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The Six Types of J-1 Waivers

Evan Winter

After completing post-graduate training in the U.S., J-1 physicians are subject to a two-year foreign residence requirement, by default. This means they must return to their home country for a minimum of two years before they can practice medicine in the U.S. However, there are a few ways J-1 physicians can have this requirement dismissed and remain in the U.S. to begin practicing. Some are much more well-known than others, but it is important to explore all options.

Conrad 30 Program

This is the most-used method for J-1 physicians to earn legal practice rights in the U.S. 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.

J-1 physicians must get sponsorship from a state health department and complete the U.S. Department of State form DS-3035, J-1 Visa Waiver Review Application in order to actually apply for this waiver. Regardless of how many applications are received, only 30 applications will be approved by each state, so it is critical that applications are submitted early and on time.

When submitting an application to a state, the 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. It is best to work with professionals who can guide you through this process and figure out the specifics of each state.

Keep in mind, some states are more competitive than others. They may only be open to applications for a few days to a few weeks until they are filled. Some of the most competitive states include Texas, Florida, California, New York, Connecticut, Michigan, West Virginia, Iowa, and Indiana.

The Department of State will notify the physician, the physician’s attorney, and the state agency that requested the waiver by mail once they make their recommendation on the physician’s application. If granted the waiver, the next steps are to fill out a Form I-129, Petition for a Nonimmigrant Worker, as well as the DOS-WRD favorable recommendation letter, in order to change your nonimmigrant status to H-1B. Once granted H-1B status, the physician can only practice medicine at an HPSA, MUA, or MUP designated healthcare facility for at least three years.

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

The second most common options for J-1 physicians are the ARC and DRA. The ARC is made up of 13 states, and the DRA is made up of eight. Both programs permit primary care and specialist J-1 physicians to apply. However, specialists are only considered in those areas that show a specific need for that kind of specialty. For example, if New Madrid Country in Missouri had a specific need for an Otolaryngologist, then they would accept applications for J-1 Otolaryngologists despite not being primary care physicians.

Both of these programs are filtered down from the state level to counties within those states. The states in the ARC program include Alabama, Georgia, Kentucky, MarylandMississippi, New York, North CarolinaOhio, Pennsylvania, South CarolinaTennessee, Virginia, and West Virginia. The DRA program includes Alabama, Arkansas, IllinoisKentucky Louisiana, Mississippi, Missouri, and Tennessee.

Click here to see the application guidelines for the DRA. For the ARC program, J-1 physicians must contact a representative from the state in which they are applying, which can be found here.

HHS Waiver

Foreign medical graduates can have their two-year foreign residency requirement waived by an exchange program regulated through the U.S. Department of Health and Human Services (HHS). The HHS Waiver, also known as the Exchange Visitor Program, is only available to primary care physicians.

The program has two primary criteria:

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

Any facility, such as a hospital or private practice, can apply for an HHS waiver if they have an HSPA score of at least 7 and the physician will provide primary care treatment. If a J-1 physician has 12 months of Fellowship training, they are deemed Specialist physicians and are no longer eligible for the HHS waiver.

Application instructions can be found here. For additional questions, contact Heber Willis at heber.willis@hhs.gov.

National Interest Waiver

Another option for J-1 physicians, the U.S. Citizenship and Immigration Services offers this kind of waiver and has three main criteria:

  1. You must show that you plan on working in the U.S. in an area of substantial intrinsic merit.
    1. Includes a letter from you  and/or your employer describing the importance of the your work
    2. Articles or other publications that describe your companies importance
    3. Letters from experts in your field attesting to your work
  2. You must show the proposed impact of your work is national in scope.
    1. Published articles or media reports
    2. Copies of contracts, agreements, or licenses showing the scope and impact
    3. Letters from current and former employers discussing your work and its national importance
    4. Letters from experts in the field attesting to your work and its national importance
  3. You must show waiving the labor certification requirement would benefit the national interests of the U.S.
    1. Copies of published articles that cite or otherwise recognize your achievements
    2. Copies of grants or other funding you received listing the amount and terms of the grants, as well as the principal and co-investigators
    3. Documents showing how your work is being implemented by others, for example:
      1. Contracts with companies using your or your company’s products
      2. Documents showing licensed technology that your and/or your company invented or co-invented, and how that licensed technology is being used by others
      3. Patents or licenses awarded to you and/or your company with documents showing how they are being used and why they are significant to your field

O-1 Visa

This is one of the more difficult methods for J-1 physicians seeking to waive the foreign residency requirement. 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.” In order to apply, J-1 physicians 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.

Department of Veterans Affairs

The Department of Veteran Affairs offers an option to waive the foreign residency requirement, but this can also be difficult to obtain. This is the criteria:

  • 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 J-1

Additional information:

  • You must be an employee receiving a W2, the J-1 waiver doesn’t grant you permission to work in the U.S.
  • 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 must work 40 hours per week.
  • You can’t get out of your J-1 waiver job, unless it’s an extenuating circumstance (i.e. clinic closes, organization is bought out, overworked to a point where it’s unsafe for patients, etc.)

If you are a J-1 physician needing help with your job search or the waiver process, don't hesitate to reach out. Our experienced team will help you through the entire process and answer any more specific questions you may have concerning waivers or the job search timeline. Visit our job search page to learn more and contact us!