J-1 Visas

Relevance to the Underserved Issue

J-1 visa waivers are one mechanism employers in underserved areas can use to attract psychiatrists.

Summary of Key Information

J-1 visas enable non-citizen medical graduates to pursue graduate medical education in the United States. The J-1 visa requires individuals who have completed their medical training to return to their home country or country of last origin for a period of at least two years before seeking entry back into the U.S. through a permanent visa.

Waivers of this requirement may be granted for the following reasons:

  • A request is made from an interested U.S. Government agency on behalf of the physician. This includes requests from the Department of Health and Human Services (HHS), Veterans Administration (VA), the Appalachian Regional Commission (ARC), and state departments of health.
  • A "hardship" waiver may be granted if the foreign residence requirement would impose "exceptional hardship" on the physician's family. This includes instances where the foreign residency requirement would result in the family having to separate and reside in two different countries (relevant for individuals whose spouse is a U.S. citizen or permanent resident or whose children are U.S. citizens) or if the requirement would mean that the family could only reside together in a war-torn country. A hardship waiver may also be granted in situations where a family member has a life-threatening illness for which there is no adequate treatment available in the country to which the physician must return.

  • An "asylum" waiver may be granted in those instances where the Immigration and Naturalization Service (INS) determines the physician is at risk for persecution because of race, religion, or political opinion upon return to his or her country of origin

  • In most instances requests for waivers from U.S. government agencies are made for primary care physicians and psychiatrists to serve patients in medically underserved areas and in Mental Health Professional Shortage Areas (HPSAs) as defined by HHS. These waivers are requested by government entities (including employers) on behalf of physicians, not by the physicians themselves. The petitioning healthcare agency needs to meet certain criteria, and must typically attest: that it has been unable to recruit a U.S. physician following an active recruitment process; that the facility is located in a designated underserved area and provides care to Medicare and Medicaid patients; and that the employment contract for the physician granted the waiver will specify a term of full time employment (40 hours per week) at the designated site for a period of no less than three years. For more information, contact the Department of Health and Human Services.

Conrad State 30 Program Note

Congressional authorization of the Conrad State 30 expired on June 1, 2006. The President signed a bill that on 1/12/2007 became Public Law No: 109-477 that would extend the program until June 1, 2008.]

Congress passed legislation in 1994 creating what is known as the "Conrad State 30" program. This program provided each state with up to 30 waivers for physicians for each federal fiscal year.

For the most part participating states require the following:

  • an offer of full-time employment as a primary care physician (some states include psychiatry) in a medically underserved area;.
  • a letter of support from the state Director of Health for a waiver through the State 30 program;
  • a "no-objection" letter from the physician's country of origin.

 This program supports placement of physicians in both rural and urban designated shortage areas. This waiver program is separate from that administered by HHS. Contact the state's Department of Health for more information. [Note - Congressional authorization of the Conrad State 30 expired on June 1, 2006. The President signed a bill that on 1/12/2007 became Public Law No: 109-477 that would extend the program through June 1, 2008.]

Relevant Web Resources

Department of Health and Human Services (www.globalhealth.gov) The DHHS website provides the regulatory guidance and detailed information on how to apply for a J-1 visa waiver including guidelines and an application form.

US Department of State, J-! Visa Exchange Visitor Program

Rural Assistance Center for additional resources.  Rural Mental Health and Substance Abuse toolkit is available on their website.