Important Notice: HHS changed guidelines in June 2020 to open up the federal J-1 waiver program to healthcare providers of all sizes. This is a big change that will positively impact many healthcare providers. 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 physicians. Contact us for a free consultation if you’d like to learn more.
Conrad Visa Waivers are a part of a federal program that allows hospitals and healthcare institutions to recruit and hire highly skilled physicians from U.S. residency and fellowship programs.
The waiver allows the foreign-born physician to waive the home residency requirement that comes with the J-1 visa.
Federal Requirements for Conrad Waivers
While states will have additional considerations for applicants and their sponsoring organizations, the United States Citizenship and Immigration Services mandates that doctors in the J-1 program:
- Agree to be employed full-time in H-1B nonimmigrant status at a health care facility located in an area designated by U.S. Department of Health and Human Services (HHS) as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP).
- Obtain a contract from the health care facility located in an area designated by HHS as a HPSA, MUA, or MUP
- Agree to begin employment at the health care facility within 90 days of receipt of the waiver, not the date his or her J-1 visa expires
Additionally, the federal Considerations Conrad Visa Waivers programs vary from state to state, and some states have much more competitive processes than others. Some states place a higher emphasis on meeting shortages in primary care physicians, and some put in place strict criteria that ensure healthcare institutions have rigorously sought to fill positions with American physicians.
State Requirements and Deadlines for Conrad Waivers
FordMurray has compiled an overview of state-by-state submission and application information for your reference. If you are considering hiring through a Conrad Waiver, contact us for a complimentary consultation so we can help you understand the specific considerations for your state, or download our immigration guide for healthcare human resource leaders. If you are a foreign physician and are exploring your employment options, read more about how to find a healthcare facility that might qualify as a sponsoring organization alternatively you can download our immigration guide for foreign medical graduates.
Conrad Visa programs are designed to follow the state’s fiscal year, running from October 1st – September 30th. Additionally, States that accept applications on an ongoing basis do not give out all of their Conrad Waivers or have a highly selective process that is geared toward recruiting specific categories of physicians or specialists.
States with Ongoing Submission Deadlines
Alaska (HPSA, MUA)
Submission Information: Applications for Conrad Waivers in Alaska are ongoing and accepted on a case-by-case basis.
Other Considerations: Healthcare facilities must provide evidence of unsuccessful attempts to hire an American physician for the position.
Delaware (HPSA, MUA)
Submission Information: Applications for Conrad Waivers in Delaware are accepted in a rolling application period.
Other Considerations: Pre-approved healthcare sites only. Additionally, Site approval includes a needs assessment, proof of attempts to hire an American physician, letters from community leaders who can attest to how the physician will alleviate healthcare concerns, and proof of a retention strategy for the physician. The deadline for site application is June 30.
District of Columbia
Submission Information: Application accepted on a rolling basis. Priority is given to primary care physicians and specialists who work in the fields that are identified as leading causes of death in DC – heat disease, cancer, cerebrovascular disease, accidents, HIV/AIDs, and chronic lower respiratory diseases.
Other Considerations: Institution must show detailed hiring efforts for an American physician for at least 6 months prior to the application.
Hawaii (HPSA, MUA, MUP)
Submission Information: The Department of Health recruits foreign born physicians year-round on a first-come, first-served basis.
Kansas (HPSA, MUA, MUP)
Submission Information: Healthcare employers must submit the “Advance Notification Request for J-1 Visa Waiver” form. Once submitted, the employer will have a specific timeframe to submit the Conrad Visa Waiver application.
Other Considerations: In addition, Employers must show proof of recruitment for six months prior to the application. Employers must sign an agreement to accept all patients, regardless of their income or ability to pay. Additionally, healthcare providers must have a nondiscrimination policy that shows they are able to provide care that is responsive to the cultural and linguistic diversity of their patient community.
Nebraska (HPSA, MUA, MUP)
Submission Information: Applications are accepted throughout the year and are reviewed within two weeks.
New Hampshire (HPSA, MUA, MUP)
Submission Information: Applications are accepted year-round.
New Jersey (HPSA)
Submission Information: Applications are accepted year-round.
South Carolina (HPSA, MUP)
Submission Information: Applications accepted at any time. Slots awarded on a first-come, first-served basis.
Other Considerations: Site approval is required by the Primary Care Office of the South Carolina Department of Health prior to application. Evidence of unsuccessful recruitment efforts is required.
Vermont (HPSA, MUA, MUP)
Submission Information: Vermont accepts positions for Conrad Visa Waivers throughout the year.
Other Considerations: Priority is given to primary care sub-specialties, including family practice, general internal medicine, obstetrics and gynecology, pediatrics, geriatrics, and hospitalists.
Wyoming (HPSA, MUA)
Submission Information: Applications are accepted year-round.
States with September Submission Openings and Deadlines
Iowa (HPSA, MUA, MUP)
Submission Information: Applications for Iowa Conrad Waivers are accepted from the second Tuesday in September through the last Friday in October. If 30 Conrad Waiver slots are not filled, applications submitted after the initial period will be reviewed.
Other Considerations: Employers must show their recruitment and retention efforts for their facility for the previous six months. Annual reports on the J-1 physician are required.
Michigan (HPSA, MUA, MUP)
Submission Information: Applications are available through the Michigan Health Council after June 1st, and accepted from September 1st until November 1st.
Other Considerations: Priority is given to safety net providers.
New Mexico (HPSA, MUA, MUP)
Submission Information: Applications are accepted from September 1st until all Conrad Waivers are awarded.
Other Considerations: The sponsoring facility must have a policy regarding patient care regardless of ability to pay.
Pennsylvania (HPSA, MUA, MUP)
Submission Information: Applications are reviewed in three periods: Firstly, September 20th – December 15th, Secondly, January 1st – June 15th, and Thirdly, July 1st – September 15th.
Other Considerations: Sponsoring facilities must sow sliding fee scales. Recruitment efforts must be documented in chronological order for at least six months in the prior year.
Texas (HPSA, MUA)
Submission Information: Applications accepted for the following fiscal year in September.
Other Considerations: Additionally an application fee of $3,000 is required. Not all HPSAs or MUAs are eligible.
Virginia (HPSA, MUA, MUP)
Submission Information: Applications are accepted from September 1st to August 31st.
Other Considerations: Priority is given to physicians who are trained in Virginia. Furthermore, Employers must provide proof of six months of unsuccessful recruitment attempts of American physicians.
States with October Submission Openings and Deadlines
Alabama (HPSA, MUA)
Submission Information: Submissions for primary care physicians may be submitted on October 1st, and are awarded based on the need and on a first-come, first-served basis. In contrast, Submissions for subspecialty applications can be submitted on the first Monday of the first full week in January.
Other Considerations: Rural hospitals and employers may submit subspecialty applications year-round. The employer must provide copies of national and in-state advertisements for the position.
Arizona (HPSA, MUA or MUP)
Submission Information: Applications will be accepted on October 2nd and must be postmarked on or before November 30th, upon which time they will be reviewed for thoroughness and adherence to state and federal guidelines. A second and third cycle application will run if Conrad Waivers remain after the first application period until slots are filled.
Other Considerations: Healthcare facilities must provide evidence of an unsuccessful attempt to hire an American physician for the position, including advertising efforts and interview outcomes.
Arkansas (HPSA, MUA, MUP)
Submission Information: Applications are reviewed on a first-come-first-served basis from October 1st through September 15th.
California (HPSA, MUA, MUP)
Submission Information: Applications for primary care physicians are reviewed in the order received from October 1st through June 30th. From July 1st – September 30, applications for primary care physicians and specialists are accepted.
Other Considerations: California requires healthcare facilities to provide a long-range plan for the retention of foreign physicians.
Colorado (HPSA, MUA, MUP)
Submission Information: Applications are reviewed in the order they are received, starting October 1st.
Other Considerations: Colorado’s J-1 Visa Waiver program has a preference for primary care physicians. The applying healthcare institution must show six months of recruitment efforts, demonstrate need within the community, and show their retention plan for the physician.
Connecticut (HPSA, MUA, MUP)
Submission Information: Applications will be accepted following October 2nd and must be hand-delivered to the Connecticut Department of Health.
Other Considerations: Slots fill quickly. Must demonstrate that required recruitment efforts for American physicians have failed.
Florida (HPSA, MUA, MUP)
Submission Information: The Florida Department of Health will accept applications on 2018-2019 Monday, October 1, 2018, at 8:00 am until Friday, October 12, 2018, at 5:00 pm.
Idaho (HPSA, MUA, MUP)
Submission Information: Conrad Visa Waivers are awarded on a first-come, first-served basis, with applications being accepted starting on October 1st.
Other Considerations: Applicants can expect a non-refundable application fee of no less than $1,000. Comprehensive proof of recruitment of American physicians is required, including regional and national print advertisements, 6 letters to area medical schools, and a mailing list of applicants who were not selected. Priority will be given to physicians with language skills appropriate to the host facility and community, and to communities with the highest need.
Illinois (HPSA, MUA, MUP)
Submission Information: Applications are processed between October 1st and October 31st. If not all slots are filled, applications will be accepted again from January 1st to January 30th, and April 1st and April 30th. Applicants are scored according to the HPSA scoring system.
Other Considerations: Applicants must submit a $3,000 nonrefundable application processing fee. Institutions must show recruitment difficulties for American physicians.
Indiana (HPSA, MUA, MUP)
Submission Information: While applications may be submitted throughout the year, processing begins for physicians begins October 1st and for specialists on January 1st.
Other Considerations: Healthcare facility must be in operation for at least six months before request, with proof of recruitment efforts for more than four months.
Kentucky (HPSA, MUA, MUP)
Submission Information: Applications must be submitted between October 1st and October 31st. If waivers remain available after the initial deadline, additional applications will be accepted until July 30th, or until waivers have been awarded.
Other Considerations: Employers must show recruitment efforts from three months to one year prior to the application.
Louisiana (HPSA)
Submission Information: Applications are accepted starting on October 1st. Until April 1st, 80% of slots are reserved for primary care physicians. Applications received after April 1st are processed on a first-come, first-served basis.
Other Considerations: Employers must show recruitment efforts 6 months prior to application. Preference is given to either physicians who completed residency or fellowship training in Louisiana.
Submission Information: Applications are accepted starting on October 1st.
Other Considerations: Application must become from a health care facility, with supplement information about physician recruitment and a retention plan for the foreign physician.
Maryland (HPSA, MUA)
Submission Information: Applications for primary care physicians for facilities in underserved areas are accepted October 1st. Other applications accepted on December 1st.
Massachusetts (HPSA, MUA, MUP)
Submission Information: The first round of applications for primary care and specialists are accepted from October 1st through December 31st. If waivers remain second round begins January 1st.
Other Considerations: Priority is given to primary care physicians, with emphasis placed on applicable language skills and the level of need. Additionally, Sponsoring facilities must participate in MassHealth.
Minnesota (HPSA, MUA)
Submission Information: Applications are accepted until October 15th. Additionally, a round of applications may be submitted if 30 waivers are not taken in the first round.
Other Considerations: Facilities must demonstrate sliding scale pay policies and commitment to healthcare for indigent clients. Furthermore, Priority is given to primary care physicians and rural locations.
Mississippi (HPSA)
Submission Information: Applications are accepted throughout the fiscal year, beginning October 1st.
Other Considerations: Sponsoring sites must request site predetermination prior to application submission. Furthermore, applications must be submitted with a $1,500 non-refundable processing fee. Employers must show robust national and regional recruitment efforts.
Missouri (HPSA)
Submission Information: Applications are accepted from October 1st until all waivers are distributed.
Other Considerations: Site approval is required from the Missouri Department of Health and Human Services.
Montana (HPSA, MUA, MUP)
Submission Information: Applications are accepted starting October 1st, and are reviewed within 20 days of submission.
Other Considerations: Additionally, Employers must show proof of six months of recruitment.
Nevada (HPSA, MUA, MUP)
Submission Information: Applications are accepted throughout the fiscal year starting October 1st. Applications are reviewed within 45 days.
Other Considerations: In addition, Site approval is required, and application fees are applicable.
New York (HPSA, MUA, MUP)
Submission Information: Applications are accepted through November 29th.
Other Considerations: Candidate must apply to applicable Interested Government Agency programs prior to applying for a New York Conrad Waiver.
North Carolina (HPSA)
Submission Information: Beginning October 1st until waivers are awarded.
Other Considerations: Candidate must apply to application Interested Government Agency programs prior to applying for a North Carolina Conrad Waiver. Additionally, The candidate and sponsoring facility must agree to accept Medicare/Medicaid.
North Dakota (HPSA, MUA, MUP)
Submission Information: Applications for North Dakota the Conrad Waiver is accepted from October 1st until slots are filled.
Ohio (HPSA, MUA, MUP)
Submission Information: Applications accepted October 1st. Primary care applications are reviewed in 45 days, other applications are reviewed in 90 days.
Other Considerations: Additionally Conrad Waivers are awarded with a preference for primary care physicians. A non-refundable application fee of $3,571. Candidate must apply to applicable Interested Government Agency programs prior to applying for an Ohio Conrad Waiver
Oklahoma (HPSA, MUA)
Submission Information: Applications are accepted throughout the year, starting October 1st.
Other Considerations: Equally important, Employers must submit a detailed report of recruitment for American physicians and retention plans for their foreign physicians.
Oregon (HPSA, MUA, MUP)
Submission Information: Applications are accepted throughout the year, starting October 1st until all Waivers are awarded.
Other Considerations: Priority is given to primary care physicians. Applications must be submitted with a $2,000 fee. Furthermore, Employers must show documentation of 6 months of recruitment efforts for American physicians.
Rhode Island (HPSA, MUA, MUP)
Submission Information: Primary care applications are reviewed from October to December.
Other Considerations: Preference is given to physicians who have completed residencies in Rhode Island. The applicant must show evidence of completion of two of the three of the following options: completion of four volunteer hours a month, certification with Medication-Assisted Therapy (MAT), or training with Culturally and Linguistically Appropriate Services (CLAS).
South Dakota (HPSA, MUA)
Submission Information: Applications are reviewed in the order they are received, beginning on October 1st.
Other Considerations: In addition, A non-refundable fee of $200 must accompany each application.
Tennessee (HPSA, MUA)
Submission Information: Priority is given to primary care physicians from October 1st through March 31st.
Utah (HPSA)
Submission Information: Applications are accepted from October 1st on a first-come, first-served basis.
Other Considerations: Employers must provide documented evidence of unsuccessful employment efforts for at least one year to recruit American physicians for the position. Additionally, Employers should provide a detailed statement for their plans to retain the physician beyond the 3-year obligation.
Submission Information: Applications are accepted from October 1st to September 30th.
Other Considerations: Priority is given to primary care physicians. Despite this, Employers must be able to document six months of unsuccessful recruitment.
West Virginia (HPSA, MUA, MUP)
Submission Information: Applications for the Conrad waiver are accepted from October 1st through September 30th.
Other Considerations: Physicians are subject to four-year contracts. Additionally, Employers must be able to document six months of unsuccessful recruitment.
Wisconsin (HPSA, MUA, MUP)
Submission Information: Applications are accepted from October 1st until all waivers are awarded.
Benefits of hiring on a Conrad J-1 visa
Sponsoring a foreign physician with a Conrad J-1 visa waiver opens up a new, talented pool of physicians for hospital and physician groups to hire. The legal process is multi-faceted and complex, and planning should begin more than a year before the actual hiring takes place. Therefore, Working with an experienced business immigration attorney can make the process more manageable and transparent.
Don’t miss your window of opportunity
The Conrad waiver application will take several weeks to several months to process at the state level. Therefore, If approval is recommended, the application is forwarded to the U.S. State Department’s J-1 Waiver Review Division (WRD) in Washington, DC. The WRD will take 8 to 12 weeks to conduct its review.
If approval is recommended by the WRD, the application is transferred to the U.S. Citizenship and Immigration Services (USCIS) for final processing of the J-1 Waiver. The sponsoring healthcare facility will then need to file an H-1B petition with USCIS to change the physician’s status from J-1 to H-1B Nonimmigrant Worker to facilitate the start of post-training work with the employer. Additionally, The physician must then serve out the 3 year period with the employer/J-1 Waiver sponsor in order to fully waive the 212(e) two-year home residency requirement.
Know optimal time to interview:
Interviewing foreign physicians will start the summer before expected graduation from residency/fellowship (for example, if a doctor will graduate in Summer ’17, candidates should be identified, ideally in Summer ’16—however new candidates may be secured any time before the 30 Conrad slots expire in the state);
Know when to file a waiver application:
J-1 Waiver Applications should be filed as close to the beginning of the filing window, usually in Sept. or Oct., as possible, however new filings can be made up to the expiration of the 30 slots depending on the rules of each State Program;
Factor in time for an H-1B Visa:
H-1B status must be obtained before the foreign physician can begin work at the facility – and note, a state medical license must be secured before the H-1B visa status can be issued by USCIS.
Allow enough time for State Dept. Review Board:
In order to make the July/August start date, employers will want to make sure the J-1 Waiver application has progressed to the State Department Waiver Review Division in the April to the early May timeframe.
For more information, you can download our 10-Page Guide for Healthcare Employers in Underserved Areas that we compiled using the questions about J-1 visas we hear most in our practice. Furthermore, If you have questions about your specific situation, contact our team of business immigration attorneys for a complimentary consultation today.
