If there is one task that becomes routine for international medical graduate (IMG) physicians holding J-1 visas, it might be managing bureaucracy. They have dealt with reams of paperwork simply to qualify for the residency Match, and pursuing a waiver to the home country-return requirement likely will be no different.
That is why experts say it is crucial for J-1 physicians seeking return requirement waivers to enter the transition to practice prepared, having laid the groundwork years in advance.
Physicians with J-1 visas “need to start the [job search] process earlier,” said Kyle Claussen, CEO of Resolve, a contract review and negotiation firm specializing in physician employment. “If a J-1 physician doesn't have their contract and their documentation done early, they really put themselves into a bind from a timeline standpoint.”
With a pressing need for decisive action, J-1 physicians—often international medical graduates (IMGs)—should plan their transition to practice starting two years before the end of residency training and leading up to the day they start their new role. Resolve, which works with thousands of physicians every year—including many in the U.S. on J-1 visas—provides a thorough timeline for J-1 physicians seeking a return requirement waiver, starting at least 18 to 24 months before the end of graduate medical education (GME).
The AMA has teamed up with Resolve to provide AMA members an exclusive discount on services that include custom contract review. Resolve offers personalized legal expertise to help physicians secure the best employment contract terms, no matter where they are in their careers. Ready to access your AMA-member Resolve discount? Learn more now.
A competitive process
The J-1 visa is a category of nonimmigrant residency visas in the U.S. for those categorized as “exchange visitors.” Physicians with J-1 visas are authorized to legally remain in the country for GME and training. Intealth—the parent organization of the Educational Commission for Foreign Medical Graduates—sponsored 17,486 J-1 physicians in GME last year.
Federal law requires that physician holders of a J-1 visa return to their home country for two years after the completion of their GME or training. The most common way that physicians seek an exemption to this rule is through the request of a designated state public health department or its equivalent, known as the Conrad State 30 Program, or often, a Conrad 30 waiver.
To qualify for a Conrad 30 waiver, the physician must:
- Have a full-time job offer at a healthcare facility in a designated healthcare professional shortage area or at a healthcare facility that serves patients from a shortage area.
- Agree to start working at the facility within 90 days of getting a waiver.
- Sign an employment contract of at least three years in length to work for at least 40 hours a week.
Each state health department can request a maximum of 30 waivers each federal fiscal year, 10 of which can be for a physician who will not work in a designated shortage area but will serve patients who live in one. Find out more information on the State Department website about J-1 visa waivers, including other waiver categories.
According to State Department data, the five countries that sent the most new physicians to the U.S. on the J-1 visa program in 2025 were:
- India—1,041 physicians.
- Canada—729.
- Pakistan—667.
- Jordan—189.
- Nepal—183.
With thousands of physicians vying for Conrad 30-eligible roles, competition for the limited slots is high.
“If you’re on a J-1 visa, the federal year from an immigration standpoint opens up Oct. 1, and so being fully ready to submit your application means having a contract that's signed prior to that,” Claussen said. “A lot of U.S. citizens can delay that a little bit.”
Getting started early is key. After logging in, AMA members can learn:
- How much lead time J-1 physicians need for waiver applications.
- How the Conrad 30 waiver program works, and why competition is intense.
- What to do at each stage of the waiver application process.
- Why having both an immigration attorney and contract attorney is critical.
- What effect employment changes can have on your visa waiver.
