-1 waivers (i.e., merit based; first in/first out; set application periods) 
  • Up to 10 waiver numbers can be used for non-medically underserved placements (Flex waivers).  The balance can only be used for placements in medically designated areas.
  • Whether the waiver is a Flex or normal waiver, the underlying goal is to show that the IMG will provide safety-net clinical services – i.e., serve the indigent and medically underserved and fill gaps in the medical delivery system.
  • If the J-1 waiver is granted, an IMG has a minimum three-year service obligation that needs to be fulfilled in H-1B status (could be more by state).

How States Determine Areas of Need

  • Medically Underserved Areas are defined as Health Professional Shortage Areas (HPSA) or Medically Underserved Areas/Populations (MUA/P). 
    • Health Professional Shortage Area (HPSA) – federal designation used to determine (among other things) where J-1 waivers are applicable.
    • Medically Underserved Areas (MUA) – another federal designation used by some states to determine (among other things) where J-1 waivers are applicable. 
    • HRSA's website will enable you to determine if a practice site is located in a designated shortage area by address.

Potential State Variations in the J-1 Visa Waiver Program

  • Primary care vs. specialty care – some states reserve their spots only for primary care; others allow some specialty care spots.
  • Application periods and filing deadlines
  • Non-compete clauses – some states mandate that there CANNOT be a non-compete clause in a contract for a physician seeking a J-1 waiver
  • Liquidated damages – if the physician departs prior to fulfilling their time commitment – they agree to a set sum that the physician has to pay
  • Filing fees
  • Reporting requirements
  • Mandatory period of service
  • Eligible employer requirements – a state could add to the federal requirements that outline which employers are eligible

Other Agencies that Offer Waivers


3RNET members Loan repayment programs Loan repayment programs J1 Visa waiver