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Reports on J-1 Visas and Visa Waivers

On May 18, 2006 the Government Accountability Office (GAO) released “Foreign Physicians: Preliminary Findings on the Use of J-1 Visa Waivers to Practice in Underserved Areas.” This report provides information on the GAO’s preliminary findings on the use of J-1 visa waivers as a means of placing physicians in underserved areas, and states’ views on the 30 waiver limit.

The report found that J-1 visa waivers continue to be a major means of placing physicians in underserved areas of the United States. Since 2002, states have been allotted 30 J-1 visa waivers per year. GAO examines state views on the 30-waiver limit and their willingness to have unused waiver allotments redistributed.

The report abstract, highlights from the report, and the complete report are available at the GAO Web site. This link will take you off of the AMA Web site. The AMA is not responsible for content on non-AMA Web sites.

This following report from June 2002 is provided as background on J-1 visas and visa waivers.

Current situation

On March 1, the U.S. Department of Agriculture (USDA) announced that it would no longer request waivers for J-1 visa holders because it could not complete thorough background checks on applicants. After the events of September 11, 2001, all government agencies involved in immigration worked with other government agencies to conduct thorough background checks on applicants for immigration. Three of the USDA’s pending J-1 waiver applicants were determined to be possible security risks.

Rural states and counties are especially vulnerable to reductions in J-1 waivers. After some pressure, the USDA agreed to complete the process for its pending waiver requests. The White House has set up an interagency taskforce to study this situation.

[Note: A bill was passed in 2005 in the U.S. House of Representatives and U.S. Senate which extends and increases the number of waivers offered to state governments from 20 to 30 per year.]

History of J-1 visas and waivers

The J-1 visa was administered by the U.S. Information Agency (USIA) to strengthen relations between the US and other countries. It fell under the purview of the USIA and not the Immigration and Naturalization Service because it’s main purpose is to disseminate information; its goal is to give people training and experience in the U.S. that they can use to benefit their home countries. Therefore, the program requires that the J-1 recipients ("visitors") return to their home countries for two years to apply the knowledge they obtained in the U.S. This "home residency requirement" always applies if the visitor's education was funded by either the U.S. or their home government, if their skills are needed in their home country, or if they are in the US for graduate medical education (GME).

In 1999, the USIA was merged in to the U.S. Department of State. The State Department reviews applications for waivers of the home residency requirement on a case by case basis. Physicians who came to the U.S. on the J-1 visa for graduate medical education may apply to have the requirement waived in the following circumstances:

  • an "interested" U.S. government agency (IGA) requests the waiver because the visitor's acquired skills are in short supply within the U.S.,
  • the visa holder anticipates persecution in his/her home country, or
  • the return will cause an exceptional hardship to the visitor's U.S. Citizen spouse or child.

There is a historical basis for enforcing these requirements on IMGs. By the early 1970s, the J-1 visa policy was widely criticized for encouraging IMGs to immigrate to the U.S. and creating a "brain drain" of physicians from developing nations. The U.S. Congress responded by eliminating preferential immigration policies in 1976 and by further tightening immigration laws on physicians in the late 1970s and early 1980s. The AMA also responded in 1982 by adopting Policy 255.995, calling for an end to "preferential immigration policies for foreign medical graduates." Clearly this policy was written in a very different historical context.

Also, the purpose of the visa and the fact that it is not designed for people who wish to immigrate to the U.S. is made clear by the rules regarding waivers. J-1 visa recipients cannot get a waiver if they marry a U.S. citizen or have a child who is a U.S. citizen. Physician J-1 recipients cannot get a waiver simply by having their home country release them from their obligation. J-1 recipients are also expected to return to the country listed as their residence at the time of application – even if the country of their residence or citizenship has changed.

For many years, several agencies served as IGAs, including the Veterans Administration, Appalachian Regional Commission, Housing and Urban Development and Health and Human Services. In 1994, two changes occurred that increased the number of waiver requests. Congress adopted the Conrad Amendment to the Immigration and Naturalization Act, which allowed states to request up to 20 waivers. Also, the USDA began to act as an IGA. The increase in waivers has been dramatic; between 1983 and 1992, 660 waivers were granted. Since 1994, the USDA alone has requested approximately 3,000 waivers.

Since the U.S. Department of Health and Human Services (HHS) began administering the program in 2003, fewer physicians have received J-1 visa waivers. Read more about recent developments in the American Medical News article: "Rural areas say more J-1 visas needed."