This section contributed by Robert Aronson, Immigration Attorney
Unquestionably, physician recruitment into rural or underserved areas is a daunting task, particularly given the existence of alternative and seemingly more attractive employment options elsewhere for physicians. However, our immigration laws can serve to induce International Medical Graduates (IMGs) and, in particular, J-1 physicians to commit to rural and underserved placements, essentially given a tradeoff between serving in hard-to-fill placements with substantial and meaningful immigration benefits.
In short, our immigration laws can, in essence, channel highly qualified IMGs into rural and medically underserved placements precisely owing to the possibility of gaining long-term immigration status in this country.
Here is how this whole recruitment process intertwines with immigration benefits.
Many IMGs come to the United States to undertake their medical residency or fellowship training programs under J-1 visas. This visa status restricts an IMG solely to working as a medical trainee. In addition, their J-1 status requires them to return to their home country for two years at the conclusion of their program of Graduate Medical Education
(GME). As long as a J-1 physician remains subject to the two-year home residence obligation, they are effectively foreclosed from gaining long-term immigration status in the United States.
Therefore, the first objective of a J-1 physician wanting to remain in this country is to get a waiver of this two-year home residence obligation and here is where our immigration laws not only assist in the recruitment of IMGs to rural and medically underserved communities, but actually give qualified employers a major recruitment advantage.
In light of the national importance of getting physicians to commit to rural and medically underserved communities, U.S. immigration laws have created a waiver program, known as the Conrad State 30 Waiver Program. Here, each state is granted 30 waivers for physicians who will be providing primary care or specialty care medical services either in designated medically underserved areas or, in certain situations, in positions where the physician will be providing critically-needed safety net services.
The employing institution needs to file a J-1 waiver application to the state department of health, checking first to understand the state’s waiver policies and procedures. But if the state of intended employment issues a favorable waiver recommendation to the federal oversight agencies, the J-1 physician is well underway to removing a substantial barrier to his/her long-term residence in the United States.
But the waiver is not enough. Rather, once the waiver has been obtained, the employer then needs to sponsor the IMG for a change from J-1 into H-1B Temporary Worker status – that is, change the IMG into an employmentauthorized visa status.
This whole immigration process does not only provide a pathway to eliminate the IMG’s obligation to return to the home country, but it also builds in a retention element, given that the IMG is legally obligated to work for the J-1 sponsor for, at minimum, three years. In addition, an employer can creatively collaborate with the IMG to extend this employment commitment for additional periods of time by undertaking sponsorship for permanent residence.
But what is important to note is the following:
- The prospect of getting a J-1 waiver and then H-1B visa status can and should be an important advantage in recruiting into rural and medically underserved areas;
- Our immigration laws further contain retention provisions that obligate an IMG to remain for stipulated periods of time with the J-1 sponsor;
- Given the immigration benefits arising from the J-1 waiver process, rural and medically underserved communities oftentimes can recruit extremely qualified IMGs who possess key professional skills of great value to the community;
- This whole process requires advance planning and open communication, but over the past 20 years, it has been utilized to steer literally thousands of J-1 physicians into placements in rural and medically underserved placements.