HHS changed guidelines in June 2020 to open up the federal J-1 waiver program to healthcare providers of all sizes. Unlike the Conrad Waiver program, HHS waivers do not carry a restrictive quota and timeline. HHS waivers present a more flexible option for qualifying hospitals that rely on foreign physician. Contact us for complimentary consultation if you’d like to learn more.
FordMurray offers free physician matching services to connect U.S. trained foreign physicians with healthcare facilities who can hire on a J-1 waiver. Foreign physicians can learn more here.
FordMurray works with healthcare organizations across the country who are involved in the J-1 visa process for physicians because it’s a win-win program. For a comprehensive look at healthcare immigration for Human Resource Leaders, click here.
Healthcare organizations get excellent staff through this program, and foreign physicians are grateful to be able to continue their career in the United States without interruption. However, it’s known as a complicated and burdensome process, particularly for employers who are navigating it for the first time.
In this Q+A, business immigration attorney Michael Murray, co-founder of FordMurray, summarizes the questions and concerns we hear most often about the Conrad 30 J-1 Visa Waiver program. For more information, download our Guide for Healthcare Employers in Underserved Areas.
Q: What are we getting into? Can my hospital realistically undertake this program?
A: If you’re reading this, you may be interested in this process but not confident your organization can undertake it. It goes without saying — this is a complicated process, as most legal processes are, and there is no doubt a steep learning curve at the outset. Ultimately, to be successful in using the J-1 visa program you want to develop a program with institutional processes and procedures that allow you to identify the right candidates and get through the process successfully. There are long-term benefits for your organization to doing so, as foreign physicians are a great staff resource.
Q: What’s the difference between a visa and a green card?
A: US immigration law is set up to have different categories of people who can enter the country. Foreign nationals aren’t U.S. citizens, nor are they green card holders. To get a visa, they must fall into another category that lets them enter the U.S. to do a specific thing for a specific amount of time. For example, if someone wants to be a tourist they can apply for a B2 visa. With a B2 they are restricted to tourist-related activities and are not allowed to work or stay here long term. There are also several categories of work visas that allow foreign nationals to enter the U.S. to work, but they may only do so for certain employers for certain periods of time depending on the type of visa they have obtained. Both the individual with the visa and the sponsoring employer have to abide by the restrictions of the visa.
Q: I’ve heard of the J-1 visa, but never used it. How does it work?
A: The J-1 visa is notorious in immigration law because it can be a thorn in your side as it has a cultural exchange requirement attached to it. A foreign national is invited to partake in a particular program, such as residency at your hospital, but when they are done with the program there is an expectation that they will take the expertise they have gained in the U.S., return home and share their knowledge and expertise.
There are other J-1 summer work and travel visas, J-1 visas for au pairs/international nannies, as well as for scholars. For our purposes we are considering a J-1 trainee cultural visa.
This visa has to be sponsored by a J-1 exchange organization, not by your hospital or clinic. It has to go through the middleman exchange agency, the Educational Commission for Foreign Medical Graduates (ECFMG), which governs and regulates which foreign physicians are authorized and allowed to come to the U.S. to do their residency. ECFMG is the gatekeeper for who can and cannot come. They administer the difficult ECFMG exam which well under half of applicants fail. Those who pass and are eligible to come to the U.S. are very smart, very high achieving, and are great candidates for any facility in the U.S. However, not every foreign physician who comes to the U.S. will be on a J-1 visa. Some may be on an H1B work visa.
There are pros and cons for physicians on choosing which way to go with their visa. Some programs only allow them to do a certain type of visa. You only need to worry about a J-1 waiver if in fact the physician is on a J-1 visa. It should be clearly marked on their CV.
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Q: So why is a J-1 visa so challenging?
A: The cultural exchange piece, also referred to as the 212E requirement from the section of law it is in, is a tough and durable requirement. For example, if a foreign national marries a U.S. citizen, they are often then free and clear of prior immigration wrongs — not so with the 212E requirement.
This is where the J-1 waiver comes into play. The Conrad 30 program is a waiver program that can be used, and if you successfully sponsor a physician through that waiver, then the physician does not have to return home, but instead can be set up that they can join your practice/facility, and in many cases stay for the long term. The big goal here is to use different government programs to get them to stay.
There are other waiver programs – hardship, etc – which are personal applications physician can do to stay, but the Conrad 30 waiver program is most often used by healthcare employers to waive the 212E requirement. As its name implies it allows each state to give 30 slots to foreign physicians who have the J-1 visa.
Q: How does a physician go from a J-1 visa trainee to an H1B professional?
A: The Conrad 30 waiver program is run and overseen by Department of Health offices in each state. Overall, the J-1 waiver process is a three-step process that you start after hiring, and before completion of residency.
The first application goes to the Department of Health office in the respective state. From there, it is decided which applications go to the federal State Department for further review, and from the State Department successful applications go on to U.S. immigration where they do final adjudication and change the immigration status of a J-1 visa holder to an H1B professional worker. And that is how a physician turns from a trainee to a worker under the visa system.
Q: How does the Conrad 30 program vary by state?
A: Conrad programs are diverse and each state runs the program in its own way. Some state offices work really well and are efficient and accessible. There are others, usually in larger states, that are overrun by volume and are harder to access. For a comprehensive list of state by state deadlines and guidelines, click here.
Q: What are some requirements for healthcare employers to qualify for the Conrad 30 J-1 Visa Waiver program?
A: The facility that is sponsoring the J-1 position needs to be located in a federally designated underserved area as defined by federal agencies. Some states will allow facilities that are not directly located in the federally designated underserved area to participate if they are located near the area and can show that the foreign physician will be substantially serving patients from the underserved area. If you’ve looked at the map and think your facility doesn’t qualify – think again if you are located near a federally underserved area and know you see people from that area. We’ve been successful with many clients who get into the program this way.
Q: What about requirements for physicians we’re trying to hire through the program?
A: The Conrad 30 program is mostly focused on physicians who do primary care work, but not every state restricts and organizes the programs right along those lines. Many states allow sub-specialists to participate, opening up a certain amount (or all) of the 30 slots to sub-specialists depending on what they think are needs and shortages.
To actually have the waiver complete there is a term of service. After the application has been processed through the different departments and the physician is able to change their status, the term of service starts then. From that point, the foreign physician has to serve at the facility for at least three years subject to a contract at the front end that has many different provisions required by the Conrad program. For more information about state by state Conrad Waiver requirements, click here.
Q: Is there an end date for a physician’s employment through the program? What about other employment requirements?
A: Once the three year term of service is complete, that’s when the waiver fully vests and the requirement to return home fully falls away. This is a special achievement for the physician, and an achievement for the healthcare facility because you know there won’t be an end date to their employment. However, more steps do have to be taken to keep the employee for the long term. It’s also important to mention that the three year term of service has to be full-time work, and there isn’t an exception to that. You can’t have someone work part-time for four years, for example.
It is possible, though, to have a physician split their time among different sites or hospitals within the same system. We do have some clients that do this, and all the time spent at those facilities can be added up to meet the full-time requirement.
Q: Do you have to wait for the second three year period of the H1B process to end before applying for the green card?
A: This is one of the common questions we hear about the J-1 visa waiver and H1B process and its incremental steps. A facility may sponsor a physician for permanent residence, but the H1B can be issued in two three-year increments (the first is the three year term of service, the second is the three year extension). The three year extension is a relatively short period of time to have an employee. You may start the green card process for a physician during the three year term of service, but you cannot finish it. The green card process is a three step process and an employer can undertake the first two steps during the term of service, but the final step can’t be done until that term of service is completed.
Q: If my hospital sponsors a physician through the Conrad 30 program, is he/she tied to my facility?
A: You would think since you have sponsored them that they are, but that’s not always the case. The regulations have an ‘escape hatch’ in that if the physician can show that they are in a situation that simply isn’t working, they can petition to move.
Let’s sum up what we’ve gone over…
The J-1 cultural exchange visa has a provision that kicks in saying a physician must return home. However, the Conrad 30 program allows facilities to sponsor and waive the 212 E requirement after a three year term of service. Once that is done, foreign physicians can continue their career here and go for permanent resident status. They are happy, and your facility has a great new physician.
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