Conrad 30 State Waiver for Physicians: Extenuating Circumstances Transfer

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The Conrad 30 State Waiver Program is designed for international medical graduates (IMGs) who have entered the U.S. in a J-1 visa status to complete medical training and are subject to the two-year home residence requirement imposed by section 212(e) of the Immigration and Nationality Act.  Any J-1 physician is automatically subject to 212(e) and must return to his/her home country for a period of two years at the end of the J-1 program unless the physician first obtains a waiver of the two-year home residency requirements. 

In order to stay and work in the U.S. in an H-1B status, an IMG must first get a waiver under either a state health department-sponsored waiver (Conrad 30 program) or another interested government agency waiver.  The Conrad 30 waiver program addresses the shortage of qualified doctors in medically underserved areas. The Program requires that the physician agree to enter into full-time employment to practice medicine in an H-1B status for at least 3 years at a health care facility located in a medically underserved Area (MUA) or Health Professional Shortage Area (HPSA).  For more detailed information on eligibility and requirements, visit the page for the Conrad 30 program on the USCIS website.

While each state has its own process and procedures for how the Conrad waiver program is administered, they all must abide by the federal program requirements.  In New York State, the Conrad Program is open for application from September to the first week in December each year.  Review the annual New York State 30 Program Information Bulletin.

If a physician needs to transfer from the waiver sponsoring employer to another employer during their three years of H-1B waiver service, they must qualify for an H-1B “extenuating circumstances” transfer and, in most cases, get a letter from their State Health Department verifying the basis for doing so.

What are extenuating circumstances?

The circumstances must be outside the control of the physician and require him/her to leave the current employer before the end of the three years of H-1B status. Depending on the circumstances, USCIS may approve the H-1B transfer petition to a new employer (either in state of out-of-state, though must also be in a federally designated underserved area) based upon the specific facts of the case.  Per USCIS guidelines, examples that qualify as extenuating circumstances include:

  • Closure of the health care facility
  • Hardship to the physician due to unforeseen circumstances beyond his/her control (change to employment terms that make it impossible for physician to continue to comply with Conrad program terms)

These two broad categories leave the USCIS with wide discretion to consider all relevant circumstances in deciding whether to approve these cases. Physicians facing circumstances that necessitate leaving their Waiver Sponsor Employer in the first three years of H-1B employment should contact an immigration attorney, to assess if the facts of their particular case are strong enough to qualify for the transfer to another employer.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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