Posts Tagged ‘FLEX’

Conrad 30 Physician J-Waiver Update for Washington State, Oregon, Idaho, Montana, and Alaska

Thursday, October 17th, 2019 by W. Scott Railton

The demand for Conrad 30 J-1 Physician waivers has risen substantially in the past few years for Washington State and Oregon. Both states received more applications than they used to when this fiscal year began on October 1st. This is probably attributable to a number of factors, including desirability of the living in these beautiful states (including in some amazing semi-rural locations), increasing employer familiarity with the J-1 program, and growing demand for qualified physicians. In particular, demand for certain specialists has grown dramatically, to some extent reflecting both growth and aging populations.

As of October 15th, Washington State reports that it has received 15 specialists applications and two primary care applications. State regulations only permit the approval of 10 specialist applications, prior to April 1st in the fiscal year. Seven specialist applications are pending approval, as in one primary care application. In all likelihood, the remaining applications may have issues which require further attention, though probably some of these concerns are quickly addressed. FLEX spots, which are for non-health professional shortage areas, become available on January 15th, provided slots remain.

As of this writing, 22 of 30 spots are reported reserved for 2020 for Oregon. The past few years, Oregon has filled up with increasing speed.
Alaska, Idaho, and Montana usually do not fill up their 30 spots.

In my experience, applications do not come together over night, as there are several components that require consideration and preparation. The starting point is coming to agreement on a contract which satisfies physician and employer, while meeting all state requirements for the waiver. Beyond that, there is much paperwork, which several discrete requirements that require differing amounts of attention. All this is to say, time is of the essence for anyone seeking spots for this fiscal year in Oregon or Washington. For 2021, it will be best to plan far ahead of the October 1st open window date, as there are some time sensitive requirements that must be met in advance of filing.

All is not lost, necessarily, if all the spots fill up. Sometimes other temporary and permanent solutions exist. Some physicians can successfully obtain O-1 Alien of Extraordinary Ability work authorizations, based on their accomplishments. Canadians physicians can sometimes obtain H-1B status, due to the fact that Canadians are “visa exempt”. It is also sometimes possible to commute from Canada to work in the U.S., and thus fulfill the two year residency requirement while working in the U.S. The U.S. Department of Health & Human Services also operates a J waiver program that can work for primary care and mental health practitioners sometimes. Other federal agencies can also act as sponsors, such as the Department of Defense has previously done via its Military Accessions Vital to the National Interest program (MAVNI). That program however is not currently operating, though DOD has authority to sponsor.

Several bills have been introduced over the years to improve the Conrad 30 program. The Conrad State 30 and Physician Access Reauthorization Act (H.R. 2895) would expand the program, and help address physician shortage needs. As a member of the International Medical Graduate Task Force, I try to stay up on the latest legislative efforts, and always willing to help connect physicians with legislators in an effort to improve access to care and physician opportunity.

I am happy to schedule consultations with physicians and/or potential employers to further discuss these and other immigration-related matters.

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Posted in General, Scott Railton |

J-1 Waiver Season for Physicians Is Here

Monday, August 26th, 2019 by W. Scott Railton

J-1 Conrad waiver slots for physicians open up on October 1st. Health Departments around the country will begin accepting J-1 waiver applications under the Conrad program. Each state is allotted 30 spots, with the majority going to primary care physicians, who agree to work for three years in a health professional shortage area. In turn, their two year foreign residency requirement is waived. We routinely prepare these applications.

Rules vary state to state, although the federal government has minimum requirements. Washington State, where we are located, historically takes between six and twelve months to fill all of its spots. In recent years, Oregon has been filling its 30 spots faster. Alaska, Idaho, and Montana make limited use of the program, and so spots tend to remain open through the year. Some states though receive more than 30 applications on the first day the window opens.

Here are a few of the key rules for Washington State:

– Up to ten sponsorships are available for Specialists between October 1st to March 31st. Additional spots may be available after March 31st.

– Washington State also allows 10 non-designated FLEX waivers per year, with these slots opening on January 15th. FLEX spots allow certain physicians to work in areas that are not designated as health professional shortage areas, provided they are assisting populations that are underserved. For example, a Seattle specialist physician that sees patients from all over Washington (or multiple states) might qualify for a FLEX waiver.

– Washington State limits employers to three waivers each, prior to June 1st of the fiscal year.

– Applicants, including integrated health care systems in a single HPSA, are limited to a.) two sponsorships per practice location; b.) one hospitalist sponsorship per hospital; c.) no more than three sponsorships total across all practice locations in the HPSA between October 1st and May 31st; d.) and no more than three FLEX spots by a an applicant for a single county.

– Sponsors must show at least 15% of total patient visits are for Medicaid or other low income patients. This is up from the former 10% figure.

– Washington State requires that sponsors show at least six months of qualifying recruitment in the past 12 months in Washington State. This sometimes can be an obstacle to filing, and so it is important to evaluate what forms of recruitment have taken place, and for how long, for prospective waiver applicants.

We are available to consult with physicians and medical facilities, to discuss this process as well as other potential options for physicians. For better or worse, there are many rules in immigration specific to physicians, such as the Conrad and other J-1 waiver programs, H-1B requirements, and admission requirements. The processes also can involve multiple state and federal agencies. We know the way, and are happy to assist.

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Posted in General, Scott Railton |

J-1 Conrad Waiver Slots for Physicians Opens On October 1st

Wednesday, September 19th, 2018 by W. Scott Railton

On October 1st, Health Departments around the country will begin accepting J-1 waiver applications under the Conrad program. Each state is allotted 30 spots, with the majority going to primary care physicians, who agree to work for three years in a health professional shortage area. In turn, their two year foreign residency requirement is waived. We routinely prepare these applications.

Rules vary state to state, although the federal government has minimum requirements. Washington State, where we are located, historically takes between six and twelve months to fill all of its spots. However, last year Oregon, which also used to be slow to fill, filled their spots in record time. Some states receive more than 30 applications on the first day the window opens.

Here are a few of the key rules for Washington State:

  • Up to ten sponsorships are available for Specialists between October 1st to March 31st. Last year, more than 10 applications were submitted during this period, but spots were still left available after March 31st. This has historically been true too.
  • Washington State also allows 10 non-designated FLEX waivers per year, with these slots opening on January 15th.
  • Washington State limits employers to only three waivers, prior to June 1st of the fiscal year.
  • Applicants, including integrated health care systems in a single HPSA, are limited to a.) two sponsorships per practice location; b.) one hospitalist sponsorship per hospital; c.) no more than three sponsorships total across all practice locations in the HPSA between October 1st and May 31st; d.) and no more than three FLEX spots by a an applicant for a single county.
  • Sponsors must show at least 15% of total patient visits are for Medicaid or other low income patients. This is up from the former 10% figure.
  • The process also requires that sponsors show at least six months of qualifying recruitment in the past 12 months in Washington State.

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Posted in General, Scott Railton |