Many medical residency programs, Graduate Medical Education or GME, will accept international medical graduates in the Exchange Visitor (J-1) program sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). The J-1 program permits physicians to complete graduate medical education or training in the U.S. while in J-1 status.

However, the J-1 visa carries with it the two-year home residence requirement, a provision that renders the J-1 physician ineligible to apply for a change of status to another nonimmigrant visa status (H or L), to apply for an immigrant visa or to adjust their status to permanent resident until the home residence has been satisfied or waived.

Introducing the Conrad 20 waiver program and its expansion to Conrad 30

The Conrad 20 Waiver Program was established by Congress in 1994 to address the physician shortage, particularly in rural and underserved areas. The Conrad Waiver is based upon the provision in the Immigration Act that provides for a waiver of the home residence requirement upon the recommendation of an interested government agency. 

Expanded to Conrad 30 in 2002, the program allows each state and Washington, D.C. the ability to serve as an interested government agency and grant up to 30 waivers for international medical graduates each year. In order to be eligible for the Conrad 30 Waiver Program, the physician must agree to practice medicine at a health care facility located in an area designated by the U.S. Department of Health and Human Services (HHS) as a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA), a Medically Underserved Population (MUP) or will be serving patients who reside in a HPSA, MUA, or MUP.

Eligibility criteria for the Conrad 30 waiver program

The physician’s employment must be full-time and for a three-year period. Some states may have a preference and need for primary care physicians while other states may allow applications from both primary care physicians and physicians who will practice in a specific specialty.

The application process is two-fold: requiring the J-1 physician to complete Form DS-3035, J-1 Visa Waiver Review Application online through the U.S. Department of State and for the employer and physician to submit an application to the state’s department of public health. There are numerous documents that both the employer and the J-1 physician need to gather in anticipation of filing the waiver application. For example, employers and physicians must provide evidence of shortage designation status for placements in HPSAs and MUA/Ps, evidence of the physician’s state medical license (or evidence that they have started the process to obtain their state license), employment contract and copy of the DS-3035.

State-specific guidelines and submission cycles for waiver applications

Employers and J-1 physicians who meet all eligibility requirements and have gathered all the required supporting documentation can submit applications to their state’s department of public health to request a waiver of the two-year home residence requirement. Each state has created its own application process and guidelines, so there is a mixture of application submission cycles. While some states accept applications on a rolling basis, the majority have application cycles that start in Sept. or Oct. and close once slots are filled or on a specific date.

If the state department of public health reviews the application and recommends a waiver, it will notify the Department of State. Once the Department of State approves the application and issues the waiver, the employer can then file an employment-based nonimmigrant petition on behalf of the J-1 physician allowing them to change to a new temporary nonimmigrant status. Once the three-year commitment is completed, physicians also have an option to obtain an immigrant visa which offers them a route to permanent residency: a green card.

Other visa waiver options for international physicians

The Conrad 30 Program is competitive due to the high number of eligible J-1 physicians and the low number of available waivers that can be distributed each year. However, the Conrad 30 Program is not the only waiver program available. Other government agencies that have an unlimited number of waivers to recommend each year and that accept applications on a rolling basis include the HHS Visa Waiver Program, the Appalachian Regional Commission (ARC) Waiver Program, the Northern Border Regional Commission (NBRC) Waiver Program, the Delta Regional Authority Waiver Program and the Southeast Crescent Regional Commission (SCRC) Waiver Program.