Foreign-born physicians who train in the US using a J-1 visa may receive a J-1 visa waiver to practice in a designated Health Professional Shortage Area (HPSA) immediately following their training, rather than returning to their home nation. To be eligible for a waiver, physicians must be sponsored by a state public health department or its equivalent. Waivers have a three-year service commitment and are provided by the federal government as part of the Conrad State 30 Program, which allows each state to recruit up to 30 physicians for the program1, 2. Historically, the program has focused on placing primary care physicians in rural areas; recently, it also supports placement of specialists in non-rural underserved areas2.
Expected Beneficial Outcomes (Rated)
Increased availability of physicians in underserved areas
Evidence of Effectiveness
There is insufficient evidence to determine whether J-1 visa waivers increase the availability of physicians in rural and other underserved areas over the long-term. Available evidence suggests that waivers may increase providers in the short-term; however, long-term retention appears less likely3, 4, 5, 6.
Studies in Wisconsin, Washington, and Nebraska suggest that physicians with J-1 visa waivers provide quality care, but typically remain in their placement area only two years beyond the required commitment5, 6, 7. The Wisconsin-based assessment suggests physicians with waivers often do not integrate well into local communities7.
Impact on Disparities
Employment of international medical graduates under J-1 visa waivers varies widely among states8. From 2001-2010, participating states used an average of 17.4 waivers out of the 30 allotted through the program2. In 2014, almost 2,000 foreign-born medical students or residents in the J-1 visa program were eligible for waivers upon completion of their residency. Alaska, Idaho, and Wyoming had no eligible students or residents, while Michigan and Texas had the greatest number eligible, 186 and 150 respectively9.
RHIhub-J1 Visa waiver - Rural Health Information Hub (RHIhub). Rural J-1 visa waiver.
US DS-J1 visa - United States Department of State (DS). J-1 visa facts and figures: view data by state.
US CIS-Conrad 30 - US Citizenship and Immigration Services (US CIS). Working in the United States, students and exchange visitors: Conrad 30 Waiver Program.
VDH-Conrad 30 - Virginia Department of Health (VDH). Conrad 30 waiver program 2017-2019 guidelines. Office of Health Equity, Virginia Department of Health; 2017.
* Journal subscription may be required for access.
1 US CIS-Conrad 30 - US Citizenship and Immigration Services (US CIS). Working in the United States, students and exchange visitors: Conrad 30 Waiver Program.
2 Patterson 2015 - Patterson DG, Keppel G, Skillman SM, Berry C, Daniel C, Doescher MP. Recruitment of Non-US Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs. Final Report #148. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2015.
3 Goodfellow 2016 - Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban and rural areas in the United States: A systematic literature review. Academic Medicine. 2016;91(9):1313-1321.
4 Wilson 2009 - Wilson NW, Couper ID, De Vries E, et al. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural and Remote Health. 2009;9(2):1060.
5 Opoku 2015* - Opoku ST, Apenteng BA, Lin G, et al. A comparison of the J-1 Visa waiver and loan repayment programs in the recruitment and retention of physicians in rural Nebraska. The Journal of Rural Health. 2015;31(3):300–309.
6 Kahn 2010* - Kahn TR, Hagopian A, Johnson K. Retention of J-1 visa waiver program physicians in Washington state’s health professional shortage areas. Academic Medicine. 2010;85(4):614–21.
7 Crouse 2006 - Crouse BJ, Munson RL. The effect of the physician J-1 visa waiver on rural Wisconsin. Wisconsin Medical Journal. 2006;105(7):16-20.
8 Thompson 2009* - Thompson MJ, Hagopian A, Fordyce M, Hart LG. Do international medical graduates (IMGs) “fill the gap” in rural primary care in the United States? A national study. Journal of Rural Health. 2009;25(2):124–34.
9 US DS-J1 visa - United States Department of State (DS). J-1 visa facts and figures: view data by state.
10 Majeed 2017* - Majeed MH, Ali AA, Sudak DM. International medical graduates and American psychiatry: The past, present, and future. Academic Psychiatry. 2017.
11 Fanari 2017* - Fanari Z. Effects of changes in visa policies and procedures on fellows-in-training and early career cardiologists. Journal of the American College of Cardiology. 2017;69(25):3115-3117.
12 White House EO - The White House. Executive Order protecting the nation from foreign terrorist entry into the United States. March 2017.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
To see all strategies: