Employing Foreign Physicians Pursuant to the Conrad 30 Program
If a foreign national physician is subject to the two-year home country physical presence requirement due to having entered the United States on a J-1 visa for the purpose of obtaining graduate medical education or training, an Interested Government Agency (“IGA”) waiver known as a Conrad 30 program may be the only option to stay in the U.S. and seek H-1B temporary worker status and/or permanent residence.
In assessing whether the program is a viable option, the proposed employer must qualify as part of a Medically Underserved Area and Medically Underserved Population (“MUA”/”MUP”) or Health Professional Shortage Area (“HPSA”).
MUA/MUPs have shortages of primary medical care, dental or mental health providers and may be geographic (by county or service area) or demographic (e.g., low income, Medicaid-eligible, culturally and/or linguistically impeded access to primary medical care services). Each is assigned an Index of Medical Underservice (“IMU”) score, which is used to determine the eligibility of an area or population for MUA/MUP status. The Score is 0 to 100, with 0 being completely underserved, and 100 being completely served. The database for determining MUAs and MUPs is available at http://muafind.hrsa.gov/.
HPSAs have shortages of primary medical care, dental or mental health providers and may be geographic, demographic, or institutional (comprehensive health center, federally qualified health center or other public facility). They are scored from 2 to 26, with 2 being the highest need. The database for determining HPSAs is available at:
Census Tract information to determine where an employer is located is available at: http://www.ffiec.gov/Geocode/default.aspx.
HPSA/MUAs can lose their designation if they become saturated markets, so it is wise to check with the Shortage Designation Branch before proceeding further.
Another consideration in determining whether the Conrad 30 program is a possibility is to find out whether the foreign physician received funding from his/her home government to pursue medical training in the U.S. If s/he did, a no-objection statement from his/her home country will be required. That statement must conform with Department of State regulations and specify that it is being furnished pursuant to Public Law 103-416.
In the State of South Carolina, all waiver applications must have the prior approval of the South Carolina Department of Health and Environmental Control, Office of Primary Care. South Carolina will sponsor up to thirty (30) waivers for foreign physicians per federal fiscal year. All physician specialties are eligible for consideration. All employers must be pre-approved by the Primary Care Office (“PCO”) and assigned a J-1 waiver slot before a waiver application will be accepted for processing.
Applicant employers may request a slot assignment at any time. Applicant employer eligibility requirements are as follows:
- Employers can be, but are not limited to, publicly funded health care facilities or private entities.
- The health care facility must be located in a federally designated shortage area or must serve an underserved population.
- A facility must currently accept Medicare and Medicaid assignment and have an approved arrangement for treating indigent, uninsured patients.
- A facility must have been providing care for a minimum of twelve (12) months in the state of South Carolina prior to submitting its request.
Upon receipt of a slot assignment, the facility should assemble the J-1 Waiver application according to instructions available at:
If additional information is required by the State of South Carolina, that information will be specified by the Office of Primary Care and communicated at the time of the slot assignment. The following is required in assembling the J-1 Waiver application:
- Physicians need to submit the Department of State data sheet and processing fee to the U.S. Department of State (“DOS”) in order to establish a case number prior to submission of applications to the South Carolina Department of Health and Environmental Control (“DHEC”).
- DHEC will complete an initial review of the application within ten (10) working days of receipt.
- All incomplete applications will be returned to sender.
- Upon approval, DHEC will forward the waiver application to the U.S. Department of State (DOS). The DOS must approve the application before it is sent to U.S. Citizenship and Immigration Services for final approval.
- DHEC will send a copy of its support letter to the physician when the application is forwarded to the DOS.
- Application status can be tracked at the DOS using this link: http://j1visawaiverstatus.state.gov/
In the State of Georgia, waiver support is based on, but not limited to: 1) compliance with State and Federal laws and regulations; 2) need for service; 3) community support for the placement; 4) employer’s commitment to treating patients regardless of their ability to pay; 5) physician’s intent to work long-term in a designated HPSA or MUA; and 6) effect of placement on other Georgia programs and policies. The thirty (30) waiver slots are limited annually as follows:
> 8 slots per medical specialty or position type
< 4 slots per employer/facility (teaching hospitals are exempt from this limit)
Up to ten (10) of the thirty (30) waivers may be allotted to physicians not located in federally-designated shortage areas if they serve patients who reside in federally-designated shortage areas.
Applicant employers must:
- Be located in a currently designated HPSA, MHPSA, or MUA.
- Be currently in operation or ready to operate at the time the J-1 physician commences employment.
- Use a schedule of fees consistent with locally prevailing rates and designed to cover the site’s reasonable costs of operation.
- Do not discriminate in the provision of services to an individual (i) because the individual is unable to pay; (ii) because payment for those services would be made under Medicare or Medicaid/PeachCare for Kids; or (iii) based upon the individual’s race, color, sex, national origin, disability, religion, age, or sexual orientation.
- Charge indigent patients on a sliding discounted fee schedule based on current federal poverty guidelines and post notice of availability where patients can easily see it;
- Accept assignment for Medicare beneficiaries and enter into an agreement with the Georgia Department of Community Health to provide services to Medicaid/PeachCare for Kids beneficiaries.
- Make a good faith effort to recruit for a U.S. citizen/permanent resident prior to signing a contract with a J-1 physician and submitting a J-1 visa waiver application.
- Agree to sponsor the J-1 physician’s H-1B visa for three years and to execute an employment contract consistent with all GA 30 policy requirements.
- Agree to submit a completed Placement Verification Form to State Office of Rural Health (“SORH”) within 30 days after employment commences.
- Agree to submit semiannual reports as directed by SORH throughout the three-year obligation.
- Agree to notify SORH, in writing, of any change in the employment contract within 30 days of said change and of any pending complaints concerning the J-1 physician with the Georgia Composite Medical Board or the Georgia Department of Community Health, as applicable.
- Agree to participate in site visits by SORH staff.
Application contents and assembly instructions are described at:
A Conrad 30 waiver temporarily lifts the two (2)-year home residency requirement so that the sponsoring employer can petition to U.S. Citizenship & Immigration Services (“USCIS”) for H-1B Temporary Worker status for the foreign physician. Failure of the foreign physician to finish out the employment contract will result in the home residence requirement being reinstated. A foreign medical graduate who is granted a waiver under Pub. L. 103-416 and who does not fulfill the requisite three (3) year employment contract or otherwise comply with the terms and conditions imposed on the waiver is ineligible to apply for a change to any other temporary visa status.