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Conrad Waiver Alternatives – How to Hire a Foreign Physician

While United States Medical Residency Programs educate hundreds of foreign medical doctors a year, employment opportunities for foreign doctors can be limited upon graduation by the Home Residency Requirement (HHR) of J-1 Visas.

The Conrad Visa Waiver – issued by state departments of public health – is one common way for foreign medical graduates to live and work in the United States without satisfying their HHR. Each state and U.S. Territory can grant up to 30 Conrad Visa Waivers, which waive the home residency requirement in exchange for at least three years employment in a federally designated medically underserved area. Conrad Visa Waivers are a popular option because they provide a clear avenue to U.S. employment and citizenship. However, only 30 waivers exist in each state each federal fiscal year, which runs from October 1st through September 31st. While some states never use all allocated waivers, some states have incredibly competitive application processes that fill almost immediately – see a state by state breakdown here.

If you are a physician or healthcare human resource professional who would like to obtain a J-1 waiver and a Conrad Visa Waiver in your current fiscal year is not an option, there are alternative ways to work in the United States without leaving the country to satisfy an HHR. Contact us for more information about any of these options, or to schedule a complimentary consultation.

HHS Waiver

Recent changes to the federal guidelines have opened up waivers from the Department of Health and Human Services (HHS) to any healthcare facility or private practice with a Health Professional Shortage Area (HPSA) score of at least 7. You can determine if your facility qualifies here. HHS waivers are specifically for physicians who will provide primary care treatment to patients.

These new guidelines are a boon for chronically understaffed healthcare facilities, as HHS waivers carry many of the same benefits of the Conrad Waiver, but without the numerical limitations and burdensome timeframe. HHS Waivers should ease some demand for Conrad Waivers, and present a more reliable solution for qualifying facilities.

Refile the Conrad Petition in the Following Fiscal Year

Though not technically a Conrad Waiver alternative, FordMurray attorneys have helped healthcare institutions hire a foreign medical graduate simply by delaying the start date of the position by six months. While most positions for medical school graduates begin in the summer after residency is completed, a January or February start date allows the healthcare institution to refile the petition for a Conrad Waiver during the start of the federal fiscal year, when 30 new waivers become available in each state.

The biggest drawback to refiling a Conrad petition is that the candidate might lose their ability to stay in the United States while the application is processed. In some cases, the candidate can obtain an extension of their J-1 status Educational Commission for Foreign Medical Graduates (ECFMG) while they prepare for and take state medical board exams. Some candidates can apply for visitor visas, while others might have to return to their home country while their petition is processed. Foreign medical graduates can remain in the United States once an H-1B visa petition is filed, so it is important to work with an experienced immigration attorney who can help navigate the process.

Hardship or Persecution Waivers

Hardship waivers can be difficult to prove and must show hardship to a qualifying (U.S. citizen or permanent resident) spouse or child of a foreign medical graduate. The hardship of being separated from the family member is usually not enough to grant a hardship waiver – circumstances must go above and beyond what would be assumed, such as a serious medical condition, security issues in the home country, or extreme cultural obstacles for qualifying family members.

Persecution waivers are granted if a foreign medical graduate can prove they would subject to persecution on the account of race, religion, or political opinion. Foreign medical graduate can apply for persecution waivers and hardship waivers concurrently.

Though incredibly difficult to prove and obtain, foreign physicians who are eligible for persecution or hardship waivers can file immediately for permanent resident status, bypassing the three-year employment and residency requirement for most green card petitions.

Canadian H-1B Loophole

Physicians from Canada have used a loophole in the 212-E law, which states physicians cannot return to the United States on a visa until their HHR is complete. Because Canada is a visa-exempt country, Canadian physicians have come to work in the United States on H-1B visas without satisfying their HHR. This Conrad alternative is not an officially sanctioned visa path and can cause headaches for physicians and employers, as border crossings become subject to the discretion of United States Customs officers. Due to the tumultuous immigration landscape of recent years, this alternative should be viewed as a last result, if at all.

Talk with an Attorney

Having hiring strategies for foreign doctors, nurses and allied health professionals can help healthcare facilities improve patient outcomes, address staffing shortages, and can even save money. We offer complimentary consultations if you’d like to talk about your specific needs and goals.