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Conrad State 30 and Physician Access Act (Part I) – Proposed Changes to J-1 Waiver Program

Conrad State 30 and Physician Access Act (Part I) – Proposed Changes to J-1 Waiver Program

In March 2013, Senators Jerry Moran (R-KS), Amy Klobuchar (D-MN), Susan Collins (R-ME) and Heidi Heitkamp (D-ND) introduced the S. 616, the Conrad State 30 and Physician Access Act, which enhances the State 30 (J-1 Waiver) program and makes it permanent. The American College of Physicians, the American Medical Association, the American College of Physicians, the National Rural Health Association, and many other organizations have voiced support for this bill. And with good reason… With the growing shortage of doctors nationwide and the aging population, many patients suffer long wait times to see a doctor or may not see one at all.

Nearly 27 percent of residents and fellows and 25 percent of all practicing physicians in the United States are foreign-born. This new bill can help reduce the physician shortage, particularly for medically underserved communities, by improving current immigration rules for foreign-born physicians. Some of the key provisions of the bill affecting the National Interest Waiver program include:


    • Makes the Conrad 30 J-1 Waiver Program permanent. Currently, the program is scheduled to end in 2015.
    • Allows physicians to change employers before completing the required three-year medical service of the J-1 waiver. Under current law, a J-1 waiver physician may change employment midstream only if they can prove “extenuating circumstances” beyond his or her control. The new bill would allow the physician to change employment without this proof; however, an additional year of service in an underserved area would be required if the physician changes jobs.
    • Protects immigration status of physicians whose contracts are terminated unexpectedly. Doctors whose employment is terminated would have 120 days to begin new employment in an underserved area before being considered out of status.
    • Imposes specific contract requirements for J-1 waivers. The employment contracts must specify the number of on-call hours, indicate whether malpractice insurance is provides, and list the addresses of each work location. In addition, non-compete clauses would be prohibited, regardless of the State’s rules.
    • Increases the number of J-1 waivers based upon a formula. All states would receive an additional 5 waivers each time 90% of the nationwide waivers are used in a year (this calculation excludes States that receive fewer than 5 waivers in a year). Any such increases in the number would be indefinite until there is a 5% decrease nationwide compared to the last year in which there was an increase in the cap. However, once the cap reaches 45 waivers, no further increases can be made unless 95% of nationwide slots filled (any state that received at least 1 waiver would count in this calculation). The bill also creates an additional three (3) waivers per state that can only be used by academic medical centers, if the work performed by the doctor is in the public interest and regardless of whether the location is designated as a shortage area.
    • Permits doctors to do their J-1 waiver service in any authorized work visa or work status. Current law requires physician to hold H-1B status during the J-1 waiver service period.
  • Eliminate the two-year home country return requirement for spouses and children of J-1 physicians, allowing them to obtain other visas, including work visas.