Why is a 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.
Steps to the J-1 Waiver Process
A physician must secure a bona fide offer of employment from an eligible employer that will sponsor an International Medical Graduate (IMG) for a J-1 waiver and a change into H-1B status. Depending on the state, a provider may also need a state license prior to applying for the waiver. Note: some state’s licensing process can take a long time so they may grant a waiver while the license is processing so as to not slow everything down.
IMG must apply for case number from the U.S. Department of State. https://j1visawaiverrecommendation.state.gov/
The health care facility applies for a J-1 waiver from the state department of health.
The state department of health (different in each state) sets guidelines that must be met to show that the physician will enhance health care access in medically underserved areas of the state. Processing time may vary by state department of health. Contact your state PCO to find out their processing time.
U.S. Department of State reviews the J-1 waiver application and decides whether to recommend the waiver be granted (4-6 weeks).
U.S. Citizenship and Immigration Services reviews J-1 waiver application and issues final approval (at least 2-6 weeks).
IMG receives the H-1B work visa after the J-1 visa waiver is approved by the U.S. Department of State.
IMG must begin work within 90 days of receiving J-1 waiver approval from USCIS.
Once You Find a Candidate You Want
A J-1 visa is specific to one employer (i.e. in most instances a candidate cannot moonlight). Ask an immigration attorney if you have questions!
The employee can sign an employment contract, but cannot work until they have the J-1 waiver and H-1B work visa.
Inquire as to whether the candidate has family that will also need assistance with the immigration process.
About the Conrad 30 Program
States can recommend 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. Consult with the Primary Care Office (PCO) regarding state specific details.
Some states allow up to 10 waivers to 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
HPSAs and Medically Underserved Areas (MUAs) are federal designations used to determine (among other things) where J-1 waivers are applicable.
Also see: https://data.hrsa.gov/ to determine if your facility is located in a designated shortage area.
Your state PCO will have further information regarding areas of need.
Potential State Variations
- Primary care vs. specialty care
- Application periods and filing deadlines
- Non-compete clauses
- Liquidated damages
- Filing fees
- Reporting requirements
- Mandatory period of service
- Eligible employer requirements
Other Agencies That Offer Waivers
United States Department of Health and Human Services (US DHHS) - Information about the program can be found here: https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/index.html
and specific clinical care requirements can be found here: https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/visitor-exchange-program/requirements-for-waiver-for-clinical-care.html
- Appalachian Regional Commission (ARC)
- Delta Regional Authority (DRA)