International Medical Graduates (IMGs) often obtain J-1 visas to enter the US for residencies and fellowships. Such IMGs must return to their home country for a minimum of two years once their training is completed. Generally, IMGs who complete a US medical residency or fellowship program are subject to this requirement and must either return to their home country for two years at the conclusion of their J-1 program or apply for a waiver of the home residency requirement. Without satisfaction or waiver of this requirement, the J-1 exchange visitor will be unable to change status within the U.S. to most other statuses, obtain an H, L, or K visa in most cases, or obtain US permanent residence.
J waivers for physicians are generally sponsored by an Interested Government Agency (IGA), either a state Conrad 30 program or a Federal agency.
The Conrad 30 State program provides waivers for J-1 physicians subject to the two year residency requirement due to their participation in graduate medical education. These waivers are available for doctors who agree to work in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs) for a minimum of three years. The Conrad waiver program makes it possible for every state (as well as the District of Columbia, Puerto Rico, and Guam) to sponsor up to 30 J-1 physicians per fiscal year. The program has been essential in reducing severe physician shortages in underserved areas. Every state may request a waiver for a clinician who agrees to practice full-time for three years in an underserved area as designated by the US Department of Health and Human Services.
There are also a few IGAs that similarly sponsor J-1 physicians to work in shortage areas such as the Delta Regional Authority, the Appalachian Regional Commission, the U.S. Department of Health and Human Services (clinical waiver), the Department of Veterans Affairs, the Southeast Crescent Regional Commission and the Northern Border Regional Commission. The state or the IGA will forward its waiver recommendation to the Department of State who will grant or deny the waiver.
A smaller number of J waivers are obtained if it can be shown that the physician would be subject to persecution in their home country on account of their race, religion, or political opinion. A doctor may also receive a waiver by demonstrating that their US citizen or lawful permanent spouse or children would suffer “exceptional hardship” if they were forced to return to their home country for two years. The no-objection waiver is not available for J-1s engaged in graduate medical education.
A J-2 waiver is also available directly through the Department of State if the J-1 spouse dies, the J-1 and J-2 spouses divorce, or the J-2 child turns 21.
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