Tips for J-1 Physicians Seeking J-1 Waiver Sponsorship

Tips for J-1 Physicians Seeking J-1 Waiver Sponsorship

Dear reader: through these blogs we strive to provide relevant content based on our experiences. We also believe it is valuable to provide the opportunity for others in the industry to share their views. The below article outlines the steps and considerations required for J-1 visa candidates. We would like to thank Steven Williams of Ogletree Deakins for sharing this information with us!

Steven Williams is an Associate at Ogletree Deakins in Denver, CO. His practice focuses on business immigration matters, representing companies and individuals in the academic, medical and high-tech fields. For more information on Ogletree Deakin’s Immigration practice, please go to

If you’re on a J-1 visa looking to find employment in the United States after you complete your training, you probably already know that there will be extra steps you have to take to begin work. We asked a lawyer who is an expert on the topic of visas to help us in providing some considerations when looking for a job on a J-1 visa.

As has been mentioned many times before, over half of the nephrologists in training in the United States are International Medical Graduates (IMGs). IMG’s often complete their U.S. residencies/fellowships in J-1 “exchange visitor” status. At the end of training, J-1 physicians must return to their home countries for two years before they can work in the U.S. in H-1B status or apply for a green card. This strict “home residency” requirement is waived if the physician agrees to provide three years of full-time medical service in a federally designated “health professional shortage area” (HPSA) or medically underserved area (MUA). These J-1 waiver applications require employer sponsorship and are processed by a state’s Department of Health under the “Conrad 30” program or a federally-designated Interested Governmental Agency.

This blog post provides tips for physicians seeking J-1 waiver sponsorship:

Timing – The timing of the J-1 waiver process is crucial. J-1 physicians should start searching for an established employer to sponsor the waiver in the second to last year of residency/fellowship. Waiver applications are normally due October 1 of each year, and the resulting H-1B work authorization should commence 8-9 months later, at the end of the residency/fellowship. As such, the employer should be working with the physician to complete the waiver application the summer prior to the last year of training to ensure timely submission.

Conrad 30 Program vs. other Interested Governmental Agencies – The Conrad 30 program allows each state’s department of public health to sponsor up to 30 J-1 physicians per year for foreign residency waivers. J-1 physician waivers are also available for facilities located in certain regions that fall under the geographic boundaries of the Delta Regional Authority (covering certain counties in Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) and Appalachian Regional Commission (covering certain counties in Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia). These agencies are federally designated to recommend J-1 physician waivers separate from the Conrad 30 Program. The Delta Regional Authority has a $3000 processing fee, unlike Conrad 30 waivers applications, which are generally free.

The Employer – Established employers, like large practice groups, hospitals and community health centers with worksites in HPSAs/MUAs, tend to be the best waiver sponsors, as they’re likely to be aware of the J-1 waiver requirements and process. These employers advertise through medical/professional journals, universities, recruiters etc. Because a J-1 waiver will be essential to perform employment, it’s important for the physician to be upfront about the waiver requirement, whether on the resume/cover letter.

Primary Care vs. Specialty Considerations – States prioritize primary care physicians for J-1 waiver slots, which typically includes pediatrics, obstetrics and gynecology, general internal medicine, family practice medicine and psychiatry. Often, the state department of health will reserve a certain number of slots for specialists – this varies by state. It’s important to remember that waivers for specialists are harder to obtain because less waivers are available and the application might even require additional evidence of the region’s need for a specialty physician.

Medical Licensure – Most waiver applications require the physician to have a medical license in the state of practice or at least proof that that state licensure is pending. This can often be a hurdle. Best practice is to start the state medical licensing process as soon as possible.

Three years of service in H-1B status – As a reminder, Physicians who train in J-1 status must work in H-1B status for the waiver-sponsor in the HPSA/MUA location (as detailed in the waiver application and H-1B petition) for three years in order to waive the home residency requirement. The three-year commitment begins once the physician commences employment in H-1B status. No other time period counts.

Changing worksite locations – Typically, physicians working in H-1B status pursuant to a J-1 waiver can only work at the HPSA/MUA worksite authorized in the initial application. In the event that the employer must add an additional worksite, it must be located in the HPSA/MUA and the employer must be meticulous in advising the Immigration Service and the waiver agencies of any worksite change/addition. The physician must perform at least 40 hour/week of service in the shortage area, so any employment at a worksite outside of the HPSA/MUA must constitute employment beyond the 40 hours and these additional worksites must be approved by the Immigration Service.

Changing Employers – J-1 waiver physicians may only terminate employment with the waiver-sponsor during the three-year waiver commitment period and change employers based on “extenuating circumstances.” Some examples of extenuating circumstances include: (1) employer closes the clinic for reasons not attributable to the physician; (2) employer fails to pay the physician the prevailing wage on the H-1B petition and Labor Condition Application; or (3) employer somehow makes it impossible for the physician to work 40 hours per week in the authorized underserved area. In sum, it’s difficult to change employers within the 3-year service period without demonstrating clearly that the physician cannot complete the service due to circumstances beyond his/her control.

Green Card – The physician must work full time in H-1B status for three full years before applying for employment/family-based permanent residence in the U.S. An immigrant visa petition (Form I-140/Form I-130) may be approved at any time during the three-year period, but the physician’s green card application cannot be filed until three years of service in H-1B status are completed.

As always, if you have questions, feel free to email us at and we’ll help to answer your questions or direct you to an expert who can.

2019-12-01T13:07:24-07:00 October 4th, 2018|18 Months before Graduation, Kidney Stories|0 Comments

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