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6 Ways J-1 Physicians Can Practice in the U.S.

Kyle Claussen

Foreign medical graduates face a number of different obstacles when pursuing their graduate medical education and eventually a career in the U.S. The first of these is receiving a J-1 visa in order to legally train in a U.S. medical residency program.

In order to pursue a J-1 visa, you must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). The U.S. State Department is ultimately responsible for designating which organization can legally sponsor a J-1 physicians.

After completing U.S. graduate medical education, J-1 physicians face to a two-year foreign residency requirement. This means you must return to your home country for at least two years before you can attempt to practice in the U.S. as a full-fledged physician.

However, you can forego this requirement by waiver sponsorship through a number of Interested Government Agencies.  The following programs allow you to practice in the U.S. upon the completion of your program:

1. Conrad 30 Program

The Conrad 30 Program is one of the most widely utilized method for foreign physicians to achieve legal practice rights in the U.S. In order to be eligible for this program, you must:

  • Agree to be employed full-time in H-1B nonimmigrant status at a healthcare facility located in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or a Medically Underserved Population (MUP).
  • Receive and sign a contract for the previously mentioned facility.
  • Begin employment at your healthcare facility within 90 days of receiving your waiver.

In order to actually apply for the waiver, you will have to attain sponsorship from a state health department and complete the U.S. Department of state form DS-3035, J-1 Visa Waiver Review Application. Keep in mind that each state will approve only 30 applications, even if they receive 40 to 50, so it is imperative that you submit your application early and on time.

Also, when submitting an application to a state, your application will either be processed by a first-come first-serve basis or states will fill their allotment and then decide which J-1 physicians to admit based on their needs. The best way to learn more about the specifics of each state’s needs is to work with professionals who can guide you through the process.


Keep in mind that some states are much more competitive than others. These states may only be open to applications for a few days to a few weeks before they are filled. These include:

Texas – Florida – California

New York – Connecticut – Michigan

West Virginia – Iowa – Indiana

Once the Department of State makes their recommendation on your application, they will notify you, your attorney, and the state agency that requested the waiver by mail. If you are granted the waiver, you will fill out a Form I-129, Petition for a Nonimmigrant Worker, along with the DOS-WRD favorable recommendation letter, in order to change your nonimmigrant status to H-1B.

Once granted H-1B status, you must then practice medicine at an HPSA, MUA, or MUP designated healthcare facility for at least three years.

2. Appalachian Regional Commission (ARC) and Delta Regional Authority (DRA)

The ARC and DRA programs are another option for J-1 physicians, with the ARC being made up of 13 states and the DRA being made up of eight.  The ARC program only considers J-1 primary care physicians who are willing to practice in outpatient settings (excludes hospitalists). 

The DRA allows both primary care and specialists J-1 physicians to apply, but specialists are only considered in those areas that show a specific need for that type of specialty physician. For example, an Otolaryngologist is obviously not primary care, but if New Madrid Country in Missouri has a specific need for an Otolaryngologist, then that J-1 physician can apply to practice there.

Both programs are filtered down from the state level down to counties within those states. The states in the ARC program include:

Alabama – Georgia – Kentucky – Maryland

Mississippi – New York – North Carolina

Ohio – Pennsylvania – South Carolina

Tennessee – Virginia – West Virginia

The states in the DRA program include:

Alabama – Arkansas – Illinois

Kentucky – Louisiana – Mississippi

Missouri – Tennessee

Application guidelines for the DRA can be found here. For the ARC program, you must contact a representative from the state for which you hope to apply for practice, which can be found here.

3. HHS Waiver

 The U.S. Department of Health and Human Services (HHS) regulates an exchange program which allows foreign medical graduates to get their two-year foreign residency requirement waived. The HHS Waiver, also known as the Exchange Visitor Program, is a waiver available for primary care physicians only. The HHS has two primary criteria for the waiver program:

  • “Research performed in an area of priority or significant interest to the agency”
  • “Health care services needed in a Health Professional Shortage Area in the United States.

Healthcare facilities must have an HPSA Score of seven or more to qualify. If you have 12 months of Fellowship training, you are deemed a specialist physician and no longer eligible for the HHS waiver.

The main contact for this program is Jessica Stewart at [email protected] and you can find application instructions here.

4. National Interest Waiver

 Another option for bypassing the foreign residency requirement is the National Interest Waiver. This waiver is offered through U.S. Citizenship and Immigration Services and has three main criteria:

  • Requirement 1: You must show that you plan on working in the United States in an area of substantial intrinsic merit.
  • Requirement 2: You must show that the proposed impact of your work is national in scope.
  • Requirement 3: You must show waiving the labor certification requirement would benefit the national interests of the United States.

5. O-1 Visa

The O-1 Visa is one of the more difficult programs to be accepted into and it temporarily waives the foreign residency requirement until you either achieve H-1B status or obtain a Green Card. According to the USCIS site, this visa is “for the individual who possesses extraordinary ability in the sciences, arts, education, business, or athletics, or who has a demonstrated record of extraordinary achievement in the motion picture or television industry and has been recognized nationally or internationally for those achievements.”

To apply, you must file Form I-129, Petition for Nonimmigrant Worker, with the USCIS. This form should be filed at least 45 days before the date of employment.

6. Department of Veterans Affairs

The Department of Veterans Affairs also offers an option to waive the foreign residency requirement, but it can be difficult to obtain. The criteria are as follows:

  • The VA will consider all U.S. citizens before any visa candidates.
  • Must provide 51% patient care.
  • Must begin working within 6 months of applying for the waiver.
  • No O-1 visa holders can get a VA waiver, must be J1.

Additional info:

  • You must commit to at least three years of employment and work at least 40 hours per week.
  • You must be an employee receiving a W2, the J-1 waiver does not grant you permission to work in the US.
  • You can moonlight, but talk to your immigration attorney to make sure you abide by your J-1 waiver requirements.
  • You can only have 1 waiver submitted at a time.
  • You cannot get out of your J-1 waiver job, unless it is an extenuating circumstance (i.e. clinic closes, organization is bought out, overworked to a point where it is unsafe for the patients, etc.).

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