Having quality physicians is essential to providing healthcare in rural communities. In many cases, the ability of healthcare facilities to remain open depends on having an adequate staff of physicians. Unfortunately, rural areas often experience difficulties in the recruitment and retention of physicians. Due to these difficulties, many communities turn to the recruitment of foreign medical graduates with J-1 Visa Waivers to fill their physician vacancies.
The J-1 Visa Program is for foreign medical graduates who wish to pursue graduate medical training in the United States. J-1 Physicians, also known as Foreign Medical Graduates or International Medical Graduates, are physicians from other countries who have sought and received a J-1 exchange visitor visa. The visa allows holders to remain in the U.S. until their studies are completed. At the completion of their studies they are expected to return to their home countries for two years before applying for a permanent visa in the United States. A J-1 Visa Waiver waives the two year home residency requirement and allows a physician to stay in the country to practice in a federally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA) if sponsored by an interested U.S. government agency. State government agencies may also sponsor J-1 physician waiver requests which are called Conrad State 30 programs.
This guide also discusses the H1-B Visa, a non-immigrant visa which allows a U.S. company to employ a foreign individual in a specialty occupation.
Communities have a unique opportunity to recruit and retain physicians who enter the U.S. on a J-1 visa and need to practice in a HPSA or MUA. Those communities that welcome these physicians to their new town are often able to retain them for years. If a community can attract a physician on a visa, an honest and early welcoming process that leads into a long term retention program is very important. Physicians who leave a town after their commitment suggest they do so because they did not have a sense of belonging.
The recruitment process should take into consideration the “fit” with the practice, the community and needs of the physician and family. If the recruitment and retention process is sensitive to the needs of the community and the physician, the potential for retention grows.
Related Guides
Frequently Asked Questions
Tools
Appalachian Regional Commission (ARC) J-1 Visa Waiver Program
Web site
Offers links to J-1 Visa Waiver state public contacts and related information necessary for becoming sponsored by a state and requesting for a waiver under the ARC J-1 Visa Waiver Program.
Bringing Doctors to the Delta
Web site
Allows foreign physicians, who are trained in the U.S., to work in medically underserved areas for three years. Accepts waiver requests for medical specialists, and has assisted with the placement of more than 50 physicians in the region.
Directory of State Primary Care Offices (PCOs)
Web site
Lists contact information for each state's Primary Care Office (PCO). PCOs represent the needs of the underserved populations and the providers who serve them. These offices can provide information on Conrad 30 J-1 Visa Waiver programs, loan repayment programs, and recruitment and retention.
Electronic Residency Application Service (ERAS)
Database
Transmits residency applications, letters of recommendation, Dean's Letters/MSPE, transcripts, and other supporting credentials from applicants and medical schools to Fellowship, Osteopathic Internship and Residency programs using the Internet.
Find Shortage Areas: HPSA by State & County
Database
Provides searching for Health Professional Shortage Areas (HPSAs) by region, state, county, designation status, and type of service- primary medical care, dental, and mental health. Includes date of latest designation status.
FindAResident
Database
Helps to locate residency and fellowship positions; puts residents in contact with programs looking to fill these positions; supplements the Electronic Residency Application Service (ERAS); and is a resource when changing specialty, location, or residency program.
FREIDA Online
Database
The Fellowship and Residency Electronic Interactive Database (FREIDA) contains over 8,700 medical education programs accredited by the Accreditation Council for Graduate Medical Education, as well as over 200 combined specialty programs. Allows searching for specialty and subspecialty programs, training institutions, medical schools, aggregate training statistics by specialty, and career plans of recent graduates.
Global Health: Exchange Visitor Program
Web site
Provides information and updates on the Exchange Visitor Program (J-1 Visa Waiver), which eliminates the two-year foreign residence requirement.
Guidelines for Medically Underserved Area and Population Designation
Web site
Supplies guidelines for use in applying the established Criteria for Designation of Medically Underserved Areas (MUAs) and Populations (MUPs). Describes three methods for designation.
National AHEC Organization - AHEC Directory
Web site
Lists contact information for regional AHECs by state. AHEC's (Area Health Education Centers) work to recruit, train and retain health professionals committed to underserved populations.
Rural Health Research: International Medical Graduates (IMGs)
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of IMGs, produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Health Research: J-1 Visa Waiver
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of the J-1 Visa Waiver, produced by the Office of Rural Health Policy's funded rural health research centers.
Shortage Designation: HPSAs, MUAs & MUPs
Web site
Provides information about health care shortage designations: Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas and Populations (MUAs/MUPs). Includes information on how to apply for these designations and how to find shortage areas.
State Licensure for International Dentists
Web site
Provides information to dentists who were educated outside the United States and Canada and wish to obtain a state dental license in the U.S.
Funding
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Maps & Map Collections
Health Professional Shortage Areas (HPSA) - Dental Health, Designated Populations
Interactive
Geographic coverage: United States
Printable map that shows nationwide the location and type of population that is underserved and designated as a dental HPSA. Data source: Health Resources and Services Administration, Bureau of Health Professions, October 2011.
Date: 2011
Health Professional Shortage Areas (HPSA) - Mental Health, Designated Populations
Interactive
Geographic coverage: United States
Printable map that shows nationwide the location and type of population that is underserved and designated as a mental health HPSA. Data source: Health Resources and Services Administration, Bureau of Health Professions, October 2011.
Date: 2011
Health Professional Shortage Areas (HPSA) - Primary Health, Designated Populations
Interactive
Geographic coverage: United States
Printable map that shows nationwide the location and type of population that is underserved and designated as a primary health care HPSA. Data source: Health Resources and Services Administration, Bureau of Health Professions, October 2011.
Date: 2011
Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs), Designated Type
Interactive
Geographic coverage: United States
Printable map that shows the designated type of MUAs and MUPs nationwide by state. Data source: Health Resources and Services Administration, Bureau of Health Professions, October 2011.
Date: 2011
Regulations, Forms & Other Useful Documents
Designated Health Professional Shortage Areas (HPSA) Statistics
Sponsoring organization: Bureau of Health Professions
Charts the number of primary, dental, and mental health professional shortage areas (HPSA) for each state and how many health care providers would be required to remove the shortage designation. Includes the percentage of designations located in rural vs. urban areas.
Date: 07 / 2011
Foreign Medical Graduates: A Brief Overview of the J-1 Visa Waiver Program
Author(s): Karma Ester
Sponsoring organization: Congressional Research Service
Provides background information on the J-1 Visa Waiver program, which allows foreign medical graduates to remain in the U.S. after completing graduate medical education, in exchange for working at least three years in a designated healthcare professional shortage area (HPSA). Includes a description of the waiver process.
Date: 06 / 2008
Foreign Physicians: Data on Use of J-1 Visa Waivers Needed to Better Address Physician Shortages
Sponsoring organization: Government Accountability Office
Examines the number of J-1 visa waivers requested by states and federal agencies; waiver physicians' practice specialties, settings, and locations; and the extent to which waiver physicians are accounted for in the Department of Health and Human Services efforts to address physician shortages.
Date: 11 / 2006
Foreign Physicians: Preliminary Findings on the Use of J-1 Visa Waivers to Practice in Underserved Areas
Sponsoring organization: Government Accountability Office
Reports preliminary findings regarding the number of J-1 visa waivers requested by states and federal agencies and states' views on the 30-waiver limit and on their willingness to have unused waiver allotments redistributed.
Date: 05 / 2006
Health Care Shortage Designations: HPSA, MUA, and TBD
Author(s): Eileen Salinsky
Sponsoring organization: National Health Policy Forum
Reviews the methodologies utilized in the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA) designations, identifies federal programs that use these designations to allocate resources, describes proposals to consolidate and improve these designations, and discusses the Affordable Care Act provision to harmonize the two designations.
Date: 06 / 2010
Health Professional Shortage Area (Fact Sheet)
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides an overview of the Health Professional Shortage Area (HPSA) payment system and general requirements.
Date: 03 / 2010
International Medical Graduates and the Primary Care Workforce for Rural Underserved Areas
Author(s): Kenneth S. Fink, Robert L. Phillips, George E. Fryer, Nerissa Koehn
An analysis of primary care IMGs compared to U.S. medical graduates working in rural underserved areas.
Journal citation: Health Affairs Volume 22 Issue 2 Pages: 255-262
Date: 04 / 2003
Organizations
Educational Commission for Foreign Medical Graduates (ECFMG)
National organization
Assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States. Offers a variety of other programs and services to physicians educated abroad and other members of the international medical community.
National Resident Matching Program (NRMP)
Nonprofit/Foundation
Provides a uniform date of appointment to positions in graduate medical education (GME) in the United States.
National Rural Recruitment & Retention Network (3RNet)
National organization
Works to help health care professionals, including dentists and dental hygienists, find practice opportunities in rural areas throughout the country. Includes state information and a list of state contacts.
U.S. Department of State Bureau of Consular Affairs
Federal government
Provides information on international travel including travel warnings and paperwork needed. Includes J-1 Visa Waiver Recommendation Application form.
Terms & Acronyms
Foreign Medical Graduates (FMGs) Physicians from other countries who wish to pursue graduate medical training in the United States. Also called IMGs (International Medical Graduates).
Health Professional Shortage Area (HPSA) Geographic regions that have shortages of professionals working in primary medical care, dental or mental health care. HPSAs may be urban or rural areas, population groups or medical or other public facilities. Geographically, HPSAs can be cities or towns, counties or groups of counties. HPSA designations are reviewed and revised annually by the Secretary of Health and Human Services based on criteria set forth in the Public Health Service Act.
International Medical Graduates (IMGs) Physicians from other countries who wish to pursue graduate medical training in the United States. Also called FMGs (Foreign Medical Graduates).
J-1 Visa Waiver Eliminates the two year residency requirement for foreign physicians training on a J-1 Visa. Allows foreign physicians to remain and practice in the United States after their training is completed.
J-2 Visa Visa for spouses and minor, unmarried children under the age of 21. They must have form IAP-66 as well as other basic documentation and demonstrate sufficient financial resources to support themselves while in the United States.
Medically Underserved Area (MUA) Medically Underserved Areas (MUAs) are federal designations derived from the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older. An IMU of 62.0 or less qualifies an area to be designated a MUA. Geographic areas designated as MUAs can be a whole county or a group of contiguous (adjoining) counties, minor civil divisions (MCD), census county divisions (CCD) or census tracts.
Medically Underserved Population (MUP) A federal designation that is derived by using the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older.
State Conrad 30 Program Allows states to sponsor up to 30 international medical graduates per year who agree to serve in underserved areas.
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