Washington State and Northwest Conrad J-1 Waiver Update

Washington State’s Conrad J-1 waiver window for foreign physicians subject to the two year foreign residency requirement opens on October 1st each year. This date is fast approaching, as hard as it is to believe, in this strange year, and so I thought I’d provide a few updates. The short message is time is of the essence for medical employers to prepare these petitions, since each state is allotted only 30 spots each year, and the numbers seem to go faster and faster each year.

The Washington State Department of Health reported receiving 36 applications this past year, which is actually as many as I can recall. Surely, many more applications were not submitted, than might have been if there were more spots. Washington State ultimately ended up approving 19 Specialist waivers, 10 Primary Care waivers, and one FLEX waiver.

Washington State uses a phased schedule for recommending waivers, emphasizing Primary Care over Specialist and FLEX positions. Primary care is defined in Washington State as family practice, general internal medicine, pediatrics, obstetrics/gynecology, geriatric medicine or psychiatry. Current regulations permit up to 10 specialist petitions on October 1st and thereafter.  Any more than that will have to wait until April 1st, and so there can be a bit of a rush for specialists to get their positions in by October 1st. FLEX spots, reserved for physicians practicing in a non-health professional shortage area but servicing patients who live in shortage areas, open on January 15th. FLEX positions require substantial additional documentation on patient mix. Similarly, specialist petitions require additional documentation on need.

Oregon also accepts applications on October 1st, and has filled all 30 slots for the past six years.  Each year, the Oregon spots seem to go faster and faster. Oregon charges a $2000 application processing fee, unlike Washington State (no processing fee), and will reserve spots when a contract is entered into with an employer. Oregon gives preference to primary care and high need specialists (Tier 1), and then on December 1st open things up for other physicians on a first-come basis. Oregon has been filling its 30 spots a bit faster than Washington State in the past few years.

Alaska, Idaho and Montana have traditionally had available J-1 Conrad waiver spots throughout the fiscal year.  Each of these states seems to be doing more to promote the program. Much of each of these states qualifies as health professional shortage areas and the separate designation of medically underserved areas. In particular, smaller practices may benefit from the Conrad program.

Idaho reports that in 2017 it opened its program to specialists and FLEX spots, in some cases. Idaho charges a $1000 processing fee for Conrad applications.  Montana has some specific contract and employer requirements, and places emphasis on primary care and psychiatry. Alaska’s program closely parallels the Department of State’s minimum guidelines. Each of these states has recruitment documentation requirements and require demonstrations of need and support.

There are other types of J waivers as well that in some cases physicians may seek, including interested government agency waivers, persecution waivers, and hardship waivers. In cases where a physician has a contractual obligation to return, a no objection letter must be obtained from the country of last permanent residence.

We may see changes to the Conrad program in the coming months. The Conrad State 30 and Physician Access Reauthorization Act (S. 948) has many proponents in the Senate, including sponsor Senator Klobuchar. If passed, this Act may lead to additional spots in some states, among many other improvements meant to address underserved needs. The proposed Healthcare Workforce Resilience Act (S. 3599, H.R. 6788) recaptures unused immigrant visa numbers and provides them to physicians (15,000) and nurses (25,000). These bills have substantial bipartisan support, and may be fit into the next relief package. They can use advocacy support from medical facilities, physicians and caregivers.

Now is the time to plan Conrad filings, for this fiscal year and even next. The spots can go quickly. Conrad applications have several time-sensitive components, which are pre-conditions to filing. The applications themselves take time to assemble, since they include a great deal of information and numerous documents. Washington State is meticulous in reviewing applications, and will request additional information or data as required, as will the other states mentioned here. With numerical caps on spots, it can be a race to the finish line sometimes.

The Department of Health and Human Services (HHS) also issues J waivers to qualified clinicians in primary care, and recently expanded its program to all primary care physicians working in health professional shortage areas with at least a score of 07 or higher. As their website says, “HHS will process an application for waiver for a physician to practice in a primary care (family medicine, general internal medicine, general pediatrics, obstetrics & gynecology) or general psychiatry who have completed their primary care or psychiatric residency training programs no more than 12 months before the date of commencement of employment under the contract.”

The COVID situation has created a unique set of circumstances for immigration, but the restrictions largely related to consular processing and international travel. Physicians who are already in the United States may seek and be granted a J waiver. Due to the complexities involved in consular processing and re-admission to the United States, international travel is to be avoided for now, if possible. We are though seeing some physicians and other essential workers obtain visas based on national interest exceptions, but each case has its own set of circumstances.  Immigration has always been laden with time sensitivities, but the latest restrictions place heightened importance on the timely filing of applications from within the United States, as well as the maintenance of status.

We are happy to schedule a consultation to discuss these and other matters with particularity. Wishing all well in health and all things during these most difficult times.