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Albany Legal Blog

The J-1 Exchange Visitor Visa and Upstate New York’s Physician Shortage

On Behalf of | Jan 31, 2024 | Immigration

I saw an article recently in our local weekly newspaper, Saratoga Today, reporting that the Northern Border Regional Commission (“NBRC”), a federal-state partnership for economic and community development within the most distressed counties of Maine, New Hampshire, Vermont, and New York, launched their J-1 Visa Program. The program is designed to make quality healthcare accessible to rural and medically underserved areas across, for our purposes, upstate New York and the North Country.  This is actually a pretty big deal, and I would argue that it did not get nearly the attention it deserved.

A little background.  The J-1 exchange visitor visa category is very broad (i.e., it has fifteen [15] subcategories like, e.g., interns or trainees, physicians, camp counselor, au pairs, summer students in the travel/work program, etc.).  One aspect of the J-1 visa category, which is unique from other nonimmigrant visa categories, is that some people who are admitted under it are subject to what is called a “two-year foreign-residency requirement”.[1]  The two-year foreign-residency requirement can be triggered in several ways including, for purposes of this discussion, if the individuals who entered the United States on the J-1 visa obtained medical training in the United States.

Fortunately, there is the ability to obtain a “waiver” of the two-year foreign-residency requirement, but it’s not always that easy to do and, for international medical graduates, it can be extremely complex.[2]  Although there are five (5) types of waivers that are available for J-1 exchange visitors, for international medical graduates, generally speaking they (with the assistance of their future employer) will be making an application (1) to an “Interested Government Agency” (“IGA”), where they will endeavor to show that the J-1 exchange visitor’s departure from the United States would be detrimental to one of its programs or that the exchange visitor’s stay in the United States is vital to one of its programs (the rationale being that it is in the public interest to have the exchange visitor remain in the United States), or (2) to one of the several types of federal, state, or what are called “Conrad 30” programs for foreign medical graduates, where here, the NBRC is acting as an agency interested in facilitating the foreign medical graduate’s employment in a federally designated “Health Professional Shortage Area” (“HPSA”) or a Medically Underserved Area (“MUA”).[3]

So, why is this so important?  Because, quite candidly, the areas where these foreign medical graduates would need to practice are incredibly underserved by medical professionals.

In order to be eligible for the waiver in a federal, state, or what is called  a “Conrad 30” program, generally the foreign national must agree to be employed full time (as an H-1B nonimmigrant worker) at a health care facility located in an area designated by U.S. Department of Health and Human Services (“HHS”) as a HPSA, MUA, or a Medically Underserved Population (“MUP”).  At this point, the NBRC is limiting its waiver recommendations for physicians who will practice primary medical care (including general or family practice, general internal medicine, pediatrics, or obstetrics and gynecology), in a designated primary care HPSA or designated MUA or psychiatric care in a designated Mental Health Professional Shortage Area.

When you combine the general need in these medically underserved upstate New York areas with what our overall society is dealing with with the pandemic still in our rear view mirror, e.g., chronic stress of adults and children, the economy and concerns about our financial well-being, ongoing global crises (both far from and at our own borders), to name just a few among so many other stressors in our daily lives, the NBRC’s new J-1 visa program is (if it’s utilized properly) a big win for the communities being served by the NBRC and the foreign nationals who received their medical education here in the United States.

New York State, and historically and more specifically, New York City, has long been the preferred destination for new immigrants to the United States.  Although immigrants no longer need to pass through Ellis Island to lawfully enter the country, many still come to our shores and settle downstate.  The NBRC’s new J-1 visa program will (we hope) contribute to mitigating the shortage of qualified health care professionals in rural upstate New York, and generally even promote much-needed immigration to these same communities.

[1]  This basically means that someone subject to this requirement must reside and be physically present for a total of two (2) years in either his or her country of nationality or country of legal permanent residence before he or she becomes eligible to change to certain other nonimmigrant visa categories (e.g., H-1B specialty occupation worker) or before obtaining permanent residency (i.e., getting a green card).
[2] There are so many discreet practice areas in the immigration law, and physician immigration is a specialty all unto itself.
[3] The other bases for applying for a waiver are (a) showing exceptional hardship to U.S. citizen or lawful permanent resident (LPR) spouse or child, (b) persecution or (c) a no objection statement from the foreign national’s home government (the latter, though, not being an option for international medical graduates).