Exchange visitor (J) visas are non-immigrant visas for individuals who have been approved to participate in exchange visitor programs in the United States. Exchange visitors are subject to the two-year home-country physical presence requirement, which means they must return to their home country for at least two years after completing their residency. Visitors who are unable to fulfill the home country presence requirement may apply for a waiver. There are several J-1 waiver application pathways, as outlined below.
Conrad 30 Waiver Program
In 1994, Senator Kent Conrad from North Dakota introduced a bill to tackle physician shortages in rural and urban areas of the United States. The law allows each state’s department of health to sponsor up to 30 IMGs per year for waiver of the J-1 two-year home-country residency requirement.
To receive a J-1 residency requirement waiver, you must serve in a federally designated shortage area. Every state has different timelines, but generally applications are accepted starting October 1 (about nine months before the job starts). The application process requires you to search for a job and then negotiate and sign the contract by this date. For example, if you are looking for a job in 2024, you should try to sign a contract by October 1, 2023.
In most states, psychiatry is considered as part of primary care. To fulfill the waiver program requirements, you need to work 40 hours/week for three years.
The U.S. Department of Health and Human Services (HHS) assigns HPSA (Health Professional Shortage Area) scores to every geographic area in the country, using data from the National Provider Identifier (NPI), the U.S. Census Bureau, the Centers for Disease Control and Prevention’s National Vital Statistics System, and the Health Resources and Services Administration’s Uniform Data System. A higher HPSA score means a more severe shortage, and thus higher priority is given to that area.
Flex spots are available (maximum 10 out of 30) for areas that do not qualify as an HPSA but still address underserved populations.
Interested Government Agencies
Interested government agencies (IGAs) are authorized to hire an IMG subject to the two-year home-country residency requirement. Current IGAs hiring IMGs include the following:
- Appalachian Review Commission
- Department of Veterans Affairs
- Health and Human Services
Source: Appalachian Regional Commission, J-1 Visa Waivers
Delta Regional Authority
The Delta Doctors Program helps provide critical medical services in areas with a perennial physician shortage. The Delta Regional Authority (DRA), which includes Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and Tennessee, can recommend J-1 visa waivers to the U.S. Department of State.
Source: Delta Regional Authority Delta Doctors
Pathways to Permanent Residency
The EB-1 visa covers a category of employment-based permanent residency in the United States that is reserved for individuals who have demonstrated extraordinary ability in their field or are outstanding professors or researchers. The eligibility criteria for each category are as follows:
EB-1A — Extraordinary Ability: To qualify for the EB-1A visa, you must demonstrate extraordinary ability in your field of endeavor. This is typically demonstrated through sustained national or international acclaim in your field, as evidenced by extensive documentation such as publications, awards and other forms of recognition. You must also demonstrate that your work will continue to benefit the United States.
EB-1B — Outstanding Professors and Researchers: To qualify for the EB-1B visa, you must demonstrate that you are an outstanding professor or researcher. This is typically demonstrated through evidence of recognition for your work in your field, such as awards or publications. You must also demonstrate that you have at least three years of experience in teaching or research in your field and that you will continue to work in your field in the United States.