Immigration: Foreign Physicians and the J-1 Visa Waiver Program

Publication Date: June 2004

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health; Population and demographics

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Abstract:

The Educational and Cultural Exchange Visitor program has become a gateway for foreign medical graduates (FMGs) to gain admission to the United States as nonimmigrants for the purpose of graduate medical education and training. The visa most of these physicians enter under is the J-1 nonimmigrant visa. Under the J-1 visa program, participants must return to their home country after completing their education or training for a period of at least two years before they can apply for another nonimmigrant visa or legal permanent resident (LPR) status, unless they are granted a waiver of the requirement.

Many FMGs are granted waivers of the two-year home residency requirement and, thereby, are able to remain in the United States to practice medicine. Under current law, such waivers can be requested by interested government agencies (IGAs). Any federal agency or state health department may act as an IGA on behalf of a J-1 physician. In return for sponsorship, the FMG in most cases has to agree to practice as a primary care physician in a designated medical shortage area for a specific period of time.

The J-1 visa waiver program has recently undergone significant change. In February 2002, the United States Department of Agriculture (USDA), which had historically been the largest sponsor of waivers, decided to end its participation as an IGA. This development and the pending expiration of the “Conrad 20” program, which allowed 20 waivers per state, threatened the continued availability of waivers. These issues raised concerns among many in medically underserved areas because it is often difficult for them to find U.S. medical graduates willing to practice in these areas. Bills introduced in the 107th Congress proposed changes to the “Conrad 20” program, including expanding the program and making it permanent.

In an effort to ensure the continued availability of medical care in underserved areas, the Department of Health and Human Services (HHS) announced it would assume USDA’s role as a sponsor of J-1 primary care physicians. This was a policy change for HHS which has historically been very restrictive in its sponsorship of waivers. Prior to this announcement, HHS had limited sponsorship to research physicians and scientists involved in research of international or national significance.

On November 2, 2002, the “Conrad 20” program was extended until 2004 and the number of waivers available to states was increased to 30. This program, which is now referred to as the “Conrad 30”or “State 30" program, expired on June 1, 2004. Two measures, H.R. 4156/S. 2302 have been introduced in the current Congress to address this issue. H.R. 4156/S. 2302 would extend the program until June 1, 2009; allow state public health departments to identify shortage areas; and make waiver recipients of state sponsored waivers exempt from the annual H-1B numerical limit of 65,000. H.R. 4453, which was reported favorably by the House Subcommittee on Immigration, Border Security, and Claims on June 3, 2004, would extend the “Conrad 30" program for one year, and make physicians exempt from the H-1B cap.