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Rural J-1 Visa Waiver

Having quality physicians is essential to providing healthcare in rural communities. In many cases, the ability of healthcare facilities to remain open depends on having an adequate staff of physicians. Unfortunately, rural areas often experience difficulties in the recruitment and retention of physicians. Due to these difficulties, many communities turn to the recruitment of non-U.S. citizen international medical graduates (IMGs) who trained on a J-1 visa to fill their physician vacancies.

The J-1 visa is a non-immigrant exchange visitor visa, and is often used by IMGs pursuing a residency or fellowship training in the United States. The J-1 visa allows holders to remain in the U.S., normally for up to a seven-year period, 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 two years before applying for an H-1B visa to re-enter (and work) in the United States. As long as an IMG remains subject to the two-year home residency obligation, he/she cannot qualify for permanent residence or an H-1B visa, which is a non-immigrant visa status that will enable the IMG to work in the United States.

Therefore, an IMG essentially has two options after completing their GME: 1) return to their home country for two years; or 2) obtain a waiver of this obligation. A J-1 visa waiver waives the two-year home residency requirement and allows a physician to stay in the U.S. to practice in a federally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) if recommended by an interested federal government agency. State government agencies may also recommend J-1 physician waivers through the Conrad 30 Waiver Program.

Frequently Asked Questions

What is the Conrad 30 Waiver Program?

Named after former North Dakota Senator Kent Conrad who sponsored the legislation, the Conrad 30 Waiver Program was initiated in 1994 through Public Law No: 109-477 to address physician shortages. Under the program, each U.S. state's health department can request J-1 visa waivers for up to 30 foreign physicians per year. The physicians must agree to work in federally designated Health Professional Shortage Areas or Medically Underserved Areas and provide safety-net services for the indigent and medically underserved for at least three years. Referred to as the FLEX 10, and administered at the states' discretion, up to 10 of a state's 30 annual waiver slots may be used for practice locations outside of designated shortage areas if the employer can demonstrate that the physician will deliver care to patients living in shortage areas.

While exact requirements vary by state and each state is given some flexibility in determining program rules, all of the following are required by U.S. Citizenship and Immigration Services:

  • A full-time contract for employment (40 hours per week) as a direct care physician 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 commence employment within 90 days of waiver receipt.
  • Three years employment, specifically in H-1B temporary worker status, with the J-1 sponsoring employer.
  • A letter of support from the authorized official requesting the physician's waiver recommendation.
  • A no-objection letter from the foreign physician's home country if his or her exchange was funded by the home government.

Interested parties should contact the Primary Care Office (PCO) in the state of their intended employment for more information and exact requirements.

Which federal organizations can recommend a J-1 visa waiver?

While any U.S. federal government agency may recommend a J-1 visa waiver, physician waivers are primarily handled by the following agencies:

Obtaining a recommendation through HHS is an option for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and American Indian/Alaskan Native tribal medical facilities defined by the Indian Self-Determination and Education Assistance Act that have a HPSA score of seven or greater and wish to hire a primary care physician. No limit currently exists on the number of recommendations HHS can issue each year.

In addition, there are two regional commissions operating as federal-state partnerships that can recommend J-1 visa waivers:

These two entities only recommend J-1 visa waivers for physicians working within their geographic jurisdiction.

Why is the J-1 visa waiver so important to rural health?

A shortage of physicians willing to serve in rural areas can make it difficult for rural communities to recruit physicians. Historically, rural healthcare facilities have been unable to recruit and retain physicians in adequate numbers. J-1 visa waivers allow rural facilities in or near designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs) to recruit IMGs to fill the vacancies. Through the Conrad 30 Waiver Program alone, 800 to 1,000 IMGs are recruited for practice in underserved areas each year, many of whom 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 wish to remain in the United States.

How can a rural community recruit a J-1 physician?

To learn more about options 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 or not pursuing a J-1 visa waiver physician is right for your community.
  • Navigate the recruitment process.

The National Rural Recruitment and Retention Network (3RNet), a network of state level organizations, can also help you in your recruitment efforts. 3RNet helps match healthcare professionals with rural practice opportunities. Their website lists contact information and J-1 employment opportunities for each state. Your job openings can be posted on this site to improve your chances of finding an appropriate candidate.

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?

Instructions for completing the J-1 visa waiver application process can be found on the U.S. Department of State Bureau of Consular Affairs website. Also, each state will have their own application process and forms for receiving a state sponsorship. See 3RNet State J-1 Visa Contacts.

Who can I contact for more information related to J-1 visa waivers?

For information related to J-1 visa waivers and for assistance in determining practice site eligibility in rural and underserved areas throughout the country, visit 3RNet State J-1 Visa Contacts.

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 or 301.594.5168. You may also use the Find Shortage Areas analyzer tools to determine if your address is located in a shortage area.

Last Reviewed: 8/14/2018