Insight

Waiver Programs for International Medical Graduates

Immigration lawyer Elizabeth L.A. Garvish offers an overview of the interested government agency waiver programs for international medical graduates.

People forming a circle with white cross in center
Elizabeth L.A. Garvish

Elizabeth L.A. Garvish

October 9, 2023 12:00 AM

There is an undeniable shortage of physicians in the U.S. Approximately 83 million people in the U.S. live in areas with limited access to primary care doctors. The Association of American Medical Colleges (AAMC) reports that the U.S. could see a shortage of up to 124,000 physicians by the year 2034.

Hospitals and medical practices increasingly rely on international medical graduates (IMGs) to fill their vacancies. IMGs are those physicians who have graduated from a non-U.S. medical school. If they desire to practice in the U.S., they must complete their residency and fellowship training in the U.S. There are two visa types (H-1B and J-1) used for IMGs completing these training programs, depending on the policies of the program. The J-1 visa requires that all IMGs return to their home country for two years after training. If they would like to stay and practice medicine in the U.S., they must obtain a waiver of the two-year residency requirement.

There are various ways to obtain a J-1 waiver, but here, we will focus on the Interested Government Agency (IGA) basis for waivers and outline the programs available to J-1 physicians. All programs require a service commitment in a health professional shortage area and an executed contract with an employer sponsor located in such an area.

Each program has its unique prerequisites, but a common requirement for all of them is that physicians must secure an offer of employment from a healthcare institution within the United States. This employment should involve full-time patient care for medically underserved populations. The healthcare facility's location must be in an area designated by the U.S. Department of Health and Human Services as a Health Professional Shortage Area (HPSA) and/or Medically Underserved Area/Medically Underserved Population (MUA/MUP).

Both the physician and the sponsoring facility must commit to maintaining the physician's employment in the shortage area for a duration of three years. This three-year service period must be completed by the physician while in H-1B status. After successfully fulfilling the three-year commitment, the J-1 physician's two-year home residency requirement is officially waived. At this point, the physician becomes eligible to apply for permanent resident status.

Here is an overview of the programs available:

Conrad 30 Waiver Program

Each State Department of Health in all 50 states administers its own program, granting up to 30 waivers for physicians each year. As a result, each state program has its own specific requirements, application process and timeline. The location of employment must be within the state sponsoring the waiver and must be within a federally designated HPSA or MUA/MUP. Many states receive more than 30 applications, and an increasingly diminishing number of states routinely do not utilize all 30 of their allotted waivers each year.

Further, states have the discretion to assign up to 10 of their 30 waivers annually to J-1 physicians whose location of employment is not within a HPSA or MUA/P if the physician will provide care to patients who reside in shortage areas (known as the “FLEX 10”).

U.S. Department of Health and Human Services (HHS) Waiver Program

Unlike Conrad 30, there is no limit on the number of available waiver slots. HHS waivers are open to physicians who intend to practice in primary care fields, including family medicine, general internal medicine, general pediatrics, obstetrics & gynecology and general psychiatry. These physicians must have completed their primary care or psychiatric residency training programs within 12 months before commencing employment with the sponsoring facility/institution. Consequently, specialists and many J-1 physicians with fellowship training are ineligible. Hospitalists do qualify in most cases if they meet the above requirements. Further, the sponsoring employer or facility must be located within a geographic area that has a HPSA score of seven or higher.

Appalachian Regional Commission (ARC) Waiver Program

To qualify for this program, sponsorship must come from a state within the Appalachian Region, which encompasses parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee and Virginia, as well as the entirety of West Virginia. The workplace location must fall within HPSA. Typically, priority is given to physicians planning to practice primary medical care. However, waiver applications for physicians intending to practice specialty medicine may be considered if they can demonstrate a compelling need. In both cases, the physician must have completed a residency in family practice, general pediatrics, obstetrics, general internal medicine or psychiatry. There is no limit to the waivers available each year.

Delta Regional Authority (DRA) Waiver Program

This program is available to facilities that qualify as HPSAs and MUA/MUPs and are within the Delta Regional Authority, which includes Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and Tennessee. This program grants waivers to primary care and specialist physicians, and there is no limit to the number of waivers that can be granted each year.

Southeast Crescent Regional Commission (SCRC) J-1 Waiver Program

This is one of the newest waiver programs to go into effect. IMGs must serve in HPSAs or MUA/MUPs that are located in the SCRC region, which is made up of specific areas of Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi and all of Florida. The program is open to primary care physicians and specialists. Physicians must provide care to the indigent, Medicaid and Medicare recipients. There is no limit to the number of waivers available each year. A filing fee of $3000 is required.

Veteran’s Administration J-1 Waiver Program

The Department of Veterans Affairs (VA) has the authority to request a waiver of the two-year home residency requirement for IMGs when there is a compelling need within a VA facility. The work may be related to patient care, research or teaching, and physicians are not required to work in medically underserved areas.

The sponsoring VA facility must demonstrate that there are no available and willing U.S. citizens or lawful permanent resident physicians to fill the position. They must also prove that they have made genuine recruitment efforts to find a qualified U.S. citizen or lawful permanent resident physician for the position. These efforts must be thoroughly documented, and there are specific requirements. The employment opportunity must constitute at least 5/8 of full-time employment within the VHA (Veterans Health Administration). If this criterion is met, the remaining portion of employment must involve a joint appointment with the VHA affiliate.

These stipulations ensure that the VA facility fully explores all avenues to locate qualified U.S. citizens or lawful permanent residents before pursuing a waiver for an IMG, particularly those possessing specialized expertise.

Conclusion

On a positive note, there are lots of options for IMGs to continue practice in the U.S. However, there continue to be substantial limitations for IMGs who have completed their medical residencies and fellowships in the United States and wish to continue their medical careers here. Each of the waiver programs mentioned earlier comes with its own set of restrictions. These restrictions range from annual caps on the number of available waivers (Conrad 30), limitations on the medical specialties in which physicians can practice (HHS) or requirements that the sponsoring facility be located in a specific state or region (ARC, DRA).

Due to the absence of a widely accessible and dependable pathway for IMGs to transition into practicing physician roles, the persistent shortage of physicians in the United States is likely to endure. In the interim, U.S. healthcare facilities and institutions are well-advised to carefully consider the options outlined above and the opportunities they offer when seeking to recruit urgently needed physician positions.

Headshot of woman with long dark hair

Elizabeth L.A. Garvish founded Garvish Immigration Law Group, LLC in 2011 with the mission to be the "Happiest Law Firm in America." In June 2022, Elizabeth was recognized as a Legal Innovator at the Daily Report’s Georgia Legal Awards and as one of Georgia's Titan 100. She is ranked in the 2023 Chambers USA Guide and was included in the 2023 LawDragon Inaugural 100 Leading Immigration Lawyers Guide. Elizabeth is a frequent speaker and presenter on U.S. immigration topics around the world. She is an active member of the American Immigration Lawyers Association (AILA), serving on various national committees as well as serving as the Past Chair of the Georgia-Alabama Chapter of AILA. egarvish@goimmigrationlaw.com

Headline Image: iStock/Prostock-Studio

Related Articles

How US Immigration Works: Everything You Need to Know


by Jennifer Verta

Explore the pathways, processes and evolving policies shaping U.S. immigration today.

Illustration of Immigrant Family Journey in Front of American Flag

IN PARTNERSHIP

Gonzalez Olivieri, LLC: An Immigration Firm You Can Trust


by Gonzalez Olivieri

Gonzalez Olivieri, LC has years of experience in immigration law specializing in helping businesses and families in Texas through complex legal proceedings.

A White Hand Holding a Stamp Above Papers on a Clipboard in Front of a Laptop

I-140 Petition


by Vivien Li and Elizabeth L.A. Garvish

I-140 petition requires financial ability to pay for small business, sole proprietor, household and other individual petitioners.

I-140 paper forms and money

IN PARTNERSHIP

Jan Pederson’s Immigration Career


by Wright, Constable & Skeen

Jan Pederson is an immigration law lawyer and partner at Wright, Constable & Skeen, where she has built a strong career working to obtain the best results for her clients.

Clock over image of person typing on computer

Changes to the New Form I-9 and Verification Process


by Nia Doaks

Best Lawyers: Ones to Watch® in America honoree Nia Doaks of Constangy, Brooks, Smith & Prophete offers guidance in navigating new Form I-9 changes.

I-9 Immigration Form with pen

Should We Eliminate the H-1B Cap?


by Roxanne H. Levine

The United States’ H-1B visa program has helped foster growth in the U.S. while also placing severe limitations on visas. It may be time to consider eliminating the program cap altogether.

Puzzle with people on it with one missing yellow piece

Compelling Circumstances EAD: A Pragmatic Policy Evolution


by Fariba Faiz

The article discusses the significance of the U.S. Citizenship and Immigration Services' Policy Alert PA-2023-18, which clarifies the criteria for obtaining Employment Authorization Documents (EADs) under category (c)(35) for foreign nationals facing compelling circumstances.

United States Employment ID and American Flag

Immigrant Survivors of Abuse: What Are Your Legal Options?


by Tracie L. Morgan

Immigrants who have survived abuse at the hands of their partners may not be aware of their legal options. Tracie Morgan, seasoned immigration attorney, explains more.

Illustration of woman hanging head in sadness against red backdrop

Domestic Visa Renewal


by Tiffany Derentz

Domestic visa renewal is a game-changer, but it will take time and resources.

Man sitting on paper airplane connected to a start button being pressed by hand

IN PARTNERSHIP

The Current Situation for Asylum Seekers in the U.S.


by Murali Bashyam and Allison Lukanich

The U.S. asylum system has a staggering over 1.3 million cases pending before immigration courts and the government must distribute more resources to aid this watershed and resolve asylum claims faster.

Shadow of person standing by broken chain link fence

Do I Really Need an Immigration Attorney? Key Factors to Consider


by Best Lawyers

Immigrating to the U.S. can be a complex and lengthy experience. In this article, Best Lawyers evaluates how an immigration attorney can help along the way.

Department of Homeland Security logo with American flag in the backdrop

The Day-To-Day of an Immigration Lawyer in the U.S.


by Best Lawyers

In this article, Best Lawyers takes a glimpse into the day-to-day life of an immigration lawyer, what roles they must take on and how their assistance may be critical to the outcome of a case.

Two U.S. flags surround gold text and official seal

Maximizing Your Chances of Approval with an Immigration Attorney


by Best Lawyers

Immigrating to a new country is often a complex, arduous and sometimes costly process. To maximizing your chances of approval on your immigration journey, seek the counsel of an experienced immigration attorney.

View of Statue of Liberty with birds in backrop

Same-Sex Couples and Marriage Visas: Everything You Need To Know


by Elizabeth Hagearty

All marriages are considered equal under U.S. law. Here’s what that means for LGBTQIA+ immigrants.

Pride flag, finger and visa document

IN PARTNERSHIP

Elevating Our Cases Into Causes


by Justin Smulison

Two female attorneys

IN PARTNERSHIP

Federal Employee Advice: I’ve Been RIF’d. Now What?


by Bernabei & Kabat

What to do after a Reduction in Force

Two toy people being held in the palm of someone's hand above a group of other toy people

Trending Articles

Introducing the 2026 Best Lawyers Awards in Australia, Japan, New Zealand and Singapore


by Jennifer Verta

This year’s awards reflect the strength of the Best Lawyers network and its role in elevating legal talent worldwide.

2026 Best Lawyers Awards in Australia, Japan, New Zealand and Singapore

Effective Communication: A Conversation with Jefferson Fisher


by Jamilla Tabbara

The power of effective communication beyond the law.

 Image of Jefferson Fisher and Phillip Greer engaged in a conversation about effective communication

The 2025 Legal Outlook Survey Results Are In


by Jennifer Verta

Discover what Best Lawyers honorees see ahead for the legal industry.

Person standing at a crossroads with multiple intersecting paths and a signpost.

The Best Lawyers Network: Global Recognition with Long-term Value


by Jamilla Tabbara

Learn how Best Lawyers' peer-review process helps recognized lawyers attract more clients and referral opportunities.

Lawyers networking

Jefferson Fisher: The Secrets to Influential Legal Marketing


by Jennifer Verta

How lawyers can apply Jefferson Fisher’s communication and marketing strategies to build trust, attract clients and grow their practice.

Portrait of Jefferson Fisher a legal marketing expert

Is Your Law Firm’s Website Driving Clients Away?


by Jamilla Tabbara

Identify key website issues that may be affecting client engagement and retention.

Phone displaying 'This site cannot be reached' message

A Guide to Workers' Compensation Law for 2025 and Beyond


by Bryan Driscoll

A woman with a laptop screen reflected in her glasses

Best Lawyers Launches CMO Advisory Board


by Jamilla Tabbara

Strategic counsel from legal marketing’s most experienced voices.

Group photo of Best Lawyers CMO Advisory Board members

Common Law Firm Landing Page Problems to Address


by Jamilla Tabbara

Identify key issues on law firm landing pages to improve client engagement and conversion.

Laptop showing law firm landing page analytics

Changes in California Employment Law for 2025


by Laurie Villanueva

What employers need to know to ensure compliance in the coming year and beyond

A pair of hands holding a checklist featuring a generic profile picture and the state of California

New Employment Law Recognizes Extraordinary Stress Is Everyday Reality for NY Lawyers


by Bryan Driscoll

A stressed woman has her head resting on her hands above a laptop

Turn Visitors into Clients with Law Firm Website SEO That Converts


by Jamilla Tabbara

Learn how to create high-converting law firm landing pages that drive client engagement and lead generation.

Laptop screen displaying website tools to improve client conversion rates

SEO for Law Firms: Overcoming Common Challenges


by Jamilla Tabbara

Tackle common SEO challenges and take the next step with our guide, How to Make Your Law Firm Easier to Find Online.

Graphic image of a phone displaying SEO rankings, with positions 1, 2 and 3 on the screen

6 Steps to Finding the Right Keywords for Your Legal Content


by Jamilla Tabbara

Follow a practical guide to keyword research and boost your law firm’s SEO to reach more potential clients.

 letters symbolizing keywords for legal content

Is Your Law Firm Missing Key Client Acquisition Opportunities?


by Jamilla Tabbara

Discover our free resource to identify ways to stand out and attract more clients.

Arrows and light bulbs rising, symbolizing growth and client acquisition opportunities for law firms

Why Mobile Optimization for Legal Websites Is Essential


by Jamilla Tabbara

Mobile optimization helps law firms build credibility, connect with clients and improve digital marketing.

A group of mobile devices with websites perfectly optimized for smaller screens.

This article is a part of the Best Lawyers Immigration Law Legal Guide. Read thought leadership from recognized lawyers and navigate a list of all honorees in the associated practice areas.

Explore the Legal Guide