J-1 Waivers For Doctors To Provide Medical Services In Underserved Areas or at VA Hospitals

Physicians who receive clinical medical residency training in the U.S. through a J-1 exchange visitor visa are required to return to their home country for two years before they are eligible to apply for an H-1B visa or permanent residency in the United States. Physicians with a J-1 visa may waive this two-year home requirement if they agree to provide medical services in a designated underserved area or at a Veterans Administration hospital.

Obtaining a J-1 waiver is a three-step process. The first step is to obtain a recommendation for a waiver from an interested government agency (IGA) or interested state agency. This recommendation is then forwarded to the United States Department of State Waiver Review Division in Washington, D.C., which issues its recommendation to the U.S. Citizenship and Immigration Services (USCIS).  The USCIS then approves the Application to Waive Foreign Residence Requirements through a Form I-612.

The federal agencies which most often act as IGAs include the Appalachian Regional Commission (ARC), which recommends waivers for shortage areas in specified counties within the Appalachian region states, and the Veterans Administration (VA), which recommends waivers for physicians to work in Veterans Administration hospitals (which may or may not be located within designated shortage areas). Any federal agency may sponsor a waiver, but these two are the most widely used. On December 19, 2002, the Department of Health and Human Services (DHHS) became an IGA for purposes of processing waivers that are based upon delivering medical services in designated underserved areas in rural or urban settings.

The United States Congress allowed all states (as well as the District of Columbia and certain territories, such as Puerto Rico and Guam) to act as interested state agencies (State 30 Program), recommending up to thirty (30) waivers for J-1 physicians per state each fiscal year. These waiver recommendations are available in addition to any VA, ARC or DHHS waivers that may be issued for locations within that state. Despite this authority, not all states have chosen to create a State 30 Program.  Some states that did not have a program are creating programs in response to the U.S. Department of Agriculture's closure in February 2002.

In order to qualify for a waiver through any program (except the VA program), the intended practice site must be located in a federally designated shortage area.  This means a Mental Health or Primary Care Health Professional Shortage Area (HPSA) or a federally designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP). While the HPSA designation is universally accepted, certain states do not recognize the MUA/MUP designation. Both HPSA and MUA/MUP areas are designated by the U.S. Department of Health and Human Services, but the methods to determine which areas are underserved differ.

The ARC program is limited to physicians who have completed residency training in a primary care field, which is generally defined as internal medicine, family practice, general practice, pediatrics, general psychiatry or obstetrics and gynecology, and the physician must agree to practice such primary care. Regulations in certain states preclude participation in a waiver program if subsequent fellowship training was received, even where it is intended that primary care be practiced exclusively in order to meet the waiver obligation. In contrast, the VA and certain State 30 programs may recommend waivers for physicians to practice a primary or subspecialty care to serve the waiver commitment.