With a J-1Visa Waiver, You Don’t Have to Return Home

Foreign Medical Graduates (FMGs) typically enter the U.S. for medical training with a J-1 visa. This visa is intended to allow people from all over the world access to U.S. medical training, but they aren’t allowed to stay. Following the end of a program, the person must leave the country within 30 days. In order to come back to the U.S. permanently, the person must live in their home country for 2 years, then apply for another visa.


The Conrad 30 Waiver Program

There are multiple ways to waive the two-year home country requirement. The government of the home country can release a no objection statement (NOS). The requirement can also be waived if it would cause exceptional hardship to a U.S. citizen or legal resident. If the person would be persecuted in his or her home country, it may be waived. The U.S. government can also waive the visa requirement if it would harm the intent of the person’s project or agency’s interest. Lastly, the Conrad 30 waiver program allows physicians to stay if they will fulfill the needs of the American healthcare system in rural or underserved areas.

Under the Conrad 30 waiver program, the department of health in each state can request waivers for 30 International Medical Graduates who would otherwise have to return home for two years before coming back. In return, the graduate must agree to practice medicine in an underserved area for three years.

The underserved area must be specifically listed as a:

  • Health Professional Shortage Area (HPSA)
  • Medically Underserved Area (MUA), or
  • Medically Underserved Population (MUP)

The person must also obtain a NOS from their home country if that country’s government funded the initial exchange. Understandably, the Conrad 30 waiver program aims to fill gaps in the number of U.S. healthcare providers while maintaining the interests of the home country.

How to Get a Conrad 30 Waiver

A physician who wishes to obtain a waiver must get the sponsorship of the state health department where they plan to practice. There is an online application, and it must be filled out before getting a recommendation. The Department of State Waiver Review Division electronically communicates the application status to the U.S. Citizenship and Immigration Services (USCIS). If there are no concerns, the USCIS will typically allow the waiver to proceed.

What About After the Waiver?

After a successful waiver, the physician must submit their waiver letter along with a Petition for a Nonimmigrant Worker, so his or her visa status can be changed to H-1B. Children or a spouse must submit an application to extend or change nonimmigrant status, so their visa can be changed to H-1B status as well. After this, the physician can begin working in an area where they are very much needed for 3 years. Following this, the physician and family may be eligible for permanent residence, an immigrant visa, or certain types of non-immigrant visas. If they don’t work for 3 years, then the physician has to go back to his or her own country for the original 2-year requirement before returning.

The U.S. Healthcare Provider Shortage

The American Academy of Medical Colleges predicts a shortage of 122,000 doctors by 2032. Demand for medical care is exceeding supply, which could result in catastrophic delays in care and negative health outcomes. Because the population is living longer, the number of patients needing care is growing. By 2032, the number of people living over age 65 is expected to increase by 48 percent. Additionally, elderly populations often have co-morbidities that require multi-disciplinary teams. On the one hand, people living longer is a great thing. However, they still need medical care. The doctors are also aging. According to the AAMC, 1/3 of doctors practicing today will be over 65 within the next 10 years. If these doctors retire early, this could drastically negate active provider numbers.

Problems with Conrad 30

Conrad 30 is one solution to the physician shortage, but it isn’t enough. Only 30 physicians per state are allowed to get waivers regardless of the state’s need. Legislators are seeing the impact that the physician shortage is already starting to have, and they are responding with solutions that involve expanding the Conrad 30 program to more satisfy the needs of America’s underserved populations.

In April, legislators submitted the Conrad State 30 and Physician Access Reauthorization Act. If passed, it would create additional waivers for each state based on need, allow spouses of doctors to work, and streamline the green card process. It is unclear if this Act will pass, but in its current state, the Conrad 30 waiver program is very limited. It responds to the need for more physicians, but it does not satisfy that need. Hopefully, the future will bring an expansion of the program, so more FMGs can stay in America to practice medicine.

Foreign Medical Graduates’ Barrier is Red Tape

According to the Association of American Medical Colleges, the United States will suffer a shortage of 122,000 doctors by 2032, which is similar to past predictions by other organizations. As aging populations with multiple, co-existing morbidities continue to grow, a shortage of this magnitude should be worrisome. People are living longer, and older physicians are retiring. For many Americans, the idea of not being able to see a physician when necessary is unimaginable. However, it is quickly becoming a reality.

One solution to the shortage of physicians in the U.S. is to enable more foreign medical graduates (FMGs) to practice medicine. There are plenty of FMGs trying to advance their medical knowledge and careers by entering the U.S. for a medical residency. There’s also too much red tape for many of them to get through. Limitations on visas and residency slots hamper America’s ability to produce enough doctors to fill this deficit.

J-1 Visa

Most FMGs apply for a J-1 visa. There are multiple requirements to be eligible for this type of visa including:

  • USMLE step 1 and step 2 CK completed and passed
  • ECFMG certification
  • Position in a graduate program or medical school
  • Statement of need from Ministry of Health

After training in the graduate program or medical school is complete, the visa holder has to go back to their home country for two years. This is intended to spread the wealth of their knowledge gained in the United States to their home country. This prevents nations from losing all of their skilled workers and increases levels of global health. It can also present significant hardship for visa holders who may not get a chance to return to the U.S. Following the 2 year return to the home country, FMGs can attempt to change their visa to an H-Temporary worker, L-Intra-company transferee or U.S. permanent resident.

J-1 visa waiver

The two-year return to home country can be waived in 3 circumstances:

  • If applicant can prove he or she will suffer in home country.
  • If applicant’s absence will be a hardship to immediate family members who are U.S. citizens.
  • Sponsorship by an Interested Governmental Agency (IGA).

Once an FMG gets a waiver and a medical license, he or she can apply for a H-1B or immigrant visa.

H-1 B Visa

To get an H-1 B visa, an FMG must have passed all USMLE exams and have an unrestricted license to practice medicine. There is no 2-year home requirement, and the FMG can be employed in the U.S. for up to 6 years. This is the best visa option for FMGs looking to enter the U.S. for a medical residency.

H1-B visa requirements

  • Position in residency or fellowship
  • Medical school graduate
  • ECFMG certification
  • USMLE steps I, II, III passed
  • State medical license if required

The story behind H1-B visas

The purpose behind H1-B visas is to get employers the skilled workers they need for their businesses. Employers petition for a pool of visa numbers, and there is a cap on the amount of visas offered at 65,000 new hires per year with 20,000 extra slots for those who have graduated with a U.S. master’s or doctorate degree. This cap is always met quickly, and the majority of H1-B visas are not in healthcare positions.

Residency Positions

Although medical schools are trying to produce more medical graduates, residencies are not able to create more slots because of a cap set by congress on the number of Medicare-funded residencies. Congress has control of how much money is allocated to teaching hospitals for residencies. The 1997 Balanced Budget Act of 1997 and 1999 capped funding, and at that time, America was looking at a surplus of physicians in the future. Things have definitely changed, but the cap has not been adjusted to make up for the shortage, mostly based on budgetary concerns. Some hospitals privately fund extra residency positions, but the majority are funded by Medicare.

Protecting the U.S.

Much of the red tape surrounding FMG visas has been an attempt to maintain the opportunities for American citizens. However, H1-B visas bring in skilled workers, and studies show that they improve the economy. One study of an increase in H1-B visas predicted that it would create 1.3 million jobs by 2045. Foreign skilled workers and FMGs are not a threat to U.S. citizen opportunity. In fact, Americans need more FMGs training to become U.S. physicians to address the shortage of physicians.

It is clear that the consideration of FMGs has not been paramount to the decision-making of the U.S. government, or else there would be more residency programs and better visa options for FMGs. However, change is coming. The looming physician shortage is scary to all Americans, and it is stimulating people to come up with solutions. One of those solutions will surely be the promotion of more FMGs into U.S. residencies. There are not many suitable alternatives.