All J-1 resident and fellow physicians sponsored by ECFMG are subject to the 212(e) home residency requirement, which obligates them to return to their home country after completing medical training in the United States. To avoid this requirement, J-1 physicians may apply for a J-1 visa waiver.
Most waiver options require the physician’s practice location to be in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), Medically Underserved Population (MUP), or Mental Health Professional Shortage Area (MHPSA) — the MHPSA designation applies only to psychiatrists. Applicants are encouraged to begin planning and preparing their waiver application 8 to 10 months in advance whenever possible.
The work site must be in a designated HPSA, MHPSA, MUA, or MUP location. Conrad 30 waivers are available to both primary care and specialist physicians. If the work location does not carry a designation, some states offer a FLEX 10 waiver. Each state has its own requirements for a FLEX 10 application, but the general principle is to establish that the employer treats patients located in underserved areas, thereby justifying a waiver for the J-1 physician. Each state has 30 spots available per year, including the FLEX 10 slots.
HHS waivers are available to primary care physicians (internal medicine, family practice, pediatrics, psychiatry, and OB/GYN) and hospitalists completing a primary care residency. In certain situations, a specialist may qualify if the fellowship is one year and the residency was completed in primary care. The work location must be designated as HPSA with a HPSA score of 7 or above. There is no annual limit on the number of HHS waivers granted. Note: The HPSA minimum score requirement applies only to HHS J-1 waiver applications.
Employment locations include certain areas in Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and all of Florida. Both specialist and primary care physicians are eligible to apply. The work site must be in a designated HPSA, MHPSA, MUA, or MUP location. There is no annual limit on spots granted.
Employment locations include certain areas in Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. Both specialist and primary care physicians are eligible. The work location must be designated as HPSA, and each state within the ARC has its own guidelines. There is no annual limit on spots granted.
Employment locations include certain areas in Alabama, Arkansas, Illinois, Mississippi, Missouri, Kentucky, Louisiana, and Tennessee. Both specialist and primary care physicians are eligible. There is no annual limit on spots granted.
Hardship and/or persecution waivers can be sought at any time during the physician’s J-1 tenure. A physician may apply under both categories simultaneously. A hardship or persecution waiver may also be filed in combination with any of the waiver options listed above.
Obtaining a J-1 waiver does not provide work authorization. After receiving a waiver, the physician will need an H-1B visa to work in the United States.
Contact our office for specifics: support@charylaw.com or call 212-812-7213.
After obtaining the J-1 visa waiver, the employer is required to apply for an H-1B visa on behalf of the physician so that the physician has work authorization. Physicians who obtain a J-1 waiver are always considered H-1B cap-exempt for the entire duration of their stay on an H-1B visa — the H-1B filing will not be subject to annual quota limitations.
All H-1B fees (attorney and filing) must be paid by the employer as per USCIS regulations. Upon H-1B approval, the physician is required to work for a minimum of three years with the initial employer and in accordance with the J-1 waiver application that was submitted.
After being granted a J-1 waiver and beginning work on an H-1B visa to complete the three-year requirement, a physician may encounter situations that necessitate a change of employer. These are known as “extenuating circumstances.” Examples include, but are not limited to:
USCIS has not provided specific guidance on what constitutes an extenuating circumstance. Please contact our office to discuss the potential of filing an H-1B change of employer petition.
If our office determines that a physician is experiencing an extenuating circumstance that necessitates an H-1B change of employer, the new work site must also be located in an underserved area. All H-1B change of employer petitions are under the purview of USCIS.
Physicians who have completed the three-year J-1 waiver requirement may file an extension to stay with their current employer or move to any employer willing to sponsor their H-1B visa — there is no underserved area requirement after the three-year obligation is fulfilled. J-1 waiver recipient physicians remain exempt from the H-1B cap for the entire duration of their time on an H-1B visa.
Both. We represent foreign-trained physicians in their J-1 waiver matters and represent healthcare employers sponsoring physicians for waivers, H-1B petitions, and green cards. The two roles often overlap, and we structure engagements accordingly.
Timelines vary by state. Some states open application windows once a year, others on a rolling basis. The Conrad 30 process itself — from state recommendation through Department of State and USCIS approval — typically runs 6–12 months. We map state deadlines to your residency or fellowship completion date in the consultation.
Sponsor opposition is uncommon but does happen, particularly with home country no-objection letters. We've handled cases where the sponsor's objection was procedural (resolvable) and cases where it required a different waiver pathway entirely. The right answer depends on the specific facts.
Yes. We're a nationwide practice and represent physicians regardless of where they're matched, residing, or planning to serve their underserved-area commitment.
A 15-minute attorney call to assess your specific facts: visa status, training timeline, employment plans, family situation, and waiver pathway options. You leave with a clear sense of whether your case is a fit for our practice and what the realistic path forward looks like.
Yes. Our engagements typically cover both the waiver and the subsequent H-1B (or O-1, or green card) filing. Coordinating both with one firm avoids the gaps and miscommunications that come from splitting representation.
Physician immigration decisions carry significant consequences for your career and your practice. At Chary Law, we guide physicians through every step of the J-1 waiver process. Contact our office today to discuss your options with an experienced immigration attorney.
