Posts Tagged ‘Oregon’

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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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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Oregon’s J-1 Waiver Program for Physicians

Tuesday, February 14th, 2017 by W. Scott Railton

The Oregon J-1 Waiver Program for physicians traditionally is slower than many states to fill its statutorily allotted 30 Conrad recommendations. In 2016, Oregon used all 30 of its slots. Indications are that the slots will all be used again by the end of the current fiscal year. In comparison, Washington State has filled its slots the last few years, typically by around mid-year. Alaska, Montana, and Idaho have used the program sparingly.

The Oregon program has a $2000 application fee, which helps the State administer the program. The recommendations are managed by the Oregon Primary Care Office, which is part of the Oregon Health Authority’s Office for Health Policy and Research. The signatory to the recommendations is currently Director Marc Overbeck. The Program Coordinator is Dia Shuhart (503-373-0364). Oregon keeps track of applications as they are being prepared, and so it is a good idea to contact Ms. Shuhart before proceeding with an application. Certain rules have changed, and such communication is encouraged.

The Oregon regulations for their J-1 program can be found at OAR-409-035. Some points of note:

• Applications are adjudicated on first come, first served basis. The State regulations say the case will be handled within 15 days. Usually it is faster, if everything is in place.

• Oregon will grant FLEX spots. None were granted in 2015, and four in 2016. The applications should be vetted with the State ahead of time.

• Placement priority is with primary care, including Family Medicine, General Internal Medicine, Pediatrics, OB/GYN and General Psychiatrists.

• If a health care facility is located in a Medically Underserved Area (MUA) or Medically Underserved Population (MUP) that is not a Health Professional Shortage Area (HPSA) or if the request is for a flex option, then the facility must obtain prior approval from the Authority and provide documentation substantiating the area’s need for a physician.

• At least 40 percent of patients must be Medicaid, Medicare or other low income patients. At least 26% of the 40% must be Medicaid eligible, either through the Oregon Health Plan or through low income Medicare dual eligibility. Low income, uninsured is defined as 200% or less of the current Federal Poverty Guidelines. Note: The 26% requirement is subject to change at the start of each program year, depending on the statewide percentage of Medicaid enrollees.

• Medicaid patients must represent a share of the overall facility’s patient population equal to or greater than the statewide percentage of the population eligible for Medicaid at the beginning of each program year as determined by the Authority. If this is not the case, a plan must be presented.

• Document attempts to actively recruit an American doctor for at least six months prior to submission of the application.

• Eighty percent of the slots allotted for each federal fiscal year are reserved for primary care physicians as defined in OAR 409-035-0010. Applications from community health centers with HPSA scores below 7 and from mental health facilities shall receive priority. The rules also state a preference for geographic distribution of the slots, and a cap of six per employer. The rules leave latitude for the program to adjust priorities according to changing needs.

Applications are mailed to:

Physician Visa Waiver Program
OHA-Health Policy & Analytics
500 Summer Street NE, E-65
Salem, OR 97301

Program details are subject to change. We are happy to assist, as need be. Oregon’s program website is here:

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Posted in General, Scott Railton |