3 Ways for Foreign-Born Physicians to File For a J-1 Waiver

Nearly 30% of physicians working in the United States were born abroad, and many of these doctors first came to the United States on a J-1 visa. A J-1 visa is a non-immigrant visa for research scholars, professors and other professionals participating in cultural exchange programs. J-1 visas are commonly sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG) to allow foreign-born physicians to complete their medical training in the United States for a period of up to seven years.

Because the J-1 visa is intended for cultural exchange rather than permanent immigration, most J-1 visa holders are subject to a “two-year home country physical presence requirement.” This requirement stipulates that J-1 visa holders return to their home country for a minimum of two years after completing their training before applying for another visa in the United States, such as a work visa. However, for physicians who wish to remain and work in the United States without first returning to their home country for two years, there are opportunities to obtain a J-1 waiver. 

A J-1 waiver allows physicians to bypass the two-year home country requirement if they agree to work in areas with underserved patient populations for a minimum three years. While this may sound straightforward, there are very specific practice requirements, application timelines, and sponsorship processes required to obtain a J-1 waiver. Moreover, a physician’s options for a obtaining J-1 waiver will depend on their specialty, practice preference, geography and personal circumstances.

Let’s explore the three most common ways for physicians to acquire a J-1 waiver: 

Conrad State 30 Waivers

The Conrad 30 State Program is one of the most desirable ways for a physician to obtain a J-1 waiver, notably because this sponsorship route is available to all specialties. The Conrad State 30 is a program sponsored by the public health department of each state to attract qualified physicians to work in underserved communities. Every year, each state offers 30 waiver slots to physicians who have secured contracts at an underserved practice in the state. 

Conrad 30 applications open on October 1st and close on March 31st. Applications are considered in the order in which they are received. While physicians of every specialty can apply to the Conrad 30 program, most states reserve a certain number of slots (usually 10-15) for physicians working in primary care practices, such as family medicine, internal medicine, and pediatrics. If the primary care spots are not all filled near the end of the application window, the state will allot the remaining openings to other specialties. Some applications may be reviewed and approved by state boards early, however many physicians must wait for a decision on their application until after the application window closes on March 31st. 

The degree of competition for Conrad 30 openings varies greatly from state to state. In the sought-after states such as New York and California, the available spots may fill up within thirty minutes of when the application portal opens on October 1st. Less populous states such as Montana or North Dakota may still have Conrad 30 spots available as late as February or March. If you plan to pursue a J-1 waiver through Conrad 30, particularly in a competitive state, it is important to start looking and interviewing for jobs as early as possible. Before you can apply for a waiver through Conrad 30, you must first have a signed contract with a qualifying employer, and the employer must submit paperwork verifying that your position meets the requirements for a J-1 waiver which can often take 2-4 weeks.  

A physician may only apply to the Conrad 30 program for one state a time. However, if you apply to one state and your application is rejected, you are then free to apply to a different state’s Conrad 30 program. 

Related: 3 Common Contract Issues that Green-Card Seeking Physicians Face

Health and Human Services Waivers

J-1 visa holders can also obtain a J-1 waiver at the request of an interested U.S. federal agency. For physicians, this interested agency is usually the Department of Health and Human Services (HHS). While the HHS offers more J-1 waivers than the Conrad-30, it is also more restrictive in several respects. First, only primary care specialists are eligible to file for a J-1 waiver through HHS. Furthermore, while the Conrad 30 may approve physicians working in any underserved practice, waivers through HHS require that physicians specifically work in a federally qualified health center (FQHC) or a rural health center (RHC).

If you plan to apply for a waiver through HHS, you must file your application within one year of completion of your residency. For physicians who plan to work immediately after finishing their residency, this requirement is typically not a problem. However, if you plan to complete a fellowship program after your residency, you may not graduate from your fellowship in time to begin your attending position and apply for a J-1 waiver. 

Persecution & Hardship Waivers

The remaining pathways to acquire a J-1 waiver are far more difficult and less common. To obtain a persecution or hardship-based waiver, a physician must demonstrate that returning to their country for two years would cause serious risk or hardship to either to themself or to a U.S citizen/resident family member, 

First, a physician may apply for a J-1 waiver on the grounds that they will face persecution upon return to their home country based on their race, religion, or political opinion. Alternatively, a physician can apply on the grounds of Exceptional Hardship. In this category, a physician must demonstrate that leaving the United States would cause extreme hardship to a spouse or child who is a U.S. citizen or lawful permanent resident. Note that mere separation from family does not meet the threshold for exceptional hardship. 

A physician of any specialty may file for a J-1 waiver recommendation on the grounds of persecution or exceptional hardship, however you cannot file for both simultaneously. If you believe your case meets the requirements for both persecution and extreme hardship, you can only apply for a recommendation under one of these bases. Once you submit Form I-612, Application for Waiver of the Foreign Residence Requirement, the U.S. Citizenship and Immigration Services (USCIS) will assess your case. Only if USCIS makes a finding of either persecution or exceptional hardship, the Waiver Review Division will proceed with the waiver recommendation. An immigration attorney can help you determine if you may qualify for a waiver on these grounds. 

Other Options:

For physicians who have signed a contract with a J-1 waiver eligible employer, but experienced a delay in waiver processing or missed the application cycles for a J-1 waiver, it may be possible to obtain an O-1 visa. O-1 visas function as a stop-gap to allow physicians to remain and work lawfully in the U.S. after their J-1 training visa expires and while their waiver processes. An O-1 visa should be viewed only as a last resort, as these visas are typically reserved for high-achieving doctors who can provide peer testaments to their outstanding contributions in the field of medicine. It requires considerable documentation and time to file an O-1 petition. However, if a physician is approved for an O-1 visa, it can allow them to begin working while they wait to apply for a J-1 waiver through Conrad 30 or HHS. Once the waiver is approved, they can apply for an H1-B employment visa.

To learn more about the J-1 waiver requirements and application process, schedule a talk with physician-specific advisors today.