J-1 Visa Waivers for Physicians

When a foreign national has graduated from medical school abroad and joins a residency program in the U.S. they will usually apply for a J-1 visa. After residency, most J-1 physicians are required to return to their home country after completing medical residency or fellowship – this is known as the 2-year home residency requirement.  In order to avoid this, J-1 physicians will apply for a J-1 visa waiver. The hiring organization can apply for a waiver many ways, but the most common (as it applies to recruiters) are the Conrad 30 Waiver, Health and Human Services Waiver (HHS), Appalachian Regional Commission, and Delta Regional Authority.  (**Veterans Administration usually does not work with recruitment agencies**) – All waivers require the location of the practice to be in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), Medically Underserved Population (MUP) or Mental HPSA – for psychiatrists. Once a J-1 waiver is granted, the sponsoring facility (employer) must apply for an H-1B visa. 

(A) Conrad 30 Waiver: Conrad 30 waivers are available to primary care and specialist physicians (state specific); The Conrad 30 program only allows states to accept up to 30 medical students per year. To apply for this type of waiver, the application must be submitted to the state’s healthcare agency. Requirements vary from state to state – check the website for deadlines for applications. Usually applications for a 2018 J-1 physician start in September or October.  Application costs vary from state to state. Some states specify what types of HPSAs can be used (geographic, population, facility-based).

(B) Health and Human Services Waiver: HHS waiver are only for primary care physicians; work location must have a HPSA score of 7+ and; a)    Be a health center as defined under Section 330 of the Public Health Service Act, and receiving a grant from the U.S. Health Resources and Services Administration; b)    A rural health clinic as defined under Sections 1102 and 1871 of the Social Security Act; or c)    A Native American/Alaskan Native tribal medical facility as defined by the Indian Self-Determination and Education Assistance Act (P.L. 93-638). Federally Qualified Health Clinics (FQHCs) can apply for the HHS waiver which has no limit on the number of applications per fiscal year. More Info: https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/visitor-exchange-program/supplementary-b-clinical-care.html

(C) Appalachian Regional Commission (ARC): Applicable to the following states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia More Info: https://www.arc.gov/program_areas/ARCARCFederalCoChairsJ1VisaWaiverPolicy.asp

(D) Delta Regional Authority (DRA): Application to the following states: Alabama, Arkansas, Illinois, Mississippi, Missouri, Kentucky, Louisiana and Tennessee. $3,000 Application Fee. More Info: http://dra.gov/initiatives/promoting-a-healthy-delta/delta-doctors/how-to-apply/

(E) Veterans Administration (VA): You will need to coordinate directly with the VA's Human Resources Department at the facility which the J-1 physician desires to work.  More information can be found on the VA's requirements here: www.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D2383&usg=AFQjCNHzCJ8uwLh9pwdx1BR4LjD8nZfTiw (Dowloadable .PDF)

(F) Other Option: Hardship or Persecution Waivers – Can apply for one of the above AND one of these waivers. This waiver is very situation specific. 

H-1B Visas

Cap-Subject H-1B

H1B visas are an employer-sponsored nonimmigrant visas that allows persons who are not citizens or permanent residents of the U.S. to work in a specialty occupation for up to six years. The H-1B visa program accepts up to 65,000 individuals plus 20,000 extra for beneficiaries who hold a master’s degree per fiscal year via a lottery system. The lottery, which happens every year on around April 1st, allows H-1B employers to file visa petitions for their workers – if chosen then the worker can begin work on October 1st of the same year.

Physicians are included in the total of 85,000. H-1Bs are limited for 6 years but can be prolonged if there is a pending or approved green card application. This H-1B visa quota is reached very quickly, often within 1-2 weeks.  The lottery system is a random selection of H-1B petitions through the USCIS’ computer program.

Cap-Exempt H-1B

The cap exempt visa petition allows certain non-profits to be excluded from the program H-1B lottery mentioned above.

To apply for the cap-exempt visa petition the affiliated or related nonprofit entity must meet one of the four requirements:

1)    Be Connected to or associated with an institution of higher education through shared ownership or control by the same board or federation;

2)    Be operated by an institution of higher education;

3)    Be attached to an institution of higher education as a member, branch, cooperative, or subsidiary; or

4)    Have entered into a formal written affiliation agreement with an institution of higher education that establishes an active working relationship between the nonprofit entity and the institution of higher education. The agreement must ensure that a fundamental activity for the non-profit entity directly contributes to the research or education mission of the institution of higher education.

NOTE: If a physician was previously on a H-1B visa based on a J-1 waiver and has completed the 3-year requirement. they are permanently exempt from the cap.