Mar, 2014

J-1 Waiver Physician Options

International Medical Graduates (IMGs) are physicians that have graduated medical school from a medical school located outside of the United States. These physicians who come to the United States for residency, many times they are required to obtain a J-1 visa in order to complete medical residency in the United States. When a J-1 physician completes their residency program, they are subject to a two-year foreign residency requirement.

Three main options are available to IMGs who wish to remain in the United States and waive the two-year home residency requirement:

  1. The IMG can apply for and obtain a persecution waiver – the IMG must demonstrate that he/she cannot return to their country of nationality or last residence due to persecution based on race, religion or political opinion.
  2. The IMG can apply for and obtain a hardship waiver – the IMG must demonstrate that returning to his/her country of nationality or last residence would result in ‘exceptional hardship’ to the IMG’s U.S. citizen or permanent resident spouse or child/children.
  3. The IMG can become sponsored by an interested governmental agency.

Since options A and B above vary and are generally more difficult to obtain, we will explain the process of obtaining a J-1 waiver based on option C. Please contact our office to discuss options the persecution waiver or the hardship waiver.

Interested Governmental Agencies (IGA) that will sponsor a J-1 visa waiver include the following agencies:

1. Conrad 30 Program (State Departments of Public Health)

Requirements: IMG must work for an employer that is located in a medically underserved area (MUA)/population (MUP) or a health professional shortage area (HPSA) for three years full-time.

The IMG and facility will have to put forward various pieces of documentation to establish that they are eligible for the Conrad waiver. Each state varies and has different application requirements. It should be noted that since 2002 each state is allowed to sponsor 30 physicians per year for J waivers. Additionally, there are waivers available for physicians who will provide healthcare to patients located in a MUA/MUP/HPSA but the facility is located outside of these areas – this is generally known as a Conrad Flex Waiver. Physicians who are specialists are allowed to apply for the Conrad waiver, however it should be noted that many states’ goal is to sponsor primary care physicians first then turn their attention to specialists. Each state varies so please contact my office to discuss your options.

If an IMG has received a H-1B, they are not subject to the annual H-1B numerical cap for as long as they maintain valid H-1B status. This includes the remaining time after they have completed their J-1 waiver requirements.

2. Delta Regional Authority (DRA)

This type of waiver only applies to employers located in the following states: Alabama, Arkansas, Illinois, Mississippi, Missouri, Kentucky, Louisiana and Tennessee.

The physicians must provide primary care in their specialty fields for at least 40 hours a week. The Delta Doctors program also accepts waiver requests for medical specialists. Physicians must provide care to the indigent, Medicaid recipients, and Medicare recipients.

Please note that there is a $3,000.00 application fee for this waiver. DRA will make a recommendation on the J-1 Visa Waiver application within 60 days of the receipt of a complete application. If approved, the DRA will forward the application to the U.S. Department of State. The time period may be extended to allow for additional investigation. There is no annual limit or cap like there is for the Conrad 30 program.

More information on the application and guidelines can be found here: http://dra.gov/initiatives/promoting-a-healthy-delta/delta-doctors/

3. Appalachian Regional Commission (ARC)

This type of waiver only applies to employers located in the following states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia.
It should be noted that the ARC waiver requires a written recommendation from the governor of the sponsoring state (listed above).
The physician must agree to provide primary medical care for at least forty (40) hours a week at a site in a Health Professional Shortage Area, as designated by the United States Public Health Service, within the legislatively defined Appalachian Regional Commission service area for a minimum of three years or longer, as a specific state policy may require. Travel or on-call time may not be included in the 40 hours required by this paragraph. However, in appropriate cases the state may make exceptions to allow travel or on-call time for obstetricians.

All requests approved initially by the federal co-chair and approved subsequently by the United States Citizenship and Immigration Services of the United States Department of Homeland Security will be subject to review by ARC’s inspector general for compliance with this policy statement and other applicable laws.

For a full list of requirements, please visit the ARC website located here: https://www.arc.gov/program_areas/ARCARCFederalCoChairsJ1VisaWaiverPolicy.asp

4. Veterans Administration (VA)

The VA will sponsor physicians in teaching, research and patient care – physician specialty is not relevant for a VA waiver. The physician must contact the VA directly for open positions through their human resources division and currently most VA hospitals/locations do not work with physician recruiters.

General VHA requirements for a waiver of the home residency requirement for physicians providing patient care include a 3-year employment commitment and evidence that the facility has engaged in a comprehensive recruitment effort and has given genuine consideration to all citizen, permanent resident, and non-immigrant applicants. The J-1 waiver process is considered the last available option when no other citizen or employable non-citizen candidates (e.g., permanent resident, H-1B, O-1) are available after robust recruitment. Waiver requests are approved only when a comprehensive recruitment effort has failed to produce a minimally qualified citizen or permanent resident candidate for a critical position.

There are several other requirements needed such as a recruitment process and the VA facility must contact the VA’s Chief Medical Director to sponsor the IMG for a waiver for the specific facility.
Please contact our office to discuss what other requirements are needed to obtain this waiver.

5. Department of Health and Human Services (HHS)

Only available for primary care physicians (clinical care) and research physicians. HHS submits its recommendation to approve a waiver request to the Department of State (DoS). DoS submits its approval recommendation to the U.S. Citizens and Immigration Service (USCIS). USCIS is the agency authorized to grant a waiver, officially.
HHS will only process an application for waiver from a facility in or with a health professional shortage area (HPSA) score of 07 or higher. Furthermore, a facility in a HPSA that scores 07 or higher must be one of the following:

  • A health center as defined under Section 330 of the Public Health Service Act, and which is receiving a grant from the U.S. Health Resources and Services Administration under this section;
  • A rural health clinic as defined under Sections 1102 and 1871 of the Social Security Act; or
  • A Native American/Alaskan Native tribal medical facility as defined by the Indian Self-Determination and Education Assistance Act (P.L. 93-638).
    These are the only facilities from which HHS will accept an application. There is no annual cap for these types of waivers.

For more information on HHS waivers, please visit the HHS website here: https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/visitor-exchange-program/requirements-for-waiver-for-clinical-care.html

Other Pertinent Information/Quick Facts:

  • A physician is permitted to only apply for one IGA at a time, but can apply for one IGA waiver and one hardship waiver concurrently.
  • Other options include O-1 visas if no J-1 waiver options available.
  • TN visas available for Mexican/Canadian Nationals – non-clinical jobs only.

Please Note: These are general guidelines and situations. Some situations for employers or physicians may differ.


Physicians can qualify for an H-1B visa under two scenarios:

  1. They are invited by a public or nonprofit private educational or research institution or agency in the US to teach and/or conduct research at or for the institution or agency (incidental patient care is permitted); OR
  2. They have passed Parts I, II and III of the National Board of Medical Examiners (NBME) examination, Steps I, II and III of the US Medical Licensing Exam (USMLE), or FLEX . All foreign physicians are required to pass one of these exams in addition to any state licensing exam. Foreign graduates of approved medical schools in the US or Canada are exempt from taking these exams.

Doctors of national or international reputation are exempt from the above requirements.

Further information:
Educational Commission for Foreign Medical Graduates
3624 Market Street
Philadelphia, PA 19104-2685
Tel: (215) 386-5900
Fax: (215) 387-9963
Website: www.ecfmg.org


Nurses can qualify for H-1B visas if the position requires a four-year nursing degree. Many nurses file directly for permanent residence. Since nursing is a designated shortage occupation, nurses may file directly for Green Card without undergoing the usual labor certification process.

The prospective employer may file an immigrant visa petition and Labor Certification Application directly with the Immigration Service together with a copy of the applicant’s nursing diploma or degree; nursing license; a certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS); NCLEX-RN exam letter or a license from the state where the nurse will work. A VisaScreen Certificate is required when the adjustment application is filed or for the final interview at the U.S. Consulate.