Options For Physicians
Physicians often come over on a J-1 for advanced training and education. One of the caveats to the J-1 visa is the 2 year foreign residency requirement. In this multi part article we examine both temporary and permanent solutions to overcoming this waiver and allowing the doctor to work and live in the United States. The first part looks at just the temporary options.
Temporary Visas (Nonimmigrant) Options
J-1 - Waiver Options of the 2 Year Residency Requirement
1. Persecution Waiver - The doctor must demonstrate persecution on the basis of race, religion or political opinion if he/she returns home
2. Hardship Waiver - The physician must demonstrate that his/her departure would impose exceptional hardship to their U.S. citizen or permanent resident spouse or child
3.Interested Government Agency (IGA) Waiver - Stating that the program the physisican undertakes is in the public interest and the two year foreign residence requirement is detrimental to the sponsoring agency's program. Some of the Available programs are:
- Conrad 30 Program Run by the 50 States ("Conrad 30a)
- Appalachian Regional Commission ("ARC")
- Delta Regional Authority ("DRA")
- Veteran's Affairs ("VA") - a possibility is to combine a university appointment (5/8 VA and 3/8 university)
- Health and Human Services (HHS) - no specialists - primary care and psychiatrists only.The doctor must have completed primary care residency training no more than 12 months prior to commencing employment in underserved area.
Conrad 30 Waiver
The Conrad 30 is a popular option and we explore in depth some of the options available. Conrad 30 waivers are tricky and I recommend you utilize the services of the best immigration lawyer you can afford.
- Offer of full-time employment (40 hours per week) in a federally designated primary care (or mental health) health professional shortage area (HPSA) or medically underserved area/population (MUA/MUP).
- Must agree to serve for three(3) years or more.
- Some states allow up to 10 of their 30 alotted physicians to work in an area not designated as a HPSA or MUA/MUP provided that the sponsoring facility serves individuals residing in underserved areas ("flex slots").
- States may allow specialists if a shortage of physicians practicing in that specialty (varies state by state).
- A written contract between the sponsoring facility and the doctor is required.
- The physician must begin practice within 90 days of the approval of the waiver by USCIS.
- The physician may not apply for another Conrad slot in another state.
- If the medical education was funded by the doctor's home country,then the doctor must obtain a no-objection statement fromt he home country.
- IMG must sign a statement that he or she understands the policies of the J waiver program, will comply with those policies, and that all statements in the application are accurate.
- The sponsoring facility must demonstrate unsuccessful efforts to recruit for the physician vacancy to be filled by the IMG.
- Conrad 30 physicians on an H-1B are exempt from the H-1B annual statutory quota.
Outline of Steps to Apply for a Conrad 30 Waiver
- Find a sponsoring facility.
- Submit the DS-3035 with fees (same case number as prior waivers if applicable) to obtain a case number from Department of State.
- Ascertain all of the applicable requirements from the State Program Administrator includingwhether flex slots are available, slots for specialists, site visit requirement, pre-approval, filing window, filing fees, historical usage of numbers, procedures, reporting requirements after approval, minimum wage requirements.
- Confirm sponsoring facility is in a designated underserved area.
- Submit application with the supporting documents.
- Your immigration lawyer will file the H-1B Petition with USCIS after DOS has issued a favorable recommendation on the Conrad 30 waiver.
Some states receive more than 30 applicants for Conrad 30 waivers. Here are some of the factors they consider when decidign which ones to choose.
- Time of filing. Usually first come first served.
- HPSA Score.
- Whether the clinic is in an urban vs. rural community.
- What type of facility is the sponsoring clinic - non-profit, rural clinics, state or federal funded funded institution or critical care center, "Safety net" providers ( serve a significant level of uninsured individuals, Medicaid, and other vulnerable patients)
- High percentage of care to uninsured and/or Medicaid patients
- Access to services - scarcity of physicians in the area
- Foreign language fluency
O-1 - Extraordinary Physicians
Physicians with significant achievements in their field who have sustained national or international acclaim and can satisfy 3 of the 10 required criteria as listed in the regulations;
- Often used for J-1 subject physicians without a waiver;
- Cannot change status in the U.S.
- Available for academic or clinical appointments - such as an academic medical center
- Employer-specific, possible the physician may need multiple O-1as.
- Valuable if physician has hit the six year cap on H-1B
- Good option if the physician has not obtained a waiver
- O-1 status merely postpones the need for a waiver it does not eliminate it.
