Foreign medical graduates who obtained graduate medical education or training in the United States through a J-1 Exchange Visitor program are subject to the two-year home residency requirement, which compels a return to the country of nationality or last residence for two years before becoming eligible for certain nonimmigrant visas or U.S. permanent residence. However, foreign medical graduates may obtain a waiver of the two-year home residency requirement based on a recommendation by an Interested Government Agency (state or federal), or through demonstrating that a U.S. citizen or permanent resident relative would suffer exceptional hardship if the exchange visitor complied with the requirement, or finally, by establishing that the exchange visitor would suffer persecution upon compliance with the requirement.
Recommendation by an Interested Government Agency:
- State Health Departments – under the “State 30 Program” each state may grant up to 30 waivers per year to J-1 doctors who agree to work fulltime for three years in a shortage area, whether a Health Professional Shortage Areas (HPSA), or in some cases Mental Health Professional Shortage Areas (MHPSA), or Medically Underserved Areas or Populations (MUA/P). Generally, the physician must provide primary care, however specialty care is possible under some programs. Requirements for waivers vary from state to state. “Flex” slots may also be available for physicians serving in non-HPSA designated areas.
- Appalachian Regional Commission – physicians practicing in the Appalachian region are eligible for waivers under this special program
- Delta Regional Authority – physicians practicing in the Delta region are eligible for waivers under this special program
- Department of Veterans Affairs (VA) – if the loss of the exchange visitor’s services would be detrimental to a VA program, a waiver may be requested from the VA under its guidelines
- Department of Health and Human Services (HHS)
- Clinical Care: physicians with J-1 visas must agree to deliver health care services for three years in a HPSA or MUA
- Research: there is no requirement of service in a medically underserved area, however these waivers are reviewed with intense scrutiny by medical experts in the exchange visitor’s field (for scientific merits) and the HHS Waiver Review Board (for policy and intentions of the HHS waiver program)
The J-1 waiver process for foreign medical graduates through an interested government agency involves an application at the state or federal level for an interested government agency recommendation, a Department of State recommendation, and, finally, U.S. Citizenship and Immigration Services approval, which is the agency that makes the ultimate decision on whether or not to approve the waiver application. View our FAQs regarding waivers here