Having quality physicians is essential to providing healthcare in rural communities, but there are certain
challenges in physician recruitment and retention in rural settings. In many cases, the ability of healthcare
facilities to remain open depends on having an adequate staff of physicians. Unfortunately, rural areas often
have difficulty recruiting and retaining physicians. Due to these challenges, many rural communities fill their
physician vacancies by recruiting International Medical Graduates (IMGs)* who have done their medical training
under the J-1 visa exchange visitor program.
The J-1 visa is a non-immigrant exchange visitor visa and is often used by IMGs pursuing a medical residency or
fellowship training in the United States. The J-1 visa allows holders to remain in the U.S., normally for up to
seven years, until they complete their Graduate Medical Education (GME). Upon completion, they are required
under U.S. immigration law to return to their home country for at least two years before gaining eligibility for
an H-1B visa to re-enter and work in the United States or for permanent residence.
Therefore, J-1 physicians have, in essence, two choices upon completing their GME: 1) they can return to their
home country for at least two years, or 2) they can obtain a waiver of this obligation. A J-1 visa waiver
eliminates the two-year home residency requirement and allows physicians to change into H-1B visa status that
will allow them to stay in the U.S. to practice in a federally designated primary care or mental health Health
Professional Shortage Area (HPSA), if recommended by an Interested Government Agency (IGA), a federal
designation. State government
agencies also recommend J-1 physician waivers through the Conrad
30 Waiver Program.
*International Medical Graduates are sometimes referred to as Foreign Medical Graduates (FMGs) by organizations
and federal agencies
Frequently Asked Questions
What is the Conrad 30 Waiver Program?
30 Waiver Program allows each state's health department to request J-1 visa waivers for up to 30 foreign
physicians per year. The physicians must agree to work in a federally designated Health Professional Shortage
Area (HPSA), Medically Underserved Area (MUA), or for a Medically Underserved Population (MUP), and provide
safety-net services for indigent or medically underserved people for at least three years, working specifically
in H-1B status. Up to 10 of a state's 30 annual waiver slots may be used for practices located outside
designated shortage areas if the employer can show that they provide services to patients who live in shortage
areas. These waivers are known as “flex” or “flex 10” waivers and are administered
according to the regulations
of individual states.
Documentation required by the U.S.
Citizenship and Immigration Services includes:
- A contract for full-time employment (40 hours per week) as a direct care physician at a facility in an area
designated as a Health Professional Shortage Area, Medically Underserved Area, or Medically Underserved
Population. However, some states may limit the type of shortage areas that qualify for sponsorship
- Commitment from the IMG to agree to begin employment within 90 days of waiver receipt
- Commitment to work for the J-1 sponsoring employer for three continuous years, specifically in H-1B
temporary worker status
- A letter of support from the authorized official requesting the physician's waiver recommendation. This
might be the governor or a designee, such as the state health director
- A no-objection letter from the foreign physician's home country if his or her exchange was funded by the
Interested parties should contact the Primary
Care Office (PCO) in the state of their intended employment for more information and exact requirements.
How has the COVID-19 pandemic affected physicians currently employed under J-1 visa waivers?
According to a policy
memorandum issued by the U.S. Citizenship and Immigration Services, IMGs are temporarily allowed to work
from home and provide telehealth services. This will not be considered a violation of his or her work
obligations until the end of the public health emergency. The employer, however, will still need to file the
proper notices to authorize these new work sites. The memorandum specifies that if an employer offers IMGs
employed by an Interested Government Agency (IGA) or through the Conrad State 30 program the flexibility to
telework from home, it must offer the same opportunity to its U.S. workers similarly employed.
Which federal organizations can recommend a J-1 visa waiver?
Any U.S. federal government agency may recommend a J-1 visa waiver, but physician waivers are most often handled
by the following agencies:
HHS will recommend waivers to primary care physicians working in geographic areas holding a HPSA score of 7 or
above. There is no limit on the number of recommendations HHS can issue.
Two regional commissions operating as federal-state partnerships can also recommend J-1 visa waivers, but only
for physicians working within the commissions' geographic jurisdictions:
Why is the J-1 visa waiver so important to rural health?
J-1 visa waivers allow rural facilities in or near Health Professional Shortage Areas (HPSAs) or Medically
Underserved Areas (MUAs) to recruit IMGs for vacancies which have been difficult to fill. On average, between
800-1000 IMGs are recruited each year through the Conrad 30 program alone. Many of these physicians choose to
remain in their communities past the three-year requirement, according to a 2016
WWAMI Rural Health Research Center report. The J-1 visa waiver benefits underserved communities in need
of physicians as well as IMGs who want to remain in the United States.
How can a rural community recruit a J-1 physician?
To learn more about the process for recruiting J-1 physicians in your state, contact your state's
Primary Care Office (PCO). The PCO can help you:
- Determine if your community is eligible to recruit a J-1 physician
- Decide whether pursuing a J-1 visa waiver physician is right for your community
- Navigate the recruitment process
The National Rural Recruitment and Retention Network (3RNET) helps match
job-seeking healthcare professionals with practice opportunities in rural and underserved areas, and can offer
help with recruiting J-1 physicians. Their website lists contact information and J-1 employment opportunities
for each state. Job openings can be posted on this site to improve the chance of finding an appropriate match.
3RNET also maintains an immigration listserv, intended primarily for people who coordinate state- or
organization-level immigration programs such as the Conrad 30 J-1 Visa Waiver program. To join the listserv,
contact Kristine Morin at morin@3RNET.org.
Rural communities have a unique opportunity to retain physicians who enter the U.S. on a J-1 visa and are
willing to practice in a HPSA or MUA. To read more about recruitment and retention strategies and tips, visit
our related Recruitment and Retention for Rural Health
Facilities topic guide.
Which healthcare professions are eligible for J-1 visa waivers?
The J-1 Visa Waiver Program is only for physicians.
Where can I find J-1 visa waiver application instructions?
Department of State Bureau of Consular Affairs website gives instructions for completing the J-1 visa
waiver application. Also, each state has its own application process and forms for receiving a state
sponsorship. See 3RNET State J-1 Visa Contacts.
Visit 3RNET State J-1 Visa Contacts for information
related to J-1 visa waivers and assistance in determining practice site eligibility in rural and underserved
For additional information regarding HPSA or MUA designations and state-specific instructions, contact your state
Primary Care Office or the HRSA Division of Policy and
Shortage Designation at firstname.lastname@example.org or 301.594.5168. You can also use
the Find Shortage Areas analyzer tools to
find whether your address is located in a shortage area.