Since at least 2013, there have been efforts to make the Conrad 30 J-1 visa waiver program for physicians permanent. But that has not happened and it continues to be necessary to reauthorize the program every year. This year, Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), Jacky Rosen (D-NV), Angus King (I-ME) and Charles Grassley (R-IA) have introduced a bill to improve and extend the program until 2021 – the Conrad State 30 and Physician Access Reauthorization Act. Without this extension, or some other extension, the program will end later this year.

The Conrad waiver program was first enacted in 1994 to permit states to recommend “J-1 waivers” for foreign physicians who have trained in J-1 visa status in the U.S. if those physicians were willing to remain in the U.S. and work in rural and/or underserved areas. The standard requirement that J-1 physicians must return to their home countries for a period of two years prior to obtaining H-1B visas or green cards could be waived in exchange for a three-year commitment to provide medical care in such areas. The waiver has thus allowed these physicians to apply for and obtain H-1B visas (or change of status to H-1B) as well as green cards without satisfying the home residence requirement. The waiver has been the quid pro quo for encouraging more physicians to serve in areas where medical care was lacking. The program currently allows for 30 waivers per state per year.

The physician shortage in the U.S. continues to grow and the Association of American Medical Colleges (AAMC) predicts that by 2030 there will be a shortage of up to 121,000 physicians. In a news release, Senator Collins said that the bipartisan reauthorization bill will promote “healthier lives” and that providing opportunities for American-trained and educated physicians is an imperative in areas where there is an unmet need.

The Conrad State 30 and Physician Access Reauthorization Act would:

• Create additional waivers per state based upon various thresholds;

• Add three waivers per state for academic medical centers;

• Allow “dual intent” for physicians who come to the U.S. in J-1 status;

• Allow spouses of doctors to work;

• Create new employment protections for the physicians in the program; and

• Streamline the green card process of participating physicians.

The legislation is endorsed by the American Medical Association (AMA), the American Hospital Association (AHA) and the AAMC. The AMA has indicated that it would also like to see legislation that would exempt foreign physicians who work in underserved areas or for the Veterans’ Administration for at least five years from the per-country green card caps. Others would like to make all foreign physicians exempt from the annual H-1B cap. Currently, physicians who work for an institution of higher education, a non-profit entity affiliated with such an institution, a nonprofit research organization or governmental research organization, or a private employer but at a cap-exempt entity are exempt from the H-1B cap, but this does not cover all physicians.

As the physician shortage continues to grow in the U.S., employers, public officials, and those living in impacted areas may continue to call for facilitating an influx of foreign national, U.S.-trained physicians to meet community and patient needs and demands.