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J-1
PHYSICIANS
Physicians currently holding a
J-1 must either serve 2 years in their home countries or obtain
a waiver of the 2 year home residency requirement before being
allowed to practice in the United States. Certain governmental
agencies offer sponsorship to J-1 physicians seeking waivers.
These include:
Other J-1 related links:
Other General Links:
1.
State Departments
of Health (Conrad State 30)
Physicians
may obtain sponsorship for a J-1 waiver
through a State Department of Health.
Each state may sponsor 30 international
medical graduates (IMGs) for J-1 waivers
each year. To qualify for the Conrad
program, an IMG must agree to be employed
for a minimum of 3 years in a facility
located within an area designated
by the Department of Health and Human
Services (HHS) as a shortage area.
Waiver applications in this category
must include the following:
- letter from State Department of Health stating
that it is in the public interest to provide the applicant
with a J-1 waiver;
- employment contract between the physician
applicant and the shortage area facility valid for a minimum
of 3 years, naming the facility and geographic area where
the applicant will work;
- evidence that the geographical area where
the applicant will work is located within a Health Professional
Shortage Area (HPSA),
a Medically Underserved Area/Medically Underserved Population
(MUA/MUP)
- physician statement agreeing to contractual
provisions;
- copies of all IAP-66 forms;
- State Department Data Sheet; and
- sequential number on each application.
See Conrad
State Programs for links to
each state's Conrad Program contact
person; see also Q&A
on State Department of Health/Conrad
State 30 for further information.
Back to top.
2. Veterans
Health Administration (VHA)
When US citizen physicians are unavailable,
the Veterans Administration (VHA) sponsors for J-1 waivers physician
exchange visitors who provide patient care (regardless of specialty),
research and education services.
Local program directors must approve all J-1
waiver requests before they are forwarded to VHA Headquarters.
VHA cannot act as an interested government agency on behalf
of an exchange visitor who has overstayed their J-1 visa at
the time the facility request is received at VHA headquarters.
In addition, waiver requests will be accepted only if the exchange
visitor is available for employment within four months or less.
To qualify, an physician exchange visitor must
have a written agreement with the facility for a period of not
less than three years. If the exchange visitor is granted a
waiver, but does not complete the three year term, then the
waiver will no longer be in effect.
VHA prefers 100 percent employment by VHA. However,
it also gives consideration to candidates with at least a 5/8
appointment with VHA and 3/8 at the affiliated university. In
any case, a physician requesting a waiver must provide clinical
care in a VHA facility.
Prior to requesting a waiver, a facility must
request a list of candidates from the Health Care Staff Development
and Retention Office (HCSDRO). If that office is unable to supply
candidates, facilities must then request special recruitment
assistance from HCSDRO, as waiver requests may only be submitted
after recruitment efforts by HCSDRO have proven unsuccessful.
Back to top.
3. Appalachian
Regional Commission (ARC)
The Appalachian Regional Commission (ARC) is
a federal-state partnership that works to create opportunities
for self-sustaining economic development and improved quality
of life. The region includes all of West Virginia and parts
of 12 other states, including: Alabama, Georgia, Kentucky, Maryland,
Mississippi, New York, North Carolina, Ohio, Pennsylvania, South
Carolina, Tennessee, andVirginia.
Under certain circumstances, the ARC will request
J-1 waivers for foreign-trained physicians doing residency work
in the US. Physicians receiving these waivers must practice
for at least 3 years in rural Appalachian areas that suffer
critical health shortages (Health Professional Shortage Areas
or HPSAs).
Requests for waivers under the ARC J-1 Visa Program must be
sponsored by a state within the Appalachian Region. All inquiries
should be made to ARC
state contacts. Back to top.
4. Department
of Health and Human Services (HHS)
Traditionally, the Department of
Health and Human Services (HHS) has sponsored J waivers only
for physicians performing research vital to the interests of
the U.S., but not for those engaged in providing clinical services.
However, recent revisions in the regulations allow HHS to request
waivers for those providing clinical services as well as for
researchers. These revisions allow HHS to review waiver applications
from community health centers, rural hospitals and other health
care providers. HHS then makes recommendations on these requests
to the Department of State (DOS) for waivers of the two year
home residency requirement. The regulations are effective as
of December 19, 2002.
HHS will review applications submitted
by private or non-federal institutions, organizations, or agencies
or by a component agency of HHS. The Board will not accept applications
submitted by Exchange Visitors or other US Government Agencies
unless under extenuating and exceptional circumstances. HHS
will verify applicants' credentials through a federal credentialing
process before making recommendations for waivers, coordinating
its review process with state health departments throughout
the U.S. Back to top.
Historically, HHS has served as
an interested government agency (IGA) with respect to J-1 waivers
only for biomedical researchers engaged in projects of national
or international significance. The Department of Agriculture
(USDA) and the Appalachian Regional Commission (ARC) have been
the most active of agencies serving as IGAs for J waivers to
provide services in shortage areas. However, in April 2002,
USDA announced that it would cease its participation as an IGA
for purposes of J waivers for physicians.
HHS eligibility criteria for physicians
seeking J-1 waivers are in addition to and independent of existing
waiver and visa criteria already in place. This program is also
distinct from the Conrad program implemented by the state departments
of health. Back to top.
PHYSICIANS
PROVIDING CLINICAL SERVICES
Criteria for a waiver recommendation
by HHS for physicians providing clinical services is as follows:
- Eligibility is limited to primary care physicians
and general psychiatrists who have completed primary care
or psychiatric residency training programs no more than 12
months prior to the date of commencement of employment under
the contract described in the criteria below. This limitation
is intended to ensure the physicians' primary care training
is current, and that they are not engaged in subspecialty
training. Primary care physicians are defined as: physicians
practicing general internal medicine, pediatrics, family practice
or obstetrics/gynecology and who are willing to work in a
primary care HPSA
or MUA/P;
and general psychiatrists willing to work in a Mental Health
HPSA.
- The Exhange Visitor (J-1 holder) must exeucute
a statement that s/he does not have pending, and will not
submit, other IGA waiver requests while HHS requests are pending.
- The Exchange Visitor must enter into a contract
with the applicant employer. This employment contract must:
- Require the Exchange Visitor to provide
primary medical care in a facility physically located
in an HHS-designated primary care HPSA
or MUA/P,
or general psychiatric care in a Mental Health HPSA.
- Require the Exchange Visitor to complete
a term of employment of not less than three years providing
primary care health servcies for not less than 40 hours
per week.
- Require the Exchange Visitor to be licensed
by the State where s/he will practice; have completed
a residency in one of the following specialties: family
practice; general pediatrics, obstetrics/gynecology, general
internal medicine, or general psychiatry; and be either
board certified or board eligible in the relevant primary
care discipline.
- It may not include a non-compete clause
or restrictive convenant that limits the Exchange Visitor's
ability to continue to practice in any HHS-designated
primary care or mental health HPSA or MUA/P after the
period of obligation.
- The contract must be terminable only
for cause and not terminable by mutual agreement until
completion of the three-year commitment, except that it
may be assigned to another eligible employer, subject
to approval by HHS and consistent with all applicable
USCIS (formerly INS) and Department of Labor requirements.
- Must provide that any amendment to the
contract comply with all applicable Federal statutes,
regulations and HHS policies.
- Be consistent with all applicable Federal
statutes, regulations and HHS policies. Back to top.
- The facility or practice sponsoring the physician:
- Must provide health services to individuals
without discriminating against them because either they
are unable to pay for those services or payment for those
health services will be made under Medicare or Medicaid.
- May charge no more than the usual and
customary rate prevailing in the geographic area in which
the services are provided.
- Must provide care on a sliding fee scale
for persons at or below 200 percent of the povery income
level. Persons with third-party insurance may be charged
the full fee for service.
- Must post a notice in a conspicuous location
in the patient waiting area at the practice site to notify
patients of the charges for service as required in this
paragraph. Back to top.
- Must provide evidence that the applicant
facility made unsuccessful efforrts to recruit a US physician
for the position to be filled by the Exchange Visitor.
- Must provide statement by the head of
petitioning health care facility to confirm that the facility
is located in a specific, designated HPSA
or MUA/P,
and that it provides medical care to Medicaid and Medicare
patients and the uninsured indigent.
- Both the employer and the Exchange Visitor
physician must submit information to the Secretary at the
times and in the manner that the Secretary may reasonably
require.
- Both the employer and the Exchange Visitor
physician must comply with all applicable Department of State,
Department of Labor, USCIS (formerly INS) and HHS statues,
regulations and policies. Back to top.
RESEARCHERS
Factors that HHS considers in determining
whether an exchange visitor engaged in research is eligible
for J-1 waiver sponsorship include:
- The program/activity at applicant institution/organization
in which Exchange Visitor is employed must be of high priority
and of national or international significance in an area of
interest to the Department.
- The Exchange Visitor must be needed as an
integral part of the program or activity, or of an essential
component thereof, so that loss of his/her services would
necessitate discontinuance of the program or a major phase
of it. Specific evidence must be provided on how the loss
or unavailability of the individual's services would adversely
affect the initiation, continuance, completion, or success
of the program or activity. The applicant organization/institution
must clearly demonstrate that a suitable replacement ofr the
Exchange Visitor cannot be found through recruitment or other
means. The Board will not request a waiver when the principal
problem appears to be one of administrative, budgetary or
program inconvenience to the institution or other employer.
- The Exchange Visitor must possess outstanding
qualifications, training and experience well beyond the usually
expected accomplishments at the graduate, postgraduate, and
residency levels, and must clearly demonstrate the capability
to make original and significant contributions to the program.
The Board will not request a waiver simply because an individual
has specialized training or experience or is occupying a senior
staff position in a university, hospital or other institution.
Note that information
on HHS web site concerning procedures,
filing fees, addresses and processing
times is not necessarily current.
Please consult the State Department's
J-1 Waiver page for accurate information
on J-1 waivers.
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