Many foreign medical graduates train in the United States on J-1 exchange visitor visas. Most J-1 physicians are subject to a two-year home residency requirement, so before they can get an H-1B, an L visa or a Green Card, they must either spend two years in their home country or obtain a waiver. The Conrad 30 program is the most common waiver route.
How the Conrad 30 program works
- State sponsorship. Each state's health department can recommend up to 30 waivers per federal fiscal year (October 1 to September 30).
- Underserved service. Most slots go to physicians who will practice in a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA) or for a Medically Underserved Population (MUP). Many states also offer up to 10 "flex" slots for facilities outside these areas that serve patients from them.
- Three-year commitment. The physician signs a contract to work full-time, at least 40 hours a week, for at least three years with the sponsoring facility, in H-1B status.
- The review chain. The state recommends the waiver to the U.S. Department of State, which recommends it to USCIS for the final decision.
What to watch in 2026
The Conrad 30 program depends on periodic reauthorization by Congress. USCIS has said that, unless Congress extends the provision, physicians who were admitted in or acquired J-1 status on or after October 1, 2025 are not eligible for a Conrad 30 waiver. Physicians who held J-1 status before that date are generally unaffected. Reauthorization bills are pending in both the House and the Senate. If you are early in residency or about to start a J-1 program, check the current status before relying on Conrad 30.
Other waiver routes for physicians
- Federal agency (Interested Government Agency) waivers, for example through the U.S. Department of Health and Human Services or regional commissions such as the Appalachian Regional Commission and the Delta Regional Authority, each with its own requirements
- Persecution waivers, if returning home would expose the physician to persecution
- Exceptional hardship waivers, if the physician's departure would cause exceptional hardship to a U.S. citizen or permanent resident spouse or child
From waiver to Green Card
Physicians who complete their service in an underserved area may qualify for a physician National Interest Waiver Green Card, which generally requires five years of full-time clinical practice in a designated shortage area or at a VA facility. Physicians can also pursue employer-sponsored Green Cards, or EB-1A or EB-2 NIW petitions based on their research and clinical record.
Practical tips
- Start the job search early. Many states open their application cycles in the fall and fill slots on a first-come basis.
- Read the state's own rules closely. Deadlines, specialty priorities and flex-slot policies vary.
- Have the employment contract reviewed. It must meet both state and federal requirements, including non-compete and termination terms.
- After the waiver is approved, the H-1B employment must generally begin within 90 days.
This article is general information as of November 2026, not legal advice. Immigration rules, fees and processing change often, and the right strategy depends on your facts. For advice on your situation, book a consultation.