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Home > Physicians> J-1 Waivers

Physicians: J-1 Waivers for Foreign Physicians

The J-1 visa continues to be the source of many problems for foreign physicians attempting to permanently relocate to the United States. On the surface, the J-1 visa is an attractive visa because it is easy to obtain and the physician’s spouse is granted work authorization. However, once a J-1 visa is issued the foreign physician is subject to a harsh two-year foreign residence requirement. This means that the foreign physician must return to his or her last country of residence for two years prior to receiving an H-1B visa or a green card. The foreign physician is not permitted to change status to any other immigration category even if the physician's spouse is a United States citizen, unless a waiver is issued.

In most cases a foreign physician who is subject to the two-year foreign residence requirement will not obtain a waiver because J-1 waivers for foreign physicians are only granted in the following situations:

  • On the basis of persecution should the foreign physician be required to return home.
  • Upon establishing that the foreign physician’s U.S. citizen spouse and/or children will suffer extreme hardship should the physician be required to return home.
  • Based on a recommendation from an Interested Government Agency (IGA)

The most commonly used of the three waiver options is an IGA recommendation but even this is difficult to obtain. It is unlikely that an IGA waiver will be issued unless the foreign physician will be employed by a federal government agency such as Veterans Affairs, or serving a Medically Underserved Area (MUA). Therefore, it is advisable for the foreign physician to consider other options such as an employment based green card or the H-1B visa prior to obtaining a J-1 visa in an attempt to avoid the harsh consequences of the two year foreign residence requirement. In some cases a foreign physician will not have an option and will require a J-1 visa to participate in a residency or fellowship program but this should only be applied for once all other options have been reviewed.

The most common method used to obtain a J-1 waiver for a foreign physician is the Interested Government Agency (IGA) request. Currently, there are four different types of IGA waivers available:

1. Appalachian Regional Commission Waivers
2. Veterans Administration Waivers
3. Conrad State 30 Waivers
4. Health and Human Services Waivers

While each of the IGA waiver programs differ to some degree there are some commonly used terms that can be found in each program. For example, in each program the foreign physician must be working in a 'Health Professional Shortage Area' (HPSA). To determine if the employer is located in a HPSA the government published Federal Register should be consulted. Secondly, all agencies require proof of substantial recruitment efforts for U.S. physicians by the employer prior to hiring the foreign physician. Thirdly, in all but the VA waiver, the foreign physician must be providing 'primary care', although each agency has defined this term somewhat differently. Lastly, all agencies require fulfillment of a long-term employment contract by the foreign physician, typically a minimum of three years. These terms are common to all J-1 waiver applications and should be clearly understood.

It is important to understand that once an IGA waiver has been granted the foreign physician must obtain an H-1B visa in order to legally work in the United States. In 1996 a law came into effect that prohibits a foreign physician on a J-1 visa from adjusting status to that of a green card holder, even if a J-1 waiver has been granted. Under the provisions of this law a foreign physician who obtains a J-1 waiver from an Interested Government Agency must change status to an H-1B nonimmigrant visa and remain in that status with the sponsoring employer for a period of no less than three years. At the end of the three-year period the foreign physician would then be permitted to apply for permanent resident status (i.e. a green card). The way of adjusting status earlier is through the filing of a national interest waiver. Even marriage to a United States citizen does not relieve the foreign physician from the need to obtain a waiver prior to adjusting status to that of a permanent resident.

There are certain instances whereby a foreign physician may obtain a visa to remain in the United States without obtaining a J-1 waiver. Please refer the O Visa, E Visa and TN Visa links for more information on these options.

If you would like to learn more about the immigration options available to foreign physicians please send a request to us at:


or contact:

Leibl & Kirkwood
12865 Point Del Mar, Suite 190
Del Mar, CA 92014, USA

Tel. (858) 481-5211
Fax. (858) 481-7271




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