BY Jessica Cook, Partner, Fisher Phillips
Texas healthcare employers seeking to hire physicians should explore the J-1 Waiver Program. The J-1 Waiver Program allows employers to hire physicians to work in healthcare facilities in rural and health shortage areas or serve those communities. Under the J-1 Waiver Program, the foreign physician must work for the sponsoring healthcare facility for three years. Therefore, this immigration option can be a great tool to alleviate physician shortages. This program is available to qualifying physicians from any country, including Mexico and Central America, who are in the U.S. on a J-1 visa to obtain medical training.
J-1 Visa for Physicians
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The J-1 visa is a temporary visa that allows international medical graduate physicians to participate in a residency or fellowship training program in the United States. The J-1 visa program is designed to promote cultural exchange. Therefore, once the physician’s program is over, the J-1 physician must return to their home country for two years to allow their home country to benefit from the knowledge gained in the US during their training. The J-1 physician must fulfill the two-year obligation before being eligible to change their visa status to certain other U.S. visas, such as H-1B, L-1, or permanent residency. To fulfill the foreign residency requirement, J-1 physicians must reside and be physically present in the country of their nationality or last residence for at least two years after leaving the U.S. However, the law does allow an exception to this rule. The physician must obtain a waiver to not return home for two years.
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Employer-Sponsored J-1 Visa Waivers
An employer who wants to hire a J-1 physician who has not fulfilled the two-year obligation can sponsor the J-1 physician for a J-1 waiver. An approved waiver means that the U.S. government has “waived” the requirement for the physician to return to their home country to fulfill the two-year obligation.
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The J-1 waiver allows a J-1 physician to work in an underserved area in the U.S. for three years instead of returning to their home country for two years. The employment must be in an area designated by the U.S. Department of Health and Human Services as a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA), a Medically Underserved Population (MUP), or serving patients who reside in a HPSA, MUA, or MUP. Additionally, the J-1 physician must be under contract to work at the healthcare facility for three years in H-1B status, and the employment must start within 90 days of the waiver approval. Once employed, the physician cannot transfer his or her visa status to a new employer unless the physician can show extenuating circumstances justifying the change in employment.
The Department of Health and Human Services (HHS) can approve an unlimited number of waivers each year, and there is no deadline for submission. Every state – including Texas – has an employer-sponsored J-1 waiver program called the “Conrad 30 Waiver,” allowing the state’s health department to recommend 30 physicians to receive yearly waivers. Each state develops its own application rules, deadlines, and guidelines, and the Texas program is administered by the Texas Conrad 30 J-1 Visa Waiver Program Office, which outlines eligibility and ranking criteria that are updated annually.
And around the rest of the country, the employer-sponsored J-1 Waiver Programs are as follows:
- Appalachian Regional Commission (ARC): ARC can approve waivers for physicians to work in the Appalachia region covering all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. There is no deadline for submission.
- Delta Regional Authority (DRA) – DRA can approve waivers for physicians to work in specific counties or parish areas in Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. There is no deadline for submission.
- Southeast Crescent Regional Commission (SCRC): SCRC can approve waivers for physicians to work in specific areas of Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and all of Florida.
Each waiver program has its own rules, deadlines, and guidelines that must be carefully evaluated to determine the best program for the employer and the J-1 physician. Some programs accept applications year-round and have no limit on the number of physicians they can approve each year. Other programs have strict application windows and limited approvals available. For programs with deadlines, they generally start accepting applications in the fall. Employers looking to hire physicians after completing training next year should start the J-1 Waiver application process in fall 2023 for employment to start in summer 2024. For programs without deadlines, employers have the flexibility to submit cases anytime. If the J-1 Waiver Program does not meet your needs, there are other immigration options you can explore for hiring physicians.