J1 waiver options for medical residency applicants

What is J1 visa?

J1 visa or the visitor exchange visa is one type of visa granted to those wishing to pursue medical residency in US. It is a non-immigrant visa with the sole purpose of providing education, learning or training to individuals from outside US. The basis of the two year home return rule comes form Section 40.202 dealing with foreign exchange visitors in the code of federal regulations which in essence states that

An alien who was admitted into the United States as an exchange visitor, or who acquired such status after admission, is not eligible to apply for or receive an immigrant visa or a nonimmigrant visa [H, K, or L]. unless: It has been established that the alien has been physically present in the country of the alien's nationality or last residence for an aggregate of at least 2 years following the termination of the alien's exchange visitor status.

The reason in part this was instituted because this visa category is supposed to be an open channel of exchange of skilled and professional personnel between US and other countries. The agreement, so it seems is - to prevent trained professionals from leaving home country after training on either side, it was made mandatory for these exchange visitors to return to home country.

What  is a J1 waiver?

There are certain exceptions which can be applied to the above stipulation of the 2 year home country return requirement. US department of state website mentions 5 criteria for waiver but in effect there are only four basic ones (Figure 1).

Figure 1: Green arrows denote the vector of retention of J1 applicants.

• Factors that are US related
• Need for state or federal agencies to fill positions where the expertise of the applicant is needed
• separation of J1 applicant with his family (who is US based citizen or GC holder) which will cause extreme hardship to family

• Factors that are home country based
• Home country has no objection to you not coming back
• There is fear of persecution in home country for the applicant.

Which factors are applicable to medical residency applicants?

No objection certificate (NOC) criteria from home country for one is NOT applicable to IMGs which leaves the other three as possibilities for waiver. The most commonly used exception is the need for US or state agencies to have physicians in the underserved area. There is a big demand for providers in the HPSAs (health professional shortage areas) but not all physicians are favored. The preferred physician categories are

1. Primary care
1. Family medicine
2. Internal medicine
3. Pediatrics
4. Ob/gyn
5. geriatrics
2. Dentist
3. Psychiatrist

It is clear from above list that if your specialize or do a fellowship - the chances that you will find a waiver job will considerably go down. Think about this before you chose your professional career plans.

The HPSAs can also be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). The complete list of HPSAs can be found at the Health Resources and Services Administration website. There are also a list of MUPs (medically underserved populations) and MUA (medically underserved which are eligible for waiver jobs. Applicants can also apply to these areas under the CONRAD 30 waiver program  or under certain circumstances, the Appalachian Regional Commission (ARC)will request a waiver of immigration requirements for foreign-trained physicians doing residency work in the United States under a J-1 visa. For the flowchart discussing the J1 waiver process check out at J1 waiver requirementmade easy.

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