J1 waiver and the Conrad 30 Program
The Conrad 30 Program was created to remedy physician shortages in federally designated shortage areas of the United States. The program waives the home residency requirement of international medical graduates (IMGs) on a J1 visa in exchange for service (currently three years) in these areas. The original program only accepted primary care but has since expanded to allow for waivers for other specialties if the individual states choose to do so.
Currently, each state has thirty waivers. Under the program, IMGs must be employed full time (40 hours/week) in a federally designated shortage area. States are allowed up to 10 “flex slots” i.e. physicians may work in locations not designated as being in shortage areas, but the sponsor (office/hospital) serves the residents of a shortage area. I received a J1 waiver and was able to fill one of these “flex slots”. The sponsor must demonstrate they are unable to find an American to fill the position i.e. they must advertise for the position and document recruitment efforts were made for at least six months. A wage study (labor certification) must be conducted and paid for by the sponsor to ensure you as the applicant are paid the prevailing wage for that position in that area.
If your specialty is not currently listed as eligible for a waiver according to the State, not all is lost. You will have to find a sponsor that has an administrator and/or dedicated lawyers, and you will need your own personal immigration lawyer. I was able to persuade a state to add Forensic Pathology to the list of specialties eligible for a waiver. The changes to the waiver system usually happen when the state is evaluating their budget. Sometimes this happens annually and sometimes it happens every two years. You must personally and carefully evaluate how long you are willing/able to stay unemployed while waiting for a potential change to occur. Even if a state has historically accepted a J1 waiver for a non-primary care specialty, it may not by the time you apply. Unfortunately, there is a great deal of complexity and uncertainty navigating a bureaucracy such as the immigration system but have faith. You are on a path less traveled, but it will make all the difference.
Typically, the states in the Midwest do not exhaust their thirty waivers and are more easily convinced of specialty needs. When I was looking for states with a waiver for my specialty, there were only three states with experience issuing J1 waivers and H1b visas. Since then, I have convinced three additional states to add my specialty to the list of specialties eligible for a waiver. Unfortunately, one of the original three states no longer accepts J1 waivers for Forensic Pathologists meaning that these opportunities only have a limited window before they close again and this varies with who works for the state during your application time.
The J1 waiver process opens once annually on the first Monday of October. Typically, it is run on a first come first serve basis until the State exhausts its waivers. An administrator from your sponsor should be there in person to file your application with the J1 waiver liaison at the State to maximize your chances of success. Communication between the sponsor, the J1 waiver liaison, and your immigration attorney during the hiring process is key to ensure all documents are completed in a timely and accurate manner.
If you transfer to another hospital or office i.e. you switch to another sponsor of your H1b visa during your return of service, and this sponsor is in another state, the initial waiver state will be the state that monitors the completion of your return of service.
