Rural J-1 Visa Waiver Overview - Rural Health Information Hub (2024)

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 two choices upon completing their GME: they can return to their home country for at least two years, or 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 mental health or primary care 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?

The Conrad 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, calculated from the physician's actual dates of employment, 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 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?

Any U.S. federal government agency may recommend a J-1 visa waiver, but physician waivers are most often handled by the following agencies:

U.S. Department of Health and Human Services (HHS), Office of Global Affairs (OGA)
U.S. Department of Veterans Affairs (VA)

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.

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. In recent years over 1,000 IMGs have been recruited each year through the Conrad 30 program. 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 [email protected].

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?

The U.S. 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 areas.

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 [email protected] 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.