J-1 Waivers for Physicians to Deliver Medical Services in Designated Underserved Areas or at VA Hospitals

Physicians who receive clinical medical residency training in the U.S. pursuant to a J-1 exchange visitor visa are required to return to their home country for two years before they are eligible to apply for an H-1B visa or permanent residency. J-1 visa physicians need not complete this two-year home requirement if they are approved for a waiver in the U.S.

Who qualifies

In order to qualify for a J-1 waiver through clinical practice through the Conrad “State 30” Program, the general rule is that the intended practice site be located in a federally designated shortage area, meaning a Mental Health or Primary Care Health Professional Shortage Area (HPSA) or a federally designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP). Both HPSA and MUA/MUP areas are designated by the U.S. Department of Health and Human Services, but the methods of determination differ. In addition, each state department of health has the option to sponsor up to ten J-1 waivers per year for physicians not working in medically underserved areas but who serve patients who reside in medically underserved areas, also known as “flex” waivers. The requirements for each state vary, so please contact one of our attorneys if you would like specific information regarding a particular state department of health’s J-1 waiver program.

In addition, there are currently four federal agencies that have initiated their own waiver programs. These include:

• Appalachian Regional Commission (ARC)
• Delta Regional Authority (DRA)
• Veterans Administration (VA)
• Health and Human Services (HHS)

The ARC and DHHS programs are limited to physicians who have completed residency training in a primary care field, which is generally defined as internal medicine, family practice, general practice, pediatrics, general psychiatry or obstetrics and gynecology, and the physician must agree to practice such primary care. In contrast, the VA and DRA may recommend waivers for physicians to practice a subspecialty to serve their waiver commitment. Each of these programs have specific requirements and some are only available to those practicing in certain states/geographical areas. In some cases, a particular practice site may present the option of multiple waiver programs through which to apply.

How to apply

Obtaining a J-1 waiver is a three-step process. The first step is to obtain a recommendation for a waiver from an interested government agency (IGA) or State Health Agency. This recommendation is then forwarded to the United States Department of State Waiver Review Division in Washington, D.C., which in turn issues its recommendation to the U.S. Citizenship and Immigration Services (USCIS), which provides approval of an Application to Waive Foreign Residence Requirements.

The significance of a USCIS approved Application to Waive Foreign Residence Requirements is limited to the waiver of the two-year home requirement. It does not, however, place the J-1 physician into a legal nonimmigrant status, nor does it imply authorization to work in the U.S. Therefore, it is imperative that the J-1 physician obtains H-1B approval as well. In order to remain in the United States and work at the waiver site, the employer must apply for an H-1B petition on behalf of the J-1 physician. An H-1B is a temporary work authorization specific to an employer.

A physician who received a waiver must remain in H-1B status for the sponsoring employer for a period of three years. A change of employment will only be considered if 'extenuating circumstances' beyond the physician’s control exist, and the request must be accompanied by a new H-1B petition.

Upon completion of the J-1 Visa waiver service obligation, the applicant will be eligible to obtain permanent resident status.