The United States has long been experiencing a physician shortage, with the American Medical Association predicting a shortage of up to 86,000 physicians by 2036. This ongoing shortage is attributed to a growing and aging population as well as a substantial portion of the current physician workforce nearing the traditional retirement age.

By 2036, the U.S. population is expected to grow by 8.4 percent, with the 65 or older age group expected to grow by 34 percent. Older Americans have greater healthcare needs and require access to more physicians. Concurrently, 20 percent and 22 percent of the current clinical workforce is comprised of physicians aged 65 or older and physicians between the ages of 55 to 64, respectively. These two factors are slowly converging to create a public health crisis whereby millions of people across the country are faced with limited or no access to medical care.

Foreign Medical Graduates (FMGs) have emerged as a force in our healthcare system accounting for nearly 25percent of the physician workforce. They practice heavily in underserved areas bringing medical care to our most vulnerable communities. However, while FMGs play a critical role in providing healthcare to the U.S. population, their path to remain in the U.S. is complex and fraught with obstacles.

Many FMGs enter the U.S. as J-1 visa holders, also known as Exchange Visitors. FMG J-1 visa holders are subject to a two-year foreign residency requirement -- meaning J-1 FMGs are ineligible to apply for an immigrant visa, adjustment of status, or change of status to another nonimmigrant classification until they have physically resided in their country of nationality of last residence for at least two years upon completion of the J-1 exchange visitor program.

There are several, complex pathways at the state and federal level for an FMG to obtain a waiver of the two-year foreign residency requirement and remain in the U.S. by practicing in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or with Medically Underserved Populations (MUPs), as designated by the U.S. Department of Health & Human Services.

Each state administers its own physician waiver program (known as Conrad 30), with its own application rules and guidelines, whereby the state can approve up to 30 waivers each year. To address certain limitations of the state Conrad 30 Program, primarily that there are not nearly enough state waivers to meet FMG, hospital, or community demands, seven Federal Regional Commission Waiver Programs have been created pursuant to the U.S. Farm Bill with the authority to issue unlimited waivers. State and federal programs are only the first step in the months long waiver process. After approval by the state or federal authority, waiver applications must then be reviewed by the U.S. Department of State with final authority to issue the waiver of that two-year requirement being held by the United States Citizenship and Immigration Services.

The myriad state and federal programs, inter-related government agencies, and ever-changing complex requirements involved in the waiver process can be overwhelming to employers and FMGs seeking a pathway to remain in the U.S. Fortunately, Ice Miller’s Immigration Team has experience working on J-1 physician waiver applications to address our clients’ employment needs, no matter how complex.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances.