HHS Expands J-1Waiver Program to Include

Physicians Practicing in Shortage Areas

On December 19, 2002, the Department of Health and Human Services issued an announcement through the Federal Register that it will serve as an Interested Government Agency (IGA) in recommending waivers of the two-year home residence requirement for physicians willing to serve in areas that do not have adequate medical coverage. HHS currently acts as an IGA in recommending waivers for outstanding scholars involved in biomedical research of national and international significance. It will now expand the waiver review program to include primary care physicians practicing in Health Professional Shortage Areas (HPSA), Medically Underserved Areas (MUA), and serving Medically Underserved Populations (MUP).

International medical graduates who enter the United States to seek graduate medical education on J-1 visas are automatically subject to the two-year home residence requirement, which obligates them to return to their home countries for at least two years before they can be eligible for most employment-based visas or permanent residence. A physician who is subject to the two-year requirement may, under certain limited circumstances, obtain a waiver of this requirement. One way of obtaining a waiver is to seek a recommendation of an IGA. In the past, the U.S. Department of Agriculture (USDA) has been active in recommending waivers for physicians practicing in rural underserved areas, recommending the highest number of waivers, compared to all other IGAs. On April 16, 2002, USDA terminated the waiver program, citing reasons such as inability to ensure compliance.

HHS has now announced that it will request waivers for physicians willing to provide primary care services in HPSAs, MUAs, and serving MUPs. This program does not supercede the already existing Conrad State 30 program, where participating states sponsor up to 30 physicians per year for waivers of the two-year requirement. Rather, the new HHS program has been created to add to the Conrad program, which can only sponsor a limited number of physicians and has left a significant gap in ensuring adequate and continuous medical coverage in underserved areas.

HHS has advised that it would recommend waivers only for physicians who practice primary care medicine (defined to include general internal medicine, pediatrics, family practice or obstetrics/gynecology) willing to work in HPSAs or MUA/Ps, and general psychiatrists willing to work in Mental Health HPSAs. It encourages J-1 physicians to apply early and states that it will not consider waiver applications for physicians who have finished their residency training more than 12 months prior to commencement of employment in an underserved area. In other words, HHS wishes to ensure that physicians applying for waivers possess current training in a primary care discipline. As most waiver programs, HHS requires demonstration that a good-faith recruitment for a U.S. physician was completed and that the J-1 physician is committed to work in the underserved community for at least three years, 40 hours per week.

This is an extremely positive development for international physicians seeking to remain in the United States after the completion of their medical training. It also gives hope and promise to those medically underserved areas that are struggling to attract qualified physicians into their communities.