Since at least 2013, there have been efforts to make the Conrad 30 J-1 visa waiver program for physicians permanent. But that has not happened and it continues to be necessary to reauthorize the program every year. This year, Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), Jacky Rosen (D-NV), Angus King (I-ME) and Charles Grassley (R-IA) have introduced a bill to improve and extend the program until 2021 – the Conrad State 30 and Physician Access Reauthorization Act. Without this extension, or some other extension, the program will end later this year.

The Conrad waiver program was first enacted in 1994 to permit states to recommend “J-1 waivers” for foreign physicians who have trained in J-1 visa status in the U.S. if those physicians were willing to remain in the U.S. and work in rural and/or underserved areas. The standard requirement that J-1 physicians must return to their home countries for a period of two years prior to obtaining H-1B visas or green cards could be waived in exchange for a three-year commitment to provide medical care in such areas. The waiver has thus allowed these physicians to apply for and obtain H-1B visas (or change of status to H-1B) as well as green cards without satisfying the home residence requirement. The waiver has been the quid pro quo for encouraging more physicians to serve in areas where medical care was lacking. The program currently allows for 30 waivers per state per year.

The physician shortage in the U.S. continues to grow and the Association of American Medical Colleges (AAMC) predicts that by 2030 there will be a shortage of up to 121,000 physicians. In a news release, Senator Collins said that the bipartisan reauthorization bill will promote “healthier lives” and that providing opportunities for American-trained and educated physicians is an imperative in areas where there is an unmet need.

The Conrad State 30 and Physician Access Reauthorization Act would:

  • Create additional waivers per state based upon various thresholds;
  • Add three waivers per state for academic medical centers;
  • Allow “dual intent” for physicians who come to the U.S. in J-1 status;
  • Allow spouses of doctors to work;
  • Create new employment protections for the physicians in the program; and
  • Streamline the green card process of participating physicians.

The legislation is endorsed by the American Medical Association (AMA), the American Hospital Association (AHA) and the AAMC. The AMA has indicated that it would also like to see legislation that would exempt foreign physicians who work in underserved areas or for the Veterans’ Administration for at least five years from the per country green card caps. Others would like to make all foreign physicians exempt from the annual H-1B cap. Currently, physicians who work for an institution of higher education, a non-profit entity affiliated with such an institution, a nonprofit research organization or governmental research organization, or a private employer but at a cap-exempt entity are exempt from the H-1B cap, but this does not cover all physicians.

As the physician shortage continues to grow in the U.S., employers, public officials, and those living in impacted areas may continue to call for facilitating an influx of foreign national, U.S.-trained physicians to meet community and patient needs and demands.

Jackson Lewis attorneys are available to assist in navigating J-1 waiver issues including applying for Conrad 30 waivers.


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Photo of Forrest G. Read IV Forrest G. Read IV

Forrest Read is a Principal in the Raleigh, North Carolina, office of Jackson Lewis P.C. He has extensive experience in both business immigration law and employment law and has particular focus in legal issues in graduate medical education (GME).

Mr. Read’s immigration practice…

Forrest Read is a Principal in the Raleigh, North Carolina, office of Jackson Lewis P.C. He has extensive experience in both business immigration law and employment law and has particular focus in legal issues in graduate medical education (GME).

Mr. Read’s immigration practice focuses on assisting employers in obtaining employment-based nonimmigrant visas (e.g., H-1B, L, O, TN) for foreign national employees and work-related immigrant (green card) visas, including PERM Labor Certifications, and advising employers on compliance with U.S. immigration laws and regulations. He has broad experience in advising large, mid-size and small employers on their various immigration needs and developing strategies to help them navigate through complex immigration issues. He also has particular experience in counseling employers in the health care industry and addressing immigration-related issues that arise for their broad range of health care professional employees (including advising on and obtaining employment authorization for medical residents and fellows and obtaining J-1 visa waivers for foreign national physicians completing their medical training in the United States). His immigration practice also includes defending employers in connection with Department of Labor H-1B and H-2B investigations.

Mr. Read’s employment law experience includes representing management, particularly academic medical centers in the GME context, in a wide array of workplace disputes and litigation before federal and state courts and administrative agencies, including matters related to discrimination, retaliation, harassment, disability, family and medical leave, various wage and hour issues, contracts, and intentional torts. He advises academic medical centers on the interplay between applicable academic law and employment law and the ramifications of what are divergent legal requirements and standards. Mr. Read also provides counsel with respect to the legal impact of competency standards for residents and trainees in GME, including situations involving discipline, remediation, and dismissal. He provides advice and guidance in the peer review process, including provision of verification and assessment of training in response to third party inquiries.

As a member of the Firm’s Corporate Diversity Counseling group, Mr. Read also has experience in providing assessments and making recommendations to corporate and institutional clients with respect to diversity and inclusion policies and initiatives, conducting related internal investigations, and shaping, developing and enforcing effective policies and initiatives to ensure consistency with client values and in furtherance of business goals and objectives.