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

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.