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J-1 physician visa waivers

Health Factors: Access to Care
Decision Makers: Local Government State Government Federal Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Insufficient Evidence
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Foreign-born physicians who train in the US using a J-1 visa may receive a J-1 visa waiver to practice in a designated Health Professional Shortage Area (HPSA) immediately following their training, rather than returning to their home nation. To be eligible for a waiver, physicians must be sponsored by a state public health department or its equivalent. Waivers have a three-year service commitment and are provided by the federal government as part of the Conrad State 30 Program, which allows each state to recruit up to 30 physicians for the program (US DS-Waiver eligibility, Patterson 2015). Historically, the program has focused on placing primary care physicians in rural areas; recently, it also supports placement of specialists in non-rural underserved areas (Patterson 2015). 

Expected Beneficial Outcomes

Increased availability of physicians in underserved areas

Evidence of Effectiveness

There is insufficient evidence to determine whether J-1 visa waivers increase the availability of physicians in rural and other underserved areas over the long-term. Available evidence suggests that waivers may increase providers in the short-term; however, long-term retention appears less likely (Goodfellow 2016, Wilson 2009, Opoku 2015, Kahn 2010).

Studies in Wisconsin, Washington, and Nebraska suggest that physicians with J-1 visa waivers provide quality care, but typically remain in their placement area only two years beyond the required commitment (Opoku 2015, Kahn 2010, Crouse 2006). The Wisconsin-based assessment suggests physicians with waivers often do not integrate well into local communities (Crouse 2006). 

Implementation

United States

Employment of international medical graduates under J-1 visa waivers varies widely among states (Thompson 2009). From 2001-2010, participating states used an average of 17.4 waivers out of the 30 allotted through the program (Patterson 2015). In 2014, almost 2,000 foreign-born medical students or residents in the J-1 visa program were eligible for waivers upon completion of their residency. Alaska, Idaho, and Wyoming had no eligible students or residents, while Michigan and Texas had the greatest number eligible, 186 and 150 respectively (US DS-J1 visa). 

J-1 visa waivers are more difficult to obtain following the March 2017 Executive Order which alters national visa policies and procedures (Majeed 2017, Fanari 2017, White House EO).

Wisconsin

In 2014, there were 14 international medical students or residents training under J-1 visas in Wisconsin (US DS-J1 visa). Wisconsin’s J-1 visa waiver program focuses on primary care, but can recommend J-1 visa waivers for foreign physicians in other specialties if exceptional need and public interest are demonstrated (WI DHS-Conrad 30).

Implementation Resources

RHIhub-J1 Visa waiver - Rural Health Information Hub (RHIhub). Rural J-1 visa waiver. Accessed on September 13, 2017
US CIS-Conrad 30 - US Citizenship and Immigration Services (US CIS). Working in the United States, students and exchange visitors: Conrad 30 Waiver Program. Accessed on September 13, 2017
US DS-J1 visa - United States Department of State (DS). J-1 visa facts and figures: view data by state. Accessed on September 13, 2017
VDH-Conrad 30 - Virginia Department of Health (VDH). Conrad 30 waiver program 2017-2019 guidelines. Office of Health Equity, Virginia Department of Health; 2017. Accessed on September 26, 2017

Citations - Description

Patterson 2015 - Patterson DG, Keppel G, Skillman SM, Berry C, Daniel C, Doescher MP. Recruitment of Non-US Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs. Final Report #148. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2015. Accessed on September 13, 2017
US DS-Waiver eligibility - US Department of State. Eligibility information: Waiver of the exchange visitor two-year home-country physical presence requirement. Accessed on September 13, 2017

Citations - Evidence

Crouse 2006 - Crouse BJ, Munson RL. The effect of the physician J-1 visa waiver on rural Wisconsin. Wisconsin Medical Journal. 2006;105(7):16-20. Accessed on September 13, 2017
Goodfellow 2016 - Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban and rural areas in the United States: A systematic literature review. Academic Medicine. 2016;91(9):1313-1321. Accessed on September 26, 2017
Kahn 2010* - Kahn TR, Hagopian A, Johnson K. Retention of J-1 visa waiver program physicians in Washington state’s health professional shortage areas. Academic Medicine. 2010;85(4):614–21. Accessed on September 13, 2017
Opoku 2015* - Opoku ST, Apenteng BA, Lin G, et al. A comparison of the J-1 Visa waiver and loan repayment programs in the recruitment and retention of physicians in rural Nebraska. The Journal of Rural Health. 2015;31(3):300–309. Accessed on September 13, 2017
Wilson 2009 - Wilson NW, Couper ID, De Vries E, et al. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural and Remote Health. 2009;9(2):1060. Accessed on September 13, 2017

Citations - Implementation

Fanari 2017* - Fanari Z. Effects of changes in visa policies and procedures on fellows-in-training and early career cardiologists. Journal of the American College of Cardiology. 2017;69(25):3115-3117. Accessed on September 26, 2017
Majeed 2017* - Majeed MH, Ali AA, Sudak DM. International medical graduates and American psychiatry: The past, present, and future. Academic Psychiatry. 2017. Accessed on September 26, 2017
Patterson 2015 - Patterson DG, Keppel G, Skillman SM, Berry C, Daniel C, Doescher MP. Recruitment of Non-US Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs. Final Report #148. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2015. Accessed on September 13, 2017
Thompson 2009* - Thompson MJ, Hagopian A, Fordyce M, Hart LG. Do international medical graduates (IMGs) “fill the gap” in rural primary care in the United States? A national study. Journal of Rural Health. 2009;25(2):124–34. Accessed on September 13, 2017
US DS-J1 visa - United States Department of State (DS). J-1 visa facts and figures: view data by state. Accessed on September 13, 2017
White House EO - The White House. Executive Order protecting the nation from foreign terrorist entry into the United States. March 2017. Accessed on September 26, 2017
WI DHS-Conrad 30 - Wisconsin Department of Health Services (WI DHS). Wisconsin Conrad 30 Waiver Program. Accessed on September 13, 2017

Page Last Updated

September 26, 2017

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