J-1 Physicians Guide to Practicing in the U.S.
Non-resident and non-citizen medical graduates must obtain legal permission to remain and/or practice medicine in the United States. The process to obtain such legal status begins with obtaining a J-1 Visa to train in a U.S. medical residency program and includes several subsequent options.
The J-1 VisaThe J-1 Visa is a type of non-immigrant visa issued to exchange visitors conducting research, professors, and programs that promote cultural exchange. They are commonly used by individuals seeking medical training and typically require sponsorship by an employer, university, or government. The recipient of a J-1 Visa may stay in the United states until the end of their exchange program plus an additional 30 days.
The J-1 visa recipient is normally required to return to their home country for a minimum of two years prior to being allowed to return to the United States legally. This is oftentimes referred to as the "two-year home residence requirement." However, there are several waivers of this home residence requirement which physicians may wish to pay particular attention to. The reminder of this guide outlines several of the important waivers of the two-year home residence requirement.
Conrad ProgramThe Conrad Program is named after North Dakota Senator Kurt Conrad who introduced the legislation creating the Conrad Program in 1994. The program was originally created as a method to address the issue of physician shortages in many rural and undeserved areas of the country. The program originally allowed each state to sponsor up to 20 international medical graduates for waiver of the two-year home residence requirement of the J-1 visa. The number of medical graduates that each state can sponsor has since been increased from 20 to 30. Each state has its own state-specific requirements to participate in its Conrad program, but there are also some general requirements which apply to all states and applicants:
1. The applicant must have received an offer for full-time employment in an area which has been federally designated as a health professional shortage area.
2. The applicant must work in the location for at least 3 years.
3. The applicant must begin working within 90 days of the waiver's approval.
4. The applicant must not apply for another state's Conrad waiver.
To apply for the waiver, an applicant will need to obtain sponsorship from a state health department. It is important to remember that each state will approve only 30 applications, so it is important to submit an application early. Some states receive many more waiver applications each year then other, and are therefore, more competitive than other states.
Appalachian Regional Commission (ARC) and Delta Regional Authority (DRA)The ARC and DRA differ slightly than the Conrad Program in that they place a few more restrictions on the types of physician they will accept into the waiver program and the location in which the physician may practice.
The ARC program is specifically for primary care physicians that wish to practice in outpatient settings only. The states participating in the ARC program are: Alabama, Georgia, kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia.
The DRA program is not restricted to only primary care physicians, but specialist J-1 physicians are only considered in areas which have a specific need for the specific type of specialty physician. For example. a cardiologist can only apply for the DRA program waiver in a specific area which has a need for a cardiologist. The states participating in the DRA program are: Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee.
United States Department of Health and Human Services (HHS) waiverThe U.S. Department of Health and Human Services (HHS) has its own program which allows non-resident medical graduates to waive the two-year home residence requirement. The HHS program is also referred to as the Exchange Visitor Program and applies only to primary care physicians. The applicant must work in a health professional shortage area in the United States and have performed research in an area of priority or significant interest.