United States: Filling Staffing Needs: Can Foreign Physicians Save The Day?

Last Updated: February 11 2014
Article by Catherine V. Wadhwani and Matthew J. Redding

First Quarter 2014

The Patient Protection and Affordable Care Act (the Affordable Care Act) contains a number of provisions aimed at increasing access to health care insurance to millions of Americans without coverage. This increased access to health care insurance will lead to an increased demand for physician services. In order to provide for the increase in physician demand, the Affordable Care Act introduced a number of incentives aimed at increasing the number of physicians in the workforce, including modifying federal Medicare payments for medical residency training, authorizing additional funding for medical residency training, and offering additional loan forgiveness and scholarship programs for medical students. While these incentives may eventually increase the output of physicians in the workforce, the shortage of physicians available is a current problem.

Medical practices, hospitals and other health care employers should affirmatively seek options to address the increased patient expectancy before it becomes an overwhelming concern. One viable option these employers should consider is sponsoring foreign physicians through a J-1 Waiver Program. This article provides a brief overview of the requirements.

An Option for Meeting Increased Patient Demands

With the anticipated increase in demand for physician services, one way for some physician employers to meet patient demand is to consider sponsoring a J-1 Exchange Visitor physician who is completing graduate medical education and training in the U.S. In a patient-care context, this may be a good option for health care providers who treat underserved patient populations.

There are many means by which an employer may sponsor a foreign physician for employment, and in some cases, very highly qualified physicians may self-petition for U.S. permanent residence. With regard to certain J-1 Exchange Visitor physicians, there is an option which requires the physicians to commit to full-time practice for at least three years in a shortage area(s) or providing services to medically underserved patients.

Employing a foreign physician through this option can help meet patient demand and provide consistency of care over the three-year commitment period. Further, during that time the physician may become well established in the area and agree to stay beyond the three-year commitment. This can greatly benefit the underserved patient population as well as bring much-needed relief to a busy practice where existing doctors often have stressful schedules.

Sponsoring a J-1 Physician

A foreign physician who completes graduate medical education and training in J-1 Exchange Visitor status under an ECFMG-sponsored (Education Commission for Foreign Medical Graduates-sponsored) program is subject to a 2-year home-presence requirement. This means that after completing training, the J-1 physician is obliged to return to his or her home country for a two-year period before being permitted to change status to H-1B or L-1 in the U.S. or obtain U.S. permanent residence (i.e., a "greencard").

Recognizing long ago that there are many areas of the country in need of highly trained physicians, Congress provided for J-1 Exchange Visitor physicians to be absolved of the two-year home presence requirement in exchange for providing care on a full-time basis to patients in areas that have been designated by the U.S. Health and Human Services agency as medically underserved or to patients who are underserved. As mentioned, the commitment is for at least three years. Approval of a J-1 Waiver application means that the two-year home presence requirement of the J-1 Exchange Visitor physician is "waived", i.e., the foreign physician is the beneficiary of a "J-1 Waiver".

There are many J-1 Waiver programs available for clinical care, including the Conrad State 30 program, as well as programs such as the Appalachian Regional Commission and Delta Regional Authority programs. There are of course other types of waiver opportunities such as Health and Human Services clinical and non-clinical waivers, Veterans Administration waivers and waivers through other government agencies, but those listed are among the most commonly used for physicians who will engage in clinical care for patients. It should be noted that some programs are limited to specific geographic areas and/or practice types. There are also a few waiver options which do not require a shortage-area commitment of the foreign physician, including persecution waivers and hardship waivers.

What Are the J-1 Waiver Requirements?

There are various options for obtaining a J-1 Waiver. One of the most widely used J-1 Waiver programs is the Conrad State 30 program. Under this program, the basic requirements are as follows:

  • Contract between the waiver sponsor and the physician for full-time patient care for at least three years
  • Full-time work in a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA) or serving a Medically Underserved Population (MUP)
  • Agreement to commence work within 90 days of receiving the waiver

These are the basic requirements under the Conrad State 30 J-1 Waiver Program. There may be, and typically are, additional requirements dictated by each state health department, such as documentation of the need for specialty medical care if a specialist is being sponsored, etc. The requirements vary from state-to-state and are sometimes revised.

Further, although the minimum J-1 waiver commitment is for a three-year period, if extenuating circumstances arise through no fault of the foreign physician, it is possible that the foreign physician may transfer to a different shortage-area employer.

In addition, it should be noted that the rules and requirements are different in the other J-1 Waiver Programs, which are too diverse to be appropriately addressed in this article.

What Are the J-1 Waiver Processing Steps?

Processing steps vary slightly among the different J-1 Waiver programs. By way of example, a J-1 Waiver Application under the Conrad State 30 program is first filed by the waiver sponsor (prospective employer) with the state health department in the state where the physician will provide patient care. To be clear, the employer seeks the J-1 waiver on behalf of the foreign physician, so the responsibility for filing the waiver application is the prospective employer's.

If the state health department supports the placement of the J-1 physician with the waiver sponsor, the state health department will forward the J-1 Waiver Application to the U.S. Department of State (DOS) Waiver Review Division with a request that it recommend to the U.S. Citizenship and Immigration Service (USCIS) a waiver of the J-1 Exchange Visitor physician's two-year home-presence requirement.

The DOS Waiver Review Division will review the J-1 Waiver Application anew, typically taking four to eight weeks for processing. If DOS agrees with the placement, it will forward the J-1 Waiver Application to USCIS with a favorable recommendation.

USCIS will conduct final processing of the J-1 Waiver Application. Generally, USCIS will take about a month to issue a decision, but processing times may change over time.

With the issuance of an approval notice, the J-1 Physician's two-year home-presence requirement is "waived", but still requires at least three years of work in H-1B status to meet the J-1 Waiver commitment.

When Can the Doctor Begin Working?

While approval of a J-1 Waiver application absolves the J-1 Physician of his or her home-presence requirement, it does not provide the physician with a right to remain in the U.S. nor with authorization to work toward completion the three-year J-1 Waiver commitment. A work-authorized status must be secured.

In the example of the Conrad State 30 Waiver, in order for the waivered physician to begin working toward completion of the three-year J-1 Waiver commitment, the sponsoring employer should file a petition for H-1B status on behalf of the physician. Note that the H-1B petition is the prospective employer's petition. Pursuant to Department of Labor Regulations, the employer may not require the foreign physician to pay legal fees or related expenses, nor recoup these from the foreign physician in any manner. When H-1B status is in place (i.e., an I-94 record has been created confirming the physician's H-1B status), the physician may report
for employment.


The Affordable Care Act's expansion of health care insurance availability will magnify the need for additional physicians in the workforce to meet patient needs. Practices, hospitals and other employers of physicians should affirmatively consider their options to handle the expected increase in their patient base. An attractive option that may be unknown to many employers is sponsorship of a foreign physician through a J-1 Waiver program.

Health care employers with underserved patients may find that sponsoring a J-1 Exchange Visitor physician may be just what the doctor ordered to meet burgeoning patient requirements expected to result from the enactment of the Affordable Care Act. With the help of experienced immigration and contract law counsel, the process should go smoothly and result in benefit to underserved patient populations, the sponsoring employer and the foreign physician.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Catherine V. Wadhwani
Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions