As this blog has touched on from several different perspectives over the years, one perpetual issue facing International Medical Graduates who come to the United States on J-1 exchange visas to engage in residency/fellowship training is the application of the two-year home residence requirement. This requirement attaches to all foreign physicians utilizing a J-1 visa to complete graduate medical education/training in the U.S., and there are only very limited options for obtaining a waiver of that requirement.

In a post from December 2021, we provided an overview of the available J-1 waiver options, including a discussion of several physician-specific waiver categories that require a period of service to patients in a medically underserved area. Some of these options/programs, such as the Appalachian Regional Commission (ARC) waiver and the Delta Regional Authority (DRA) waiver, are geographically limited, and only available to healthcare facilities/physicians located in the geographic footprint of those particular regional commissions.

Since that post, there have been several important developments that merit an update. First, in the Summer of 2022, the Southeast Crescent Regional Commission (SCRC) developed and implemented a J-1 Waiver Program for foreign physicians. This program is modeled closely after the Delta Regional Authority’s existing J-1 program. However, given that the SCRC’s geographic footprint covers areas that are not already covered by the DRA, this new program will expand J-1 waiver access for physicians in the southeastern United States, particularly in areas of Virginia, North Carolina, South Carolina, Georgia, Alabama, Mississippi, and all of Florida. The SCRC J-1 waiver program is open to both primary care physicians and medical specialists, making it an attractive option for physicians seeking to work in the covered geographic area, to avoid the uncertainty of the numerically limited Conrad State 30 waiver program. The SCRC’s full waiver guidelines are available here.

In more good news, in late August the Northern Border Regional Commission (NBRC), which has jurisdiction over several counties in Maine, New Hampshire, Vermont, and New York, announced that it will also implement its own J-1 waiver program for physicians, likely to begin in Fiscal Year 2023. While the NBRC has been in existence since 2008, funded by Congress since 2010, and authorized to support health care-related activities, thus far in its tenure its health care-related activities have primarily been limited to issuing grants to health care facilities within the region. However, after receiving requests and feedback from interested stakeholders, the NBRC ultimately decided it will hire a health care program specialist to implement a J-1 waiver program to be available to physicians who agree to practice in federally designated underserved/shortage areas within the NBRC’s footprint.

The details of the program – such as the timeline for applications, the steps employers will need to follow and particular requirements for eligibility, and whether the program will be available to both primary care physicians and specialists – are still to be worked out, but this is promising news for healthcare facilities in the Northeastern United States that may rely on foreign physicians to address their shortage of available providers. This is of particular significance to medical facilities in New York, a state where the allotment of 30 waivers through the Conrad State 30 waiver program is routinely insufficient, with New York State receiving anywhere from 50 to 100 requests for its 30 available waivers in recent years. Thus, the NBRC waiver program, once up and running, should help alleviate some of that pressure. In New York, the NBRC covers Cayuga, Clinton, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Niagara, Oneida, Orleans, Oswego, Rensselaer, Saratoga, Schenectady, Seneca, St. Lawrence, Sullivan, Washington, Warren, Wayne, and Yates counties.