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Everything you need to know about the J-1 visa waiver for physicians

The J-1 visa is a common choice for those opting to participate in programs that promote cultural exchange, especially in the medical field.

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The United States is a popular destination for physicians across the world looking to further their training and medical education. 

While there are other visas that may allow a foreign national to stay in the U.S., the J-1 visa is a common choice for those opting to participate in programs that promote cultural exchange, especially in the medical field.

Many individuals in the U.S. on J-1 visa, however, are subject to the two-year home residency requirement in order to adjust to permanent resident status or change to a non-immigrant status (such as H-1B or L1).

There are several conditions where the two-year home residency stay can be waived for physicians in the U.S. We’ll share here what those conditions are, as well as other important information that may help foreign nationals on a J-1 visa.

What is the J-1 visa program?

J-1 visa is for foreign nationals who wish to take part in work-and-study-based exchange and visitor programs in the U.S. There are several different J-1 visa programs, including a program for physicians. To get a J-1 visa, you must meet certain eligibility requirements and participate in a program through an approved sponsoring agency, organization, or institution.

Exchange visitors that are eligible for J-1 visa can include, but aren’t limited to:

  • Students

  • Research assistants

  • Teachers

  • Specialists

  • School counselors

  • Professors

  • Scholars

  • Au pairs

These public or private institutions are accredited through the Exchange Visitor Program designated by the U.S. State Department.

The J-1 exchange visitor visa program was created by the passage of the Mutual Educational and Cultural Exchange Act in 1961. This act, also known as the Fulbright-Hays Act, introduced the J-1 exchange visitor visa program to strengthen the relationships between the U.S. and other countries by allowing the exchange of cultures and educational opportunities. 

The J-1 exchange visitor visa program was originally administered by the U.S. Information Agency, but it now falls under the U.S. DOS.

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What is the J-1 visa program for physicians?

Through the J-1 visa program, eligible doctors can travel to the U.S. to complete graduate medical education or training programs. 

The program is administered through the State Department, which has designated the Educational Commission for Foreign Medical Graduates (ECFMG) as the sponsor for all physicians who hold J-1 visas to participate in clinical training programs in the U.S.

The ECFMG is responsible for monitoring the host institutions and the J-1 visa holders to ensure that they meet federal requirements. This program allows physicians from other countries to travel and live in the U.S. while they complete their graduate medical education or training. Once they have completed their programs, they may be subject to the two-year home-country residence requirement unless an exception applies that allows them to secure a J-1 visa waiver.

Eligibility for the J-1 physician visa

There are usually strict eligibility guidelines for physicians who want to participate in the J-1 visa exchange visitor program. Interested applicants may require completion of education and training in other countries to qualify for the programs for which they plan to attend in the U.S. 

Other requirements may include the following:

  • The ability to adapt to the cultural and educational environments of the programs

  • Have needs, experiences, and backgrounds that are suitable for the programs

  • Have English-language competency in written and oral communication

  • Pass qualifying examinations administered by the ECFMG

  • Provide a statement from their home countries that their countries requires the particular skills that the physicians wish to acquire

  • Have contracts or agreements from the host institution that are signed by the physicians and the officials responsible for the training or education

Applying for the J-1 visa for physicians

If you meet the eligibility requirements, you may need to be sponsored by the ECFMG to attend an approved host institution in the U.S. Usually, the ECFMG sponsors all J-1 clinical programs and advanced research for physicians in the J-1 visa program who have obtained certification.

To obtain the certification, the foreign national physician should, among other documents, pass the steps or exams required from the U.S. Medical Licensing Examination (USMLE).

According to the ECFMG website, these steps or exams may include the following:

  • USMLE Step 1 and Step 2 CK;

  • Visa Qualifying Examination (VQE);

  • The National Board of Medical Examiners (NBME) Part 1 and Part 2;

  • Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) examinations; or

  • Any acceptable combination of the above listed steps and exams. 

You may also be required to provide a statement of need from your home country’s health department and an offer letter from a training program provided by a U.S. host institution. Once the ECFMG verifies that you’ve met the requirements, you may be issued the Certificate of Eligibility (Form DS-2019).

This certificate may be presented to the U.S. consulate in your home country along with other supporting documents to receive your J-1 visa. You may also be required to show proof that you have an active medical insurance to cover your stay in the U.S. An applicant’s spouse and children will also be eligible for J-2 visas that allow them to travel with the applicant to the U.S. depending on the J-1 visa secured by the foreign national. These dependents may also be required to have active medical insurance for the duration of their stay in the U.S.

Proof of non-immigrant intent

To qualify for a J-1 visa as a physician, you may also be required to show the consular officer that you plan to return to your home country. As situations can vary, the specific evidence you may be required to provide may also differ.

Documents that prove property ownership, evidence of extensive family ties, and memberships in various organizations are examples of documents that may substantiate your claim that you are returning to your home country after you’ve finished your education.

Employment while on a J-1 visa status as a physician

Under the U.S. Code of Federal Regulations, J-1 visa holders who are physicians may not be allowed to have a second job in addition to their regular employment or work outside of their programs. You may receive compensation for work that you perform that is within your program as a curricular requirement. The work, however, usually has to fall within the scope of the program's curriculum. If you are participating in a program that does not include work, you may not be allowed to accept outside employment.

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The two-year home-country residence requirement

Foreign national physicians who come to the U.S. through the J-1 visa program for medical training or education are subject to the two-year home-country residence requirement, but there are some notable exceptions. 

The two-year home-country residence requirement typically means that once your program of study is complete, you may be required to return to your home country for a minimum of two years before you can travel to the U.S. on a different visa type. You must either fulfill this requirement or obtain a waiver of the home-residency requirement before you can apply for an H or L nonimmigrant visa or permanent resident status. 

If you came to the U.S. to consult, research, observe, or teach, the two-year home-country residence requirement may not automatically apply. However, you may be subject to it if your home country's government or the U.S. government were the ones providing financing for your visit. You may also be subject to the home-residence requirement if your field of study appears on your home country's exchange visitor skills list. You can check the list for your home country on the U.S. DOS website.

If you did not enter the U.S. for graduate medical education, you may be eligible to obtain a waiver by securing a "no objection" statement from your home country. You can learn more about that waiver process in detail here. 

J-1 waiver of the home-country residence requirement for physicians

Waivers for the two-year home-country residence requirement for physicians who attend graduate education or training in the U.S. may be available if you meet one of the following conditions:

  • Your U.S. or lawful permanent resident spouse or child would suffer an exceptional hardship.

  • You would be subjected to persecution based on your race, political opinion, or religion if you were forced to return to your home country.

  • A U.S. government agency requests a waiver for you because you are substantially and actively involved in an activity or program that is sponsored by or is of interest to the agency.

  • A state's Department of Public Health or its equivalent requests a waiver on your behalf.

If you receive a waiver based on the request of a state health department or government agency, you may be required to maintain full-time employment as a specialty employee for at least three years in a medically under-served area that has been designated as having a shortage of healthcare workers or in a facility for the Department of Veteran Affairs. Your employment must start within 90 days of the date you receive your waiver and be a minimum of 40 hours per week. Failure to comply with the waiver’s requirements may subject you to the two-year residency requirement.

After completing the three years of employment, you may then be eligible to obtain a change of status, such as an H-1B or a lawful permanent resident status.

What is a “medically underserved area”?

This is defined as an area with a shortage of healthcare experts and is usually in rural parts of the country. This may include areas with a shortage of mental health professionals or physicians.

Accepting the waiver typically means that the foreign national physician is ready to start work within 90 days of obtaining the waiver for a total of 40 hours a week within the designated facility. The minimum length of employment for the potential candidate is three years. 

Obtaining an IGA J-1 visa waiver

Foreign national physicians aren’t the only ones who are eligible to request an Interested U.S. Federal Government Agency (IGA) waiver, although it may be one of the most common waivers for foreign physicians who are subject to the two-year home-country residence requirement.

Interested applicants who are eligible for the J-1 waiver IGA are typically foreign medical graduates who are willing to be employed in a medically underserved area. Among the terms of this waiver may include that the physician has been extended full-time work within a healthcare facility that’s located in a medically underserved area.

The typical first step to obtaining an IGA J-1 visa waiver is to find a government agency that will sponsor you. It may not have to be the same agency for which you worked under your J-1 visa program. However, if the agency is different than the one through which your program was sponsored, you may need to reach out to it.

Most physicians usually obtain J-1 waivers by being sponsored by either a state Conrad 30 Waiver program or a federal agency.

You can complete Form DS-3035 through an online application, which is available on the U.S. DOS website.

After you complete the application, you may print it out in black and white ink together with the barcode. You may then mail the following five things:

  1. The completed Form DS-3035 application

  2. The application barcode

  3. Copies of all DS-2019/IAP-66 forms ever issued to you

  4. Two self-addressed, stamped envelopes

  5. The application fee of $120

If an exchange visitor is represented by an attorney, a Notice of Entry of Appearance as Attorney or Representative (Form G-28) may also be submitted. In some cases, the attorney or authorized legal representative may be the one filing the form.

Support for getting IGA J-1 waiver

Several factors may affect your application for IGA J-1 waiver:

Role or Involvement

The more critical the role a foreign national physician plays in a project, the more likely the employer may support the waiver application, which may also encourage support from the IGA. This may be shown through ongoing contributions, breakthroughs in research, publications, patents, and more. Strong recommendation letters may have a role in improving the interested applicant’s chances.

Timeline

If the foreign national physician is deeply involved in a project and his or her return to the home country will have a detrimental effect on the project, this may also support the waiver request.

What is the Conrad 30 Waiver program?

This program allows J-1 physicians to apply for a waiver for the two-year home residency requirement upon completing the J-1 program to address the shortage of medical professionals in underserved areas. 

Different rules and applications may apply to each state, although the general requirements typically remain the same.

According to the U.S. Citizenship and Immigration Services (USCIS) website, the J-1 physician should:

  • Agree to a full-time employment in H-1B nonimmigrant status at a designated health care facility

  • Provide an employment contract pertaining to the full-time work

  • Provide a “no objection” letter from the physician’s home country if the exchange program was funded by his or her home government

  • Start employment within 90 days of receiving the waiver

If the foreign national physician is interested in a waiver via the Conrad 30 Waiver program, he or she may first obtain sponsorship of a state health department and complete the U.S. DOS Form DS-3035, also known as the Visa Waiver Review Application. 

The waiver application is typically sent by the state public health department that agrees to sponsor the J-1 physician. This application is sent to the DOS Waiver Review Division (DOS-WRD) for recommendation.

Where to send the waiver application

According to the U.S. DOS website, you may use one of the following addresses to send your J-1 waiver application:

For postal service

Department of State J-1 Waiver

P.O. Box 979037

St. Louis, MO 63197-9000

For courier service

Department of State J-1 Waiver

P.O. Box 979037

St. Louis, MO 63101-1200

Supporting documents

After submitting the main application, other supporting documents may also be submitted by third-party organizations on your behalf. The specific documents and the third party who will submit them will depend on the basis on which you are requesting the waiver.

Below are the possible bases and their respective third parties:

  • Request by an IGA

    - the interested U.S. federal government agency

  • Persecution

    - USCIS

  • Exceptional hardship to a lawful permanent resident or U.S. citizen spouse or child

    - USCIS

  • Conrad State 30 Program

    - the designated State Public Health Department or its equivalent

You may also be required to submit some supplementary materials, including the following:

  • Resume

  • Signed statement that includes the date which will serve as a declaration and certification that you have obtained the cooperation of the agency that is submitting your request and that you do not have any pending requests to any other government agencies

  • Letter of request from the head of the sponsoring agency about the importance of waiving the two-year home-country residence requirement

  • Signed employment contract in which you agree to work for a minimum of three years for 40 hours per week in the designated health care facility

  • Proof that the designated facility is qualified by the U.S. Department of Health and Human Services (HHS)

The director of the facility may have to sign a declaration that the facility is in a medically underserved area. The letter usually has to state that medical care is delivered to uninsured patients and patients who receive Medicaid and Medicare. Additionally, the facility's statement may also contain some proof of its recruiting efforts to try to secure a qualified U.S. citizen for the position. If you would like to be represented by an attorney, you may need to submit Form G-28.

Third parties may send the supporting documents to:

Waiver Review Division U.S. Department of State CA/VO/DO/W SA-17, Floor 11 Washington, DC 20522-1711

This address may not be used when first submitting the waiver application and processing fee.

After you have completed the steps and provided all the required documents, your case may be considered by the Waiver Review Division. You may check the status of your waiver application online

How long do J-1 waiver processes take?

The processing time for a J-1 waiver request may vary depending on the basis on which you are applying the waiver. Typical durations range anywhere from 1 month to 6 months, although there may be discrepancies from case to case.

Immigration options after completing the home-country residence requirement or obtaining a waiver

After you have obtained a waiver or completed the home residency requirement, you may apply for an H-1B non-immigrant visa or status as a lawful permanent resident. As a physician, you can apply to become a permanent resident of the U.S. through the national interest waiver, the labor certification process, or as an alien of extraordinary ability. We break down how you transition from a J-1 to a Green Card in more detail here.

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