J Waivers for Physicians

Nearly all physicians who come to the United States on a J-1 visa to pursue graduate medical training or education, are subject to the two-year home residency requirement. This means, that at the conclusion of their J-1 program, they must either return to their home country for at least two years, or receive a waiver before they may change their status to certain visa classifications or apply for a green card.

Under United States immigration law, physicians can apply to waive the two-year home residency requirement in three circumstances:

1. The physician can demonstrate that they will be persecuted in their home country on account of their race, religion, or political opinion (click here for more info);
2. The physician can demonstrate that being forced to leave the United States for two years would cause exceptional hardship to a United States citizen or lawful permanent resident spouse or child (click here for more info); or
3. Based on the recommendation of an Interested Government Agency.

Interested Government Agencies

1. State Department of Public Health (Conrad 30 Waiver Program)

The Conrad 30 Waiver Program, allows states to sponsor 30 physicians each year for waivers of the two-year foreign residency requirement (“Conrad Waiver”). According to federal regulations, in order to receive a Conrad Waiver, a physician must:

• Receive a letter from the state department of public health where the physician will be employed, stating that it will be in the public interest to grant them a Conrad Waiver;
• Agree to be employed full-time for a period of three years in a facility located in a designated underserved area;
• Obtain a contract for full-time employment for a period of three years at a facility located in a designated underserved area;
• Obtain a “no objection” statement from the physician’s home country if the home country’s government funded the exchange program; and
• The physician must agree to begin employment within 90 days of being granted the Conrad Waiver.

Each state’s department of health has developed its own rules and guidelines for determining who it sponsors for Conrad 30 Waivers. The rules and guidelines vary widely from state to state.

2. United States Department of Health and Human Services

The United States Department of Health and Human Services (“HHS”) sponsors a limited number of physicians for waivers of the two-year home residency requirement. In order to receive a waiver recommendation from HHS, a physician must agree to practice primary care or general psychiatry for a period of three years in an area designated as a Health Professional Shortage Area by HHS.

3. United States Veterans Administration

The United States Veterans Administration (“VA”) sponsors physicians working for the VA for waivers of the two-year home residency requirement. Unlike HHS, the VA sponsors both primary care physicians and specialist physicians. In order to be eligible for a waiver, the physician must obtain a three-year contract to work at a VA facility in a clinical position. In addition, the applicant will have to show: (1) the loss of the physician’s services would necessitate the discontinuance of a VA program, or a major phase of it; and (2) the VA has undertaken recruitment efforts that have failed to locate a United States based physician to fill the position.

4. The Appalachian Regional Commission

Physicians practicing in certain states can seek a waiver recommendation from the Appalachian Regional Commission (“ARC”). ARC is made up of 13 states, Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia.

ARC will only issue a waiver recommendation if the following eligibility guidelines are met:

• The physician agrees to provide primary medical care for at least forty hours a week at a site in a Health Professional Shortage Area in one of the ARC states;
• The physician’s employer demonstrates that it has made a reasonable good faith effort to recruit a United States based physician for the job opportunity at the same salary during the six-month period prior to the waiver request;
• The physician must sign at least a two-year employment contract with their employer. The contract must not include a non-compete clause or a restrictive covenant which prevents or discourages the physician from practicing in a Health Professional Shortage Area at the conclusion of their contract;
• Prior to the commencement of their employment, the physician must be licensed in the state where they will practice;
• Prior to the commencement of their employment, the physician must have completed a residency in one of the following specialties: family practice, general pediatrics, obstetrics, general internal medicine, or psychiatry;
• At the time they apply for a waiver, the physician must not have been out of status for more than 180 days since receiving a visa; and
• The facility or practice sponsoring the physician must agree to provide health services to individuals without discriminating against them because: they are unable to pay for those services, or payment will be made under Medicare or Medicaid.

5. The Delta Regional Authority

The Delta Regional Authority (“DRA”) is a region of 252 counties located in eight states: Alabama, Arkansas, Illinois, Mississippi, Missouri, Kentucky, Louisiana, and Tennessee. The DRA will sponsor waivers of the two-year home residence requirement for physicians who agree to work at least 40 hours a week for three years at a facility in the DRA. The facility must also be located in either a Health Professional Shortage Area, a Medically Underserved Area, or a Mental Health Professional Shortage Area (in the case of a psychiatrist). Similar to physicians seeking a waiver recommendation from ARC, the physician’s employer must have actively attempted to recruit a United States based physician during the six months’ prior to sponsoring the physician for a waiver. In addition, the employer must agree to accept Medicare and Medicaid patients, and must provide services on a sliding fee scale to uninsured and low-income individuals.

Contact an Experienced Immigration Lawyer Today

If you are a physician or an employer looking to learn more about how Hartzman Law Firm can help you with a J Waiver, please contact us at (412) 495-9849 or fill out a contact form online. Our principal attorney, Daniel Hartzman has provided legal representation to countless individuals seeking J waivers and is well versed in the J waiver process.

We offer free consultations in person, by phone, and by secure video conferencing. Weekend consultations are also available by request.

Call us! We are here to help you!